When Is Insurance Not Really Insurance? When You Need Pricey Dental Care.

May 21, 2018
By: David Tuller
Source: https://khn.org

I’m 61 years old and a San Francisco homeowner with an academic position at the University of California-Berkeley, which provides me with comprehensive health insurance. Yet, to afford the more than $50,000 in out-of-pocket expenses required for the restorative dental work I’ve needed in the past 20 years, I’ve had to rely on handouts — from my mom.

This was how I learned all about the Great Divide between medicine and dentistry — especially in how treatment is paid for, or mostly not paid for, by insurers. Many Americans with serious dental illness find out the same way: sticker shock.

For millions of Americans — blessed in some measure with good genes and good luck — dental insurance works pretty well, and they don’t think much about it. But people like me learn the hard way that dental insurance isn’t insurance at all — not in the sense of providing significant protection against unexpected or unaffordable costs. My dental coverage from UC-Berkeley, where I have been on the public health and journalism faculties, tops out at $1,500 a year — and that’s considered a decent plan.

Dental policies are more like prepayment plans for a basic level of care. They generally provide full coverage for routine preventive services and charge a small copay for fillings. But coverage is reduced as treatment intensifies. Major work like a crown or a bridge is often covered only at 50 percent; implants generally aren’t covered at all.

In many other countries, medical and dental care likewise are segregated systems. The difference is that prices for major procedures in the U.S. are so high they can be out of reach even for middle-class patients. Some people resort to so-called dental tourism, seeking care in countries like Mexico and Spain. Others obtain reduced-cost care in the U.S. from dental schools or line up for free care at occasional pop-up clinics.

Underlying this “insurance” system in the U.S. is a broader, unstated premise that dental treatment is somehow optional, even a luxury. From a coverage standpoint, it’s as though the mouth is walled off from the rest of the body.

My humbling situation is not about failing to brush or floss, not about cosmetics. My two lower front teeth collapsed just before my 40th birthday. It turned out that, despite regular dental care, I had developed an advanced case of periodontitis — a chronic inflammatory condition in which pockets of bacteria become infected and gradually destroy gum and bone tissue. Almost half of Americans 30 and older suffer from mild to severe forms of it.

My diagnosis was followed by extractions, titanium implants in my jaw, installation of porcelain teeth on the implants, bone grafts, a series of gum surgeries — and that was just the beginning. I’ve since had five more implants, more gum and bone grafts and many, many new crowns installed.

At least I’ve been able to get care. The situation is much worse for people with lower incomes and no family support. Although Medicaid, the state-federal insurer for poor and disabled people, covers children’s dental services, states decide themselves on whether to offer benefits for adults. And many dentists won’t accept patients on Medicaid, child or adult, because they consider the reimbursement rates too low.

The program typically pays as little as half of what they get from patients with private insurance. For example, as Kaiser Health News reported in 2016, Medicaid in Colorado pays $87 for a filling on a back tooth and $435 for a crown, compared with the $150 and $800 that private patients typically pay.

“It’s really a labor of love to do it,” said Dana Lubet, a recently retired dentist in Madison, Wis., who estimated Medicaid paid only a third of his costs. Accepting too many, he said, “could easily kill your practice.”

A few years ago, while in his mid-50s, Nick DiGeronimo, a facility maintenance worker at a New Jersey sports center, obtained private insurance coverage through the Affordable Care Act, hoping to get treatment for progressive tooth decay.

He needed two implants but, to his dismay, the plan did not cover them. To pay the $10,500 bill, he had to take out loans. “Dental insurance is basically useless,” said DiGeronimo. “It’s a sham, a waste of money, and another case of the haves versus the have-nots.”

As for older Americans, many lose employer-based dental coverage when they retire even as they suffer from increasing dental problems. Among those 65 and older, 70 percent have some form of periodontal disease, according to the Centers for Disease Control and Prevention. Yet basic Medicare plans do not include dental coverage, although options exist for seniors to purchase it.

Overall, in 2015, almost 35 percent of American adults of working age did not have dental insurance. By contrast, only about 12 percent of American adults under 65 did not have medical insurance in 2016. That lack of coverage and treatment can diminish economic and social opportunities — for instance, it can be costly at work or in a job interview not to smile because of unsightly or missing teeth.

Eventually, poor prevention and treatment can become a medical problem — leading to serious, and occasionally deadly, health consequences. In an infamous 2007 case — described by Mary Otto in her book “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America” — Deamonte Driver, a 12-year-old boy in Maryland, died after a tooth infection spread to his brain. The family’s Medicaid coverage had lapsed.

Research has demonstrated links between periodontal infections and chronic conditions like diabetes and cardiovascular disease. Studies have found associations between periodontitis and adverse pregnancy outcomes, such as premature labor and low birth weight. Tooth problems also hinder chewing and eating, affecting nutritional status.

The split between the medical and dental professions, however, has deep roots in history and tradition. For centuries, extracting teeth fell to tradesfolk like barbers and blacksmiths — doctors didn’t concern themselves with such bloody surgeries.

In the U.S., the long-standing rift between doctors and dentists was institutionalized in 1840, when the University of Maryland refused to add training in dentistry and oral surgery to its medical school curriculum — leading to the creation of the world’s first dental school.

Dentists have in some ways benefited from the separation — largely escaping the corporate consolidation of American medicine, with many making good livings in smaller practices. Patients often willingly pay out-of-pocket, at least to a point.

Some people deliberately forgo dental coverage, considering it less urgent than having insurance against medical catastrophes. “You might not get a job as hostess at the restaurant, but by the same token people that have a lot of missing teeth live to tell the tales,” Lubet said.

With fluoridation and advances in treatment, many Americans have come to take the health of their teeth for granted and shifted their attention to more cosmetic concerns. And the dental field has profited from the business.

In my experience, which includes extensive travel in other countries, Americans often seem disoriented or even horrified when confronted with imperfect dentition. During my period of intense dental care here, I hated wearing temporaries and often braved the public with missing front teeth. I found myself routinely reassuring people that, yes, I knew about the gap, and yes, I was having it dealt with.

Meanwhile, the bold line between what is covered or what is not often strikes patients as nonsensical.

Last fall, Lewis Nightingale, 68, a retired art director in San Francisco, needed surgery to deal with a benign tumor in the bone near his upper right teeth. The oral surgeon and the ear, nose and throat doctor consulted and agreed the former was best suited to handle the operation, although either one was qualified to do it.

Nightingale’s Medicare plan would have covered a procedure performed by the ear, nose and throat doctor, he said. But it did not cover the surgery in this case because it was done by an oral surgeon — a dental specialist. Nightingale had no dental insurance, so he was stuck with the $3,000 bill.

If only his tumor had placed itself just a few inches away, he thought.

“I said, what if I had nose cancer, or throat cancer?” Nightingale said. “To separate out dental problems from anything else seems arbitrary. I have great medical insurance, so why isn’t my medical insurance covering it?”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

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May, 2018|Oral Cancer News|

Eight-time GRAMMY® winner Ziggy Marley partners with the Oral Cancer Foundation

Source: ww.prnewswire.com
Author: press release

The Oral Cancer Foundation has a new relationship with eight-time GRAMMY® winner, Emmy winner, humanitarian, singer, songwriter and producer, Ziggy Marley. Mr. Marley has generously offered to allow CharityBuzz to auction off three (3) VIP events for two (2) on his REBELLION RISES TOUR. The winner(s) will enjoy this highly anticipated tour that only a select few get to experience up close and personal, meeting Mr. Marley. After the concert at a tour city of the winners choosing, a photo opportunity will be provided during their meet & greet with Ziggy Marley himself. The tour starts in America and travels to several European cities. Raising funds for the oral cancer issue via OCF, this auction will help support awareness campaigns, research, early discovery initiatives, and outreach that will help save lives. The auction begins today; May 20, 2018. Available tour dates are here: https://bit.ly/2dZPCcR (Dates may be subject to change).

Grammy winning artist Ziggy Marley partners with the Oral Cancer Foundation to raise awareness of the disease, and funds for its many missions to reduce impact of oral cancers. (PRNewsfoto/Oral Cancer Foundation)

Reggae icon Ziggy Marley will release his seventh full-length solo studio album, Rebellion Rises, on May 18th through Tuff Gong Worldwide. Fully written, recorded and produced by Marley, this passionate and indelible new collection of music encourages people to stand together in activism through love.

Ziggy Marley has released many albums to much critical acclaim. His early immersion in music came at age ten when he sat in on recording sessions with his father, Bob Marley. As front man to Ziggy Marley & The Melody Makers, the group has released ten live and studio albums, three of which became GRAMMY-winners with such chart-topping hits as “Look Who’s Dancing,” “Tomorrow People,” and “Tumbling Down.” Then, in an effort to pursue his own creative endeavors, 2003 saw the launch of Ziggy’s solo career with the release of Dragonfly (RCA Records). His second solo effort, Love Is My Religion (Tuff Gong Worldwide), won a GRAMMY in 2006 for Best Reggae Album, as did the subsequent release of Family Time (Tuff Gong Worldwide) in 2009 for Best Children’s Album. 2011’s Wild and Free was also nominated for Best Reggae Album, the same year in which Ziggy debuted his first-ever graphic novel, Marijuanaman. In addition to his music, Marley established the U.R.G.E. (Unlimited Resources Giving Enlightenment) organization to help children in poverty.

You can go directly to the auction item and start bidding at the following link: https://www.charitybuzz.com/catalog_items/meet-ziggy-marley-with-2-vip-tickets-to-his-rebellion-1527300

About the Oral Cancer Foundation
While the financial support for the many missions OCF engages in is important, our view of this amazing opportunity is focused elsewhere. The foundation represents a deadly disease that in the US too many people have not even heard of until it directly impacts their lives. That lack of visibility, that lack of the disease having a significant voice, has far reaching implications. The most obvious is that without national awareness, the knowledge of avoidable risk factors that might bring you to it does not exist. Further, absent a well-established national screening program, the early discovery of pre-cancers, and early stage disease does not currently take place often. This means poorer long-term outcomes, a much higher morbidity from the treatments patients must undergo to cope with an advanced stage disease, and a high 5-year death rate.

While OCF may be the largest of the oral cancer charities and within that group have the greatest reach, we still are small when compared to charities that represent larger incidence cancers whose names are household words. These large charities impact hundreds of thousands each year in the US alone, and take in tens, if not hundreds of millions of dollars a year in donations to advance their agendas and serve the populations they represent. We do not have those assets to work with, but we can develop strategic partners that help us in other ways. OCF’s thoughts are on what this relationship means to that paradigm. We may be at a tipping point in the disease if we can raise the awareness of it. When people with this much visibility become associated with a problem, it cascades into CHANGE.

We hope all of you who read this, especially those who have had this disease touch their lives, will Share on FaceBook, Tweet, and post on Instagram about this relationship, the auctions, and spread the word; so that this opportunity of increased visibility for oral cancer, and a change from late to early discovery and diagnosis can be realized.

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An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

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Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.

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Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”

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Flexible robotic surgery opens new paths in cancer treatment

Source: newsok.com
Author: staff

Robotic surgery is continuing to expand and provide patients with a variety of less invasive treatment options – especially when it comes to cancer treatment.

Dr. Brad Mons, a head and neck surgeon at Cancer Treatment Centers of America®in Tulsa, said the Flex Robotic® System, which the hospital added last year, is an especially significant breakthrough for people diagnosed with head and neck cancer.

“With this system, we can get to the small areas of the mouth and pharynx more easily to remove tumors in the region,” Mons said. “This affords us the ability to be much less invasive in head and neck cancer surgeries.”

Robotic surgery is continuing to expand and provide patients with a variety of less invasive treatment options. Photo provided by CTCA.

Currently only available at a small number of hospitals in the United States and designed to overcome line-of-sight limitations, the Flex Robotic System utilizes a uniquely flexible robotic endoscope to give surgeons the ability to navigate a path through challenging areas of the mouth, throat, rectum and colon.

For patients, this means potentially faster recovery time and lower risk of complications or side effects.

Because the Flex Robotic System operates through natural openings rather than requiring large incisions in the body, potential benefits include shorter hospital stays, reduced post-surgical pain, lower risk of infection and complications, less blood loss (and fewer transfusions) and scarring and faster return to normal activities. For throat cancer patients, the technology also means less damage to tissues and muscles critical to eating and daily activities. For colorectal cancer patients, the system provides lower possibility of a colostomy.

“Part of our mission is to continually provide innovative therapies and technology for our patients,” Mons said. “With tools like the Flex Robotic System, we have yet another way to help improve the lives of our patients—and that’s really what it’s all about.”

Cancer Treatment Centers of America has multiple locations across the country, including a state of the art facility in Tulsa. CTCA has been helping patients win the fight against cancer using advanced technology and a personalized approach for more than 30 years.

Source: Cancer Treatment Centers of America

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High carbohydrate diet may increase mortality risk in certain cancers

Source: www.specialtypharmacytimes.com
Author: Gina Kokosky

Consuming simple carbohydrates may increase risk of recurrence among patients with head and neck cancer, according to a study published by the International Journal of Cancer. New findings suggest that a patient’s diet could have a significant impact on their ability to combat cancer.

The authors also suggest that patients who moderately consume fats and starches after treatment, such as whole grains, potatoes, and legumes, are less likely to have a recurrence of head and neck cancer, according to the study.

The study followed more than 400 patients for 26 months after their initial diagnoses of squamous cell carcinoma on the head or neck. Most of the patients were treated for oral cancer or oropharyngeal cancer, including cancers of the tonsils, tongue, and surrounding tissue, according to the study.

Patients were most often diagnosed in stage 3 or 4 of cancer at an average age of 61 years old. During the study, cancer recurred 17% of the time, resulting in 42 deaths. Another 70 patients died from other causes during the study.

The researchers examined all food, drink, and dietary supplements consumed by the participants for 1 year prior to treatment and 1 year after treatment, according to the authors.

The authors found that those who consumed the least amount of simple carbohydrates, such as refined grains, desserts, and sweetened beverages, were having 1.3 servings per day, while those who consumed the most were consuming 4.4 servings of simple carbohydrates.

Patients who consumed a high amount of carbohydrates—such as sucrose, fructose, lactose, and maltose—prior to treatment were at a higher risk of mortality than those who consumed less carbohydrates, according to the authors.

While carbohydrate intake may be linked to mortality rate among patients, the associations varied by cancer type and stage, the authors noted. Those with oral cavity cancer were found to have a greater risk of mortality due to a high carbohydrate intake, while those with oropharyngeal cancer were not affected by their carbohydrate intake, according to the findings.

A high carbohydrate intake was also found to be associated with an increased risk of mortality among patients with cancer in stages 1 to 3, while those with stage 4 cancers were not at an increased risk.

The authors noted that moderate consumption of fats and starchy foods—about 67 grams per day—can lower the risk of recurrence and mortality.

The authors also suggest that while there is a clear association among carbohydrate intake and risk of mortality, more research needs to be done to determine whether there is a direct relationship.

“Although in this study we found that higher total carbohydrate and total sugar were associated with higher mortality in head and neck cancer patients, because of the study design we can’t say that there’s a definitive cause-effect relationship,” Anna Arthur, PhD, MPH, RD, lead author, said in a press release.

The findings of this study suggest that diet plays an important role in treating cancer and prompts further research on the relationship between diet and cancer.

“Our results, along with the findings of other studies, suggest that diet composition can affect cancer outcomes,” Amy M. Goss, PhD, RD, co-author, said in the press release. “We’d like to determine if this is true using a prospective, intervention study design and identify the underlying mechanisms. For example, how does cutting back on sugar and other dietary sources of glucose affect cancer growth?”

References
Arthur AE, Goss AM, Demark-Wahnefried W, et al. Higher carbohydrate intake is associated with increased risk of all-cause and disease-specific mortality in head and neck cancer patients: Results from a prospective cohort study. International Journal of Cancer. 2018. DOI: 10.1002/ijc.31413

Study explores carbohydrates’ impact on head, neck cancers [news release]. University of Illinois’ website. https://news.illinois.edu/view/6367/638053. Accessed April 13, 2018.

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Doctors paying for sons to have cancer jab

Source: www.bbc.com
Author: Anna Collinson, Reporter, Victoria Derbyshire programme

Doctors and health professionals are regularly paying hundreds of pounds for their teenage sons to receive a vaccination against cancer that girls already receive for free on the NHS, the Victoria Derbyshire programme has been told. Is boys’ health being put at risk?

“Had the HPV vaccine been available when I was a boy, I believe I would not have developed throat cancer more than 30 years later,” said Jamie Rae, 53.

“I’m basing this on the overwhelming majority of research I have seen over the years and countless experts I have spoken to.

“That’s why I’m desperate for boys to be able to receive it.”

HPV is the name given to a large group of viruses. It is very common and can be caught through any kind of sexual contact with another person who already has it. Doctors say 90% of HPV infections go away by themselves – but sometimes infections can lead to a variety of serious problems. For boys, this includes cancer of the anus, penis, mouth and throat.

Since 2008, girls aged 12 to 18 across the UK have been offered HPV vaccinations as part of the NHS childhood vaccination programme. It is currently not offered to boys of the same age, but it can be done privately, costing several hundred pounds.

Mr Rae founded the Throat Cancer Foundation after the treatment he received in 2010. He said at the time there was little information on HPV and he did not want anyone to go through his experience.

“I had radiotherapy for 35 days except weekends. I felt extreme burning in my neck and mouth and I was covered in sores. The pain was excruciating,” he explained. “It’s a lengthy recovery time. You have to teach yourself to swallow again and you get a dry mouth all the time.”

His foundation is part of HPV Action – which represents more than 50 groups and charities that are calling for both genders to receive the vaccination on the NHS.

‘Indefensible’
Mr Rae said the current disparity between boys and girls was “appalling”.

“Lots of doctors are having their boys vaccinated because they can afford it, as are those who are better informed,” he said. “But what about those who can’t afford it? Cases of throat cancer are soaring. It’s indefensible.

“Every day that goes past where boys are not being vaccinated condemns them to a whole host of diseases that we could prevent.”

HPV Action says around a dozen countries including Australia, Canada and the US are already vaccinating boys or are planning to do so in the near future. The government’s vaccination advisory committee is currently reviewing whether boys should receive the HPV vaccination.

A spokesperson for the Department of Health and Social Cares says it will carefully consider its advice once they’ve received it. Campaigners hope there will be a decision this year, possibly as soon as June. A debate is taking place on Wednesday at Westminster Hall about the issue.

The argument for vaccinating boys against HPV:

  • About 15% of UK girls eligible for vaccination are currently not receiving both doses, a figure which is much higher in some areas
  • Most older women in the UK have not had the HPV vaccination
  • Men may have sex with women from other countries with no vaccination programme
  • Men who have sex with men are not protected by the girls’ programme
  • The cost of treating HPV-related diseases is high – treating anogenital warts alone in the UK is estimated to cost £58m a year, while the additional cost of vaccinating boys has been estimated at about £20m a year

Source: HPV Action

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Can poor oral health cause falls in the elderly?

Source: www.medicalnewsbulletin.com
Author: Viola Lanier PhD, MSc

There is some research that indicates that, however unlikely it seems, poor oral health may contribute to the risk of falls. This question recently led researchers in Japan to investigate if poor oral health could in fact be associated with incident falls in the elderly.

As the baby boomer population ages, incidental falls have increasingly become a major public health concern around the world. In England, 28-35% of those over 65 years of age experienced a fall in 2016, while in Japan falls and fractures accounted for 12.2% of senior citizens requiring long-term care. Though hip fractures and light bruises are the most common outcomes, the most unfortunate incident can cause death. Therefore, identifying risk factors that can be modified may serve as an intervention for reducing falls in the elderly.

Examining oral health conditions and comparing incidental falls was important for researchers from the Graduate School of Dentistry at Kanagawa Dental University in Japan because the association between the two has been controversial in the research community. One study determined an association between a decrease in occlusal function and postural instability, whereas, a different study showed that occlusal disharmony is a risk factor for a decrease in balance function. Interestingly, a recent study that investigated 4,425 older community dwellers who had less than 19 teeth and lacked dentures, had a higher frequency of falls.

The JAGES Project Longitudinal Study
For this research study, panel data was used from the Japan Gerontological Evaluation Study, which was conducted between 2010 and 2013. Questionnaires were completed by 19,995 males and 20,858 females over 65 years old who did not have a history of falls during the previous year. The researchers then used a multilevel logistic regression model to determine the association between poor health in 2010 and multiple incident falls in 2013. The results were recently published in the journal PLoS ONE.

For both sexes, poor oral function, including difficulty eating tough foods and choking, was associated with incident falls. However, females who had between 10 and 19 teeth and lacked dentures were significantly associated with incident falls; compared with those who had more than 20 teeth. Additionally, those who had fewer than nine teeth, with or without dentures, experienced a higher likelihood of falls.

Adding interesting results to the research community, these findings suggest that poor oral health, having fewer teeth, and not using dentures are predictors of incident falls. These falls, essentially caused by dry mouth, choking, and difficulty eating tough foods, agree with some of the previous finding’s and thus, may help to reduce controversial views about this topic. Though this area needs further investigation to determine whether improving oral health can reduce the risk of falls in the elderly, basic screening test that assess oral health may contribute to the reduction of incidental falls in the frail older adults.

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April, 2018|Oral Cancer News|

With oral cancer on the rise, dentists can play an important role

Source: http://exclusive.multibriefs.com
Author: Tammy Adams

Today’s dental professionals routinely see and deal with many issues and conditions that were not so common just a few short decades ago. For example, there has been a marked increase in the incidence of oral cancer in the United States, sparking the need for regular oral cancer screening as part of a preventive dental checkup. This additional screening is now routinely performed in many dental practices across the nation.

The American Cancer Society estimates that around 50,000 Americans are infected with oral cancer each year. In past generations, oral cancer was mostly linked to smoking, alcohol use or a combination of the two. But even as smoking rates have fallen, oral cancer rates have risen (especially in men), and researchers have concluded that this is likely caused by the human papillomavirus (HPV), a sexually transmitted disease.

Early diagnosis makes a difference
Oral cancer is often only discovered when the cancer has metastasized to another location, most commonly the lymph nodes of the neck. Prognosis at this stage of discovery is significantly worse than when it is caught in a localized intraoral area.

According to the Oral Cancer Foundation, the best way to screen for HPV-related oral and oropharyngeal cancer is through a visual and tactile exam given by a medical or dental professional, who will also perform an oral history taking to ask about signs and symptoms that cover things that are not visible.

Most of the symptoms of a developing HPV-positive infection are discovered by asking questions, using a test, a light or other device.

ADA supports dental industry with this growing challenge
In 2017, a panel of experts convened by the American Dental Association (ADA) Council on Scientific Affairs published a clinical practice guideline called the “Evidence-Based Clinical Practice Guideline for the Evaluation of Potentially Malignant Disorders in the Oral Cavity.”

The goal of this guideline is to inform dentists, orthodontists and other dental professionals about triage tools for evaluating lesions, including potentially malignant disorders, in the oral cavity. If you’re a dentist or an orthodontist, the ADA offers the following considerations concerning the diagnosis of oral and oropharyngeal cancers:

  • Clinicians should obtain an updated medical, social and dental history as well as perform an intraoral and extraoral conventional visual and tactile examination in all adult patients.
  • For patients with suspicious lesions, clinicians should immediately perform a biopsy of the lesion or refer the patient to a specialist.
  • Salivary and light-based tools are not recommended for evaluating lesions for malignancy.

If you are a dental professional and want to learn more about the dental industry’s role in addressing the rising occurrence of oral cancer, visit the ADA’s Oral and Oropharyngeal Cancer page.

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April, 2018|Oral Cancer News|