Go Lean…Caribbean

Go Lean Commentary

In 1971, there was a War Declaration … against the dreaded disease of Cancer.

We all know someone that has battled cancer. Many of us know people who fought and lost. Truly, the designation of a War on Cancer is appropriate. Here is the historical details as related in the 2013 book Go Lean … Caribbean on Page 157:

The Go Lean book does not portend to be a manual on diagnosing or treating cancer. But it does strategize a roadmap for economic empowerment. It clearly relates that healthcare, disease management, cancer treatments and medicines are germane to the Caribbean quest for health, wealth and happiness. The primary author of the book was inspired to write this roadmap, after his sister died after a 32-year battle with cancer – See Dedication (Page 2). This supplemented the fact that their mother died first of breast cancer, almost 50 years ago in 1970.

This is now war …

… battles continue … there are victors and victims.

Yes, some people do survive their battles with cancer. They live to share lessons with the rest of us. These lessons are not just medical, but emotional, social and yes: economic as well.

Examine the experiences here in this news article from the American Daily Newspaper “USA Today“. The story is too important to ignore; (despite the American settings, there is application for us in the Caribbean as well):

Title: Life after cancer: More survivors living longer, facing new health challenges
Sub-title: More cancer patients are living longer. Few are getting the help they need to stay healthy
By: Kim Painter, USA TODAY

When Susan Leigh finished treatment for Hodgkin lymphoma back in 1972, she says, “no one knew what was going to happen.”

Certainly, no one knew that the Arizona woman would develop three more cancers and heart damage, all likely linked to the aggressive radiation and chemotherapy treatments that helped save her life.

Those treatments were new at the time. When Leigh finished them, apparently cancer-free, she was a pioneer.

“I remember saying to my radiation doctor, what do I do now?” recalls Leigh, 71, a retired cancer nurse. “What do I do to keep this from coming back and to recover?

“He said he really didn’t know. He said maybe I could try taking a good multivitamin pill.”

Four decades later, doctors know much more. They know that some cancer survivors are at increased risk for other cancers later, and for problems ranging from brittle bones to heart failure.

They also know more about how to help patients head off or manage those risks.

But few patients are getting that help – even 13 years after the influential Institute of Medicine warned that many survivors were “lost in transition,” and weren’t getting adequate follow-up care.

“The number of cancer survivors continues to grow, yet high-quality, coordinated survivorship care is still infrequent,” experts from the National Academies of Sciences, Engineering, and Medicine said in a recent follow-up report (the nonprofit includes the former Institute of Medicine).

“Strides have been made, but there’s also been an acceleration in the demand,” says Neeraj Arora, associate director for science at the nonprofit Patient-Centered Outcomes Research Institute.

Arora, a 25-year survivor of non-Hodgkin lymphoma, helped write the report.

Even today, Leigh says, too many people “don’t get the kind of follow-up care they need.”

“Doctors say, ‘You are OK, we don’t need to see you anymore.’ ”

Numbers are growing – and so is the need
The American Cancer Society says more than 15.5 million Americans with a history of cancer were alive in 2016. By 2026, the group says, that number will rise to 20.3 million.

The population of survivors is also aging. Nearly two thirds are over age 65, meaning most face health challenges beyond those linked to their cancer.

And those over age 85 are the fastest growing segment – giving famous survivors such as Supreme Court Justice Ruth Bader Ginsburg, 85, and former President Jimmy Carter, 94, a lot of generational company.

Meanwhile, cancer patients, young and old, are living longer.

“Now, thanks to early detection and better treatment, we have a lot more people living many years beyond their initial diagnosis,” says Catherine Alfano, the cancer society’s vice president for survivorship.

The five-year survival rate for all cancers combined stands at 70 percent for whites and 63 percent for blacks, the society says. That’s up from 39 percent for whites and 27 percent for blacks in the 1960s.

People treated in 2019 might do still better. But they also might face unknown long-term risks, even from treatments meant to be less toxic and more targeted than those of the past.

Surviving cancer does not mean leaving health concerns behind.

Cancers can recur. And some survivors face an increased risk of other cancers, sometimes related to their treatment.

Some cancer treatments can damage bones, hearts and other organs in ways that might not show up for decades. Leigh and Arora can attest to that: both have been diagnosed with congestive heart failure.

Patients can leave initial treatment with ongoing symptoms. More than a quarter of patients in one study reported lingering problems such as fatigue, sleep disturbances and foggy thinking.

In another survey, 24 percent of survivors reported poor physical health and 10 percent reported poor mental health – roughly double the rates for other adults.

Psychologist Julia Rowland led the National Cancer Institute’s Office of Cancer Survivorship for 18 years.

“People are now thinking of cancer survival not just in terms of lifespan but health span,” she says. “There’s a growing recognition that it’s not just the length of life but the quality of life.”

The push for survivorship care plans
Arora, now 49, was diagnosed two decades after Leigh. But he also left treatment unprepared for his future.

“I got absolutely top-notch treatment. But when I left, after five years, my doctor said, ‘You are good.’ He said, ‘You don’t need to see anybody.’ Which today I know is not the right thing to say.  But that’s where the field was then.”

Under reforms first envisioned by the Institute of Medicine in 2006, patients are supposed to leave initial treatment with two things: A brief written summary that lists all treatments received and a survivorship care plan.

For a breast cancer survivor, the plan might prescribe regular mammograms and an exercise program. It might tell someone who took heart-toxic chemotherapy drugs to watch for cardiac symptoms. Some patients might be urged to keep seeing their cancer care team, often or occasionally; others might be told they face few cancer-related risks and can return to routine care by their regular doctors.

Ideally, advocates say, the plan starts a dialogue among providers, patients and caregivers and tells patients where to seek help with mental health, family matters, jobs and finances.

But when 53 top cancer centers were surveyed several years after the initial recommendation, fewer than half were using the plans.

The Commission on Cancer, which accredits cancer centers, started in 2015 to require them to phase in the plans. But uptake was so slow that the commission altered the standard in 2018 to allow more time for full implementation.

Costs, staffing shortages and inadequate electronic records all slow adoption, the National Academies reports.

Even where care plans have been adopted, their usefulness has not been proved.

“The data is not impressive,” Rowland says. One reason, she says, is that “people are treating this not as a conversation, but a piece of paper.”

Innovative cancer programs are now weaving survival planning into every phase of care, Alfano says. They’re also seeking better ways to use technology to track and guide patients.

But those innovations are not reaching enough patients, she says.

Progress for survivors
Leigh says much progress has been made since she became a founding member of the National Coalition for Cancer Survivorship in 1986.

“When we first started this, we were called cancer victims,” she says. “It was a way of looking a it that said you didn’t have any control.”

Today, the survivor community embraces everyone from newly diagnosed patients to the growing cadre of chronic cancer patients who stay on therapies for years.

Some, Leigh notes, reject the label “survivor,” for various reasons, including perceptions that it excludes those who will never be cancer-free. But even that debate, she says, is a sign that the movement has matured.

Another sign of progress: Most states now at least mention cancer survivors in their official cancer control plans, says Larissa Nekhlyudov, an associate professor of medicine at Harvard Medical School.

It’s not clear what impact state efforts have had, she says. But some states have launched innovative programs, often with funding from the federal Centers for Disease Control and Prevention.

In Kansas, for example, health officials worked with farmer’s markets for seniors to boost fruit and vegetable consumption among survivors. Iowa created educational materials for survivors facing sexual problems. Vermont trained survivors to counsel newly diagnosed patients as part of a program called Kindred Connections.

Volunteer David Cranmer says the program helps the volunteers almost as much as it helps those they counsel.

“We have training sessions with potluck suppers, and people get together and tell their stories,” says Cranmer, 70, of Williston, Vermont.

His own story includes a bone marrow transplant for chronic myeloid leukemia in 1999, followed by thyroid cancer. He’s now undergoing long-term chemotherapy for another condition, amyloidosis.

Despite his difficulties, he says, his story offers hope – and plants the idea that today’s cancer patients can and should plan for their futures.

“Most people aren’t thinking five or ten years from now. They are thinking about today,” he says. “But when I call up and say I’m a 20-year cancer survivor, that turns on a light that oh, there is life after cancer.”

Source: USA Today Newspaper; posted February 15, 2019; retrieved February 19, 2019 from: https://www.usatoday.com/in-depth/news/50-states/2019/02/13/life-after-cancer-survivors-oncology-survivorship-plans-long-term-health/2794121002/

————

Related: Advice for cancer patients: plan on surviving

————

VIDEO – Four-time cancer survivor pioneers recovery and advocacy – https://www.usatoday.com/videos/news/2019/02/13/four-time-cancer-survivor-pioneers-recovery-and-advocacy/2859322002/

USA TODAY – Susan Leigh has beaten multiple cancers and heart problems and now champions survivorship care plans for patients and their families.

Lessons abound – we must Battle Cancer Better:

• We reap what we sow in this war. Hard work, smart work and better work pays off in victory.
• Some places are better for surviving cancer than others.
• The battle continues … even after cancer has been defeated … initially.
• There are high-tech (advances drugs and surgical procedures) and low-tech solutions (diet, exercise, stress management, positivity, etc.).
• The Caribbean must prepare and invest in Research & Development (R&D) and treatment deliveries for our people and visiting guests (patients) who may want to benefit from a new Caribbean commitment to Battle Cancer Better.

This theme has been elaborated upon in previous Go Lean commentaries; see a sample list here:

Cancer is a crisis … everywhere. This is not just an American drama and solutions do not only emerge from America.

The Go Lean book demonstrates how developing the ethos that a “crisis is a terrible thing to waste”, could help save lives … and communities. There are winning battles in the War on Cancer, but we must do the heavy-lifting to succeed.

Let’s fight … and keep on battling!

Many of our loved ones have died trying. Let’s not allow their deaths to be in vain. Let’s work harder, smarter and better and win more battles in this War on Cancer. This is how we can make our homeland a better place to live, work, heal and play. 🙂

About the Book
The book Go Lean…Caribbean serves as a roadmap for the introduction and implementation of the technocratic Caribbean Union Trade Federation (CU), for the elevation of Caribbean society – for all member-states. This CU/Go Lean roadmap has these 3 prime directives:

• Optimization of the economic engines in order to grow the regional economy to $800 Billion and create 2.2 million new jobs.
• Establishment of a security apparatus to ensure public safety and protect the resultant economic engines.
• Improve Caribbean governance to support these engines, including a separation-of-powers between the member-states and CU federal agencies.

The Go Lean book provides 370-pages of turn-by-turn instructions on “how” to adopt new community ethos, plus the strategies, tactics, implementations and advocacies to execute so as to reboot, reform and transform the societal engines of Caribbean society.

Download the free e-Book of Go Lean … Caribbean – now!

Who We Are
The movement behind the Go Lean book – a non-partisan, apolitical, religiously-neutral Community Development Foundation chartered for the purpose of empowering and re-booting economic engines – stresses that reforming and transforming the Caribbean societal engines must be a regional pursuit. This was an early motivation for the roadmap, as pronounced in the opening Declaration of Interdependence (Pages 11 – 13):

viii. Whereas the population size is too small to foster good negotiations for products and commodities from international vendors, the Federation must allow the unification of the region as one purchasing agent, thereby garnering better terms and discounts.

ix. Whereas the realities of healthcare and an aging population cannot be ignored and cannot be afforded without some advanced mitigation, the Federation must arrange for health plans to consolidate premiums of both healthy and sickly people across the wider base of the entire Caribbean population. The mitigation should extend further to disease management, wellness, obesity and smoking cessation programs.

xi. Whereas all men are entitled to the benefits of good governance in a free society, “new guards” must be enacted to dissuade the emergence of incompetence, corruption, nepotism and cronyism at the peril of the people’s best interest. The Federation must guarantee the executions of a social contract between government and the governed.

xvi. Whereas security of our homeland is inextricably linked to prosperity of the homeland, the economic and security interest of the region needs to be aligned under the same governance. Since economic crimes … can imperil the functioning of the wheels of commerce for all the citizenry, the accedence of this Federation must equip the security apparatus with the tools and techniques for predictive and proactive interdictions.

xxiv. Whereas a free market economy can be induced and spurred for continuous progress, the Federation must install the controls to better manage aspects of the economy: jobs, inflation, savings rate, investments and other economic principles. Thereby attracting direct foreign investment because of the stability and vibrancy of our economy.

Sign the petition to lean-in for this roadmap for the Caribbean Union Trade Federation.