Resolution got you down? Stanford expert recommends “everything in moderation”

Photo by congerdesign
Photo by congerdesign

I don’t usually make New Year’s resolutions, but this year is the exception. My life has gotten too sedentary as a freelance writer who works at home. Like most Americans, I need to exercise more and eat healthier. It’s time to stop the holiday binge eating.

So I welcomed the good advice of Marily Oppezzo, PhD, a registered dietician and postdoctoral fellow at the Stanford Prevention Research Center, who specializes in helping people improve their health and well-being. In a recent Stanford BeWell article, she provides guidance to those hoping to make healthier lifestyle choices.

Oppezzo recommends that we stop classifying foods as sinful or good. “While some decisions are arguably healthier than others, we certainly don’t need to get our character and sense of self involved, a mind game that sets health up as binary, rather than a spectrum,” she says in the article. This all-or-nothing thinking, she argues, can result in binge eating — eating one “bad” cookie can lead to eating a whole bag, since you’re already “off the wagon.”

Instead, she says it is better to relish the taste of your favorite food without “pouring guilt all over it,” because you’re more likely to be satisfied and eat less of it.

If you make only one small dietary change, she suggests that you eat more vegetables. “Find one vegetable you love that is quick and easy for you to prepare and eat — and even defrosting frozen spinach to add to a soup or mixing in pre-packaged riced cauliflower … counts! Bring your veggie to work, and add [it] to three lunches next week,” says Oppezzo.

In terms of exercise, she said she thinks walking is particularly underrated. Walking can help your joints, improve your cognitive and creative thinking, reduce your stress level and provide a way to socialize with friends, she said.

However, it is important to be realistic when setting your health goals for this year — and tailor your plan to fit your personal likes and limitations. “In fact, it is important to weigh the factors of culture, individual circumstance, and motivational readiness when advising any (very young to very old) age segment of the population,” Oppezzo said.

And a parting word of wisdom? “’Everything in moderation’ turns out to be so true!,” Oppezzo said.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Advertisements

Cancer clinical trials: Stanford strives to enroll more diverse participants

Image by geralt,
Image by geralt

In a previous post, I described why I enrolled in a clinical trial at Stanford to treat my Hodgkin’s lymphoma. But I didn’t share the result: I received radiation therapy and chemotherapy — instead of the standard treatment of exploratory abdominal surgery — and I’m confident it helped me to be cancer free for the last 20 years.

However, my experience was unusual: Very few cancer patients participate in clinical trials and many aren’t even aware that they qualify for one. In order to advance cancer research, more participants are needed — especially ethnic and racial minorities who are vastly underrepresented in clinical trials. This is particularly important for diseases that occur more frequently or appear differently in non-white populations. For example, African American women have a 41 percent higher mortality rate for breast cancer than white woman, despite having a lower incidence rate, but only about 5 percent of clinical trial participants — for all diseases — are African American.

The Stanford Cancer Institute (SCI) knows this problem well.

“A key way participants learn about our cancer clinical trials is through physician referrals,” said Rachel Mesia, community engagement manager at SCI. “Physicians and oncologists practicing at Stanford educate their patients about clinical trials. They also network with physicians from other health-care practices to prompt them to make referrals.”

Participants also find Stanford cancer clinical trials through SCI’s clinical trials information service, which directs callers to an English- or Spanish-speaking outreach specialist who provides general clinical trials information and links callers to study coordinators.

Similarly, Mesia said SCI’s website and mobile app make it easier for patients to locate clinical trials that match their medical conditions using patient-friendly word searches. The mobile app will be updated in January to add new features.

“I’ve heard from many sick patients that they don’t have the energy to constantly go onto a search engine to see if any new clinical trials have opened up,” said Sarah Pelta, SCI’s communications manager. “That’s why were putting push notifications into our mobile app, as well as the ability to sign up for email notifications. So patients can just receive an email when a trial opens up that matches their search parameters.”

Also key to successful recruitment is the inclusion of stories from past clinical trial participants to help make a human connection. “From our website analytics and from speaking to patients, we know that patients really want to see what other patients are experiencing. So we’ve added patient photographs and videos to our website,” Pelta said.

SCI tackles the challenge of minority recruitment by reaching out to particular communities, in part by distributing information at community health and cancer patient events, Mesia said. “We also partner on educational presentations with a variety of community organizations, such as cancer support groups, social service organizations and churches,” she said. “And we participate in some ethnic-specific media interviews, including television, radio and newspapers.”

In addition, SCI has interactive kiosks dispersed throughout their cancer centers that provide basic clinical trials information and a search tool — in English, Spanish, Chinese and Russian.

Over the last six years, SCI has also held a Cancer Clinical Trials Awareness Week event to further increase visibility. In April 2017, this will be expanded to a month-long event highlighting genomics, immunology and other targeted approaches to cancer. Everyone is invited, and they’re planning to make the talks available online to expand access, Mesia told me.

The SCI has adequate participation overall, but they are still struggling to recruit minorities. “Currently our greatest disparity lies amongst the African American population,” Mesia said. “We’re doing okay with African Americans who are existing cancer patients at Stanford, but there is an issue when we look at our catchment area as a whole.” One barrier is that fewer African Americans live near Stanford’s cancer centers, and those living in more distant Bay Area counties have significant commute challenges, she said. “The reality is that some people’s personal lives make it unfeasible to be part of a Stanford clinical trial.”

But that just means the SCI staff need to work even harder. “We need social and health equity for all populations who are getting cancer,” Mesia said.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.

Cancer clinical trials: Why I chose to participate, but so many others don’t

Photo by geralt
Illustration by geralt

When I was 29 years old, I was one of the healthiest people I knew. I biked 10 miles to work, played ultimate frisbee, slept at least eight hours each night and ate nutritious, organic food. And then I found an enlarged lymph node in my neck.

My life suddenly became a whirlwind of doctor appointments and diagnostic tests: chest X-rays, blood tests, CT scans, a lumbar puncture, lymph node biopsy and a lymphangiogram. The tests showed another enlarged lymph node near my heart, and I was diagnosed with stage IIA Hodgkin’s lymphoma.

Unbelievably, I had cancer. I was faced with scary medical decisions that could impact both my survival and fertility. How do you make those kinds of decisions? As a scientist, I immediately started researching Hodgkin’s and talking to medical experts.

According to my physician, the standard treatment for stage II Hodgkin’s entailed exploratory abdominal surgery in order to biopsy my organs and check for further signs of the disease, as well as removal of my spleen. This would be followed by radiation therapy to my chest and neck.

Most people choose the standard treatment — it’s the gold standard for a reason, right? However, I wasn’t convinced that I wanted the surgery, because my diagnostic tests showed no sign of the disease below my diaphragm. I didn’t want to unnecessarily lose my spleen, which plays a vital role in the immune system by filtering blood and fighting certain deadly bacteria.

Luckily, my physician recommended another treatment option: a Hodgkin’s clinical trial at the Stanford Cancer Institute. This phase III clinical trial was testing whether a specialized chemotherapy cocktail was more effective at treating stage II Hodgkin’s than the standard abdominal surgery, and the investigators’ previous clinical trials had shown excellent results with similar chemotherapies.

So I struggled with whether I wanted radiation therapy combined with exploratory surgery or chemotherapy — both were scary and both would have long-term side effects. However, it wasn’t really my decision. I could only decide whether or not to enroll in Stanford’s clinical trial, and then the treatment option would be randomly selected for me. Eventually I decided I could live with this lack of control, because both treatments were going to be effective.

People typically participate in a clinical trial to “advance medicine” or “improve the lives of others,” according to the Center for Information and Study on Clinical Research Participation. While I was happy to contribute to scientific research, I enrolled in the clinical trial for myself — to get the best care. I knew that other study participants came from across the world to Stanford since it was one of the premier places for Hodgkin’s treatment, and I lived just five miles away.

I was fortunate in many other ways as well; I had personal health insurance. I also had flexible hours as a research scientist and could work full-time during treatment, so I didn’t have financial worries. In addition, I was used to communicating with doctors as peers, so I didn’t fear being a ‘guinea pig.’

These types of barriers — limited access to trials, financial concerns and trust issues — prevent many people from participating in clinical trials. Nationwide, only about 3 percent of adults with cancer participate in clinical trials. As a result, about 40 percent of all oncology clinical trials fail to meet their minimum patient enrollment, which has a major impact on cancer research.

Researchers use many tactics to attract trial participants. In an upcoming post, I’ll share what I learned about Stanford’s efforts to boost the enrollment of minorities in its oncology clinical trials.

This is a reposting of my Scope blog story, courtesy of Stanford School of Medicine.