Lecture 7&8: PC in Cancer and Viral Disease Flashcards Preview

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Flashcards in Lecture 7&8: PC in Cancer and Viral Disease Deck (44)
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1

Cancer is ranked what in leading causes of death globally?

2nd

2

T/F most of cancer deaths occur in high income countries

FALSE- 70% cancer deaths occur in LMIC

3

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

4

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

5

How does the US influence other countries' opiophobia'?

Declaring the War on Drugs
$100 billion spent
We still produce/import excess opioids

6

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

7

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

8

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%

9

What are 3 main challenges to cancer care?

1. lack of infrastructure (ex 385 radiotherapy machines for 1 BILLION people in africa)

2. Poor distribution of resources (most radiotherapy machines are located in 3 African countries-SA, Egypt, Morocco)

3. Lack of data

10

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

11

What were 4 reasons why Uganda was successful in meeting opioid needs?

1. People put pressure on authority (older doctors, etc) and president actually listened

2. President acknowledged AIDS epidemic

3. Specially trained nurses can prescribe morphine

4. 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

12

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

13

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

14

What are the 6 steps to addressing cancer in developed world?

1. Planning- assess needs, capacity, social context
2. Prevention- education, reduce risk factors
3. Early Detection- screenings, self exams
4. Better Treatment- equity of drug/tx distribution
5. Palliative Care
6. Policy and Advocacy

15

Why is early detection of cancer so important?

many patients are diagnosed at late stages when curative treatment may no longer be an option.

16

What are the 2 main components of early detection?

1. Early diagnosis
-greater probability of surviving, less $$ treatment


2. Screening
-ex: VIA (vinegar method for cervical cancer)- low income
pap smears- middle/high income
mammography- for well developed systems

17

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

18

Why is cervical cancer the most deadly cancer for women in the developing world?

1. increased HPV risk
2. inaccessible dx/treatment
3. lack of access to contraceptives (women may not be able to insist on their use even if accessible)

19

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

20

T/F Early detection is always useful regardless of available treatment

FALSE

Early detection is only useful where effective treatment is feasible

21

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

22

What are the 3 main global priorities in cancer prevention?

1. Cancers with high burden but low preventability
(ex- breast + prostate)
2. Cancers with a known cause
(cervical- prioritize HPV vaccine)
3. Cancers preventable through established interventions
(liver cancer/lung cancer- prioritize admin of HBV vaccine + antismoking campaigns)

23

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

24

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

25

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

26

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)

27

What is the time from HIV seroconversion to AIDS?

8-10 years
18-30 month survival after AIDS (avg)

28

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)

29

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

30

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