Bike To Beat Cancer Tuesday, Aug 23 2022 

Join nearly 1,000 people of all abilities and sizes as they pedal to Norton Cancer Institute – Brownsboro in an energetic fundraising effort that builds momentum year after year. Byline: David Steen Martin It won’t be a long bike ride, but it will be a meaningful one for Laila S. Agrawal, M.D., when she and her family participate in Bike [...]

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Homelessness And Health Costs: This Kentucky Mom Faced Cancer While Living In Her Car Monday, Nov 18 2019 

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Cancer was what finally pushed Kristi Reyes into living in her car.

The mother of four had worked all her life, starting at age 7 when she helped out at her family’s furniture store. Most of her work was in retail. It was paycheck-to-paycheck but she kept her kids together and a roof over their heads.

But then in 2012 she was diagnosed with breast cancer. She started cycling through jobs because of the time she needed to take off for recovery from treatment. Soon, she was too sick to work at all and things continued to slide. She had Medicaid, what she calls a medical card, but it wasn’t enough.

“Even though I had a medical card, there were out of pocket things that medical didn’t cover,” Reyes said. “I don’t care how much money you make. Money is never enough when you’re sick like that.”

Mary Meehan | Ohio Valley ReSource

Kristi Reyes now spends time with her grandson in her new home.

She and three of her children, who were ages 11, 13, and 15, all stayed in the car for awhile. But soon she was forced to let her children live with other people.

She remembers recovering from surgery to remove cancerous lymph nodes, homeless and alone. Eventually, she was too sick for treatment to even continue.

“I couldn’t even walk up a flight of stairs without being out of breath, almost needing oxygen,” she said. Her diabetes was out of control. She was also having trouble with her kidneys.

But Reyes said she knew other people who had it worse.

“At the same time, I think that was kind of something that kept me going. Right? Like knowing that somebody had it worse than I did.”

At least, she said, she had a car.

Housing And Health

In fact, Reyes’ case is not unique. The National Alliance to End Homelessness estimates there are 15,000 people experiencing homelessness in Kentucky, West Virginia and Ohio. Many more are living on thin financial margins. The Robert Wood Johnson Foundation reported earlier this year that half of rural Americans say they could not afford to pay an unexpected bill of $1,000, and nearly a third say that they have had trouble paying medical bills.

Jessica N. Sucik directs homeless services for HealthFirst Bluegrass, a federally qualified health center in Fayette County, Kentucky. HealthFirst serves 25,000 patients, many of them poor. It also runs two health clinics for the homeless.

HealthFirst Bluegrass

Jessica Sucik of HealthFirst Bluegrass.

She said there is a saying in public health that “housing is healthcare.”

Just the nature of chronic illnesses such as diabetes or COPD can limit how much people can work. 

“So they know they can’t work permanently, 40 hours a week,” she said. “They’re working as they can, but they also can’t afford housing or whatever treatment they need to overcome their condition.” 

Circumstances can change quickly. 

“With chronic medical conditions, something temporary can very, very quickly turn into a permanent homelessness status,” she said.

That leads to challenges paying the bills. It can be an unrelenting cycle.

“Without that, it’s like, you know, building a house on sand,” Sucik said. ”You have to have that safety and that security blanket of safe, stable and affordable housing before you can take care of yourself and be able to meet your needs.”

In recent years, HealthFirst has adopted a team approach with all patients. There is a medical provider, a social worker, a case manager and psychiatrist to provide medical, psychological and social support instead of leaving patients to fend for themselves.

“The magic that happens when you address not just the physical health issues, but also the things that are preventing them from getting those physical health issues addressed, is really, that’s where it’s at,” she said.

Alexandra Kanik | Ohio Valley ReSource

Policy Solutions

But others say homelessness or personal bankruptcy due to medical costs point to a need for more systemic change.  

One policy solution gaining traction among Democratic presidential candidates is Medicare for All, a proposal that would eliminate private health insurance and replace it with a government-run system. Leading contenders Sen. Elizabeth Warren and Sen. Bernie Sanders support such a proposal. 

rural-homeless-rent-burden-map-v3Alexandra Kanik | Ohio Valley ReSource

Warren estimates her proposed plan would cost $20.5 trillion above expected health care costs over ten years. She says that could be paid for largely with an increase in taxes on the top income brackets and through savings in medical costs, but that claim has met some skepticism from policy experts. Sanders has been less specific about the costs and has said his proposal would find savings through cutting administrative costs. 

The Urban Institute has estimated that a switch to a single-payer system would require $59 trillion over 10 years, about $7 trillion more than the costs under the current system.

Dr. Steffie Woolhandler is co-founder of the advocacy group Physicians For A National Health Program, which argues for a single-payer system. Her group says research shows more than 60 percent of personal bankruptcies are tied to medical bills. She says a single-payer system can reduce costs and relieve families from going into debt, which is why many other countries have such a system.

“Virtually every other developed country guarantees health care to everyone living there,” she said. “This is true in Europe, it’s true in Canada, and it’s true in Australia. The United States is an outlier.”

She said the idea is gaining appeal in the U.S.

“What I’m seeing, really since 2016, is that the idea of Medicare for all has become an issue with non physicians and a lot of people who don’t work in health systems but are users of that healthcare system are actually talking about Medicare for All,” she said.

rural-homeless-care-categoryAlexandra Kanik | Ohio Valley ReSource

A Kitchen Table

Reyes doesn’t spend a lot of time considering such policy decisions. Taking care of herself and her family is about all she can handle. 

For about four years from the time she was first diagnosed with cancer, she was struggling to keep her employment, living mostly in her car, and separated from her children. 

She tried from time to time to get into a shelter but whenever she’d reach out, they were full.  One day, she said, she couldn’t take it anymore.

“I was at my wit’s end. Like I didn’t know what else to do. I was tired, worn out. My body felt like I couldn’t handle it anymore,” she said. “Honestly, I just started praying.”

Finally, she found help and a new home. 

She called the Salvation Army and was referred to the Housing and Homeless Coalition of Kentucky. Within two months, she was off the street.

Last year, she moved into a house in Frankfort, Kentucky, where she lives with her children, two grandchildren and her boyfriend. Because of her ongoing medical problems she has been approved for lifetime housing assistance and resumed her cancer treatment. 

“That made it even better. Because I know no matter the struggles of my health, or the battles that I got to fight with it. I’m always going to have that support.”

About a month ago, she was well enough to start working at a Subway sandwich shop.

A simple, second-hand dining room table is her favorite place to be.

“That’s the thing, that’s my thing,” she said with a laugh. “Because I can come in, I can cook for my children. And we can sit at the table and have a meal together.”

Looking back, Reyes said, she realizes now that she was in denial about just how bad her health was. And she hopes other people will take some comfort in knowing things can change for the better. 

“You just have to tell yourself, ‘OK, I’m not going to give in today,” she said. “You know, people just need to know that just because you’re going through things, it doesn’t necessarily mean that you’re going to be stuck there for a lifetime.”

U of L To Enroll Some Cancer Patients In New Clinical Trials Tuesday, Oct 15 2019 

University of Louisville logoThe University of Louisville Brown Cancer Center will start enrolling some patients with cancer in clinical trials for an innovative gene therapy.

Doctors at the Cancer Center will remove a patient’s immune system cells, and then those cells will be genetically engineered and reinserted to better fight cancer cells.

Robert Emmons, a Blood and Marrow Transplant physician at the cancer center, said the process involves removing and changing a patient’s own immune system cells.

“We now have learned how to take a patient’s own immune system cells, T cells, that are the cells that help to fight cancer many times by themselves, and make them better cancer fighters by introducing new genes that allow them to directly bind to and attack the specific cancer that we want them to fight,” Emmons said.

Emmons says the center will only enroll about 20 patients initially as the clinical trial is in the initial stages. The goal is to eventually ramp up to many more patients within months or a year.

The diseases the Cancer Center will target are some types of lymphoma and leukemia.

 “This is not in any way standard therapy — there are certainly risks associated with any kind of therapy like this,” Emmons said. “And that’s why the only patients who would qualify for therapy like this will be patients that will have failed other standard therapies that are already approved.”

The new therapy is available because of a gift from Louisville resident Thomas E. Dunbar for the creation of a specialized center that’s able to fulfill requirements from the federal government to participate in the trials. 

Some of these therapies are already available on the consumer market. The U of L clinical trials are for additional types of cancer, and may eventually lead to the development of new drugs. 

 

 

Study Finds Smoking Health Effects Linger Longer Than Previously Thought Tuesday, Aug 20 2019 

Smoking has long been tied to an increased risk of cardiovascular disease. But until now, the evidence has pointed to heavy smokers’ risk returning to normal five years after quitting. A new study released Tuesday from Vanderbilt University Medical Center found it takes much longer for heavy smokers’ bodies to recover: 10 to 15 years until the risk returns to the level of someone who has never smoked. Heavy smokers were defined as smoking the equivalent of a pack a day for 20 years. 

“The conventional wisdom is that within five years of smoking cessation, your cardiovascular risk goes back to that of someone who has never smoked, [but] we found that it could take longer,” said Vanderbilt lead study author Meredith Duncan. 

There is a bright spot in the study though: cardiovascular risk does decline dramatically within five years after quitting, compared to people who keep smoking. 

“Even among these really heavy smokers, we found that there’s a huge benefit of quitting, and that they experienced a 39 percent reduced risk of cardiovascular disease within five years of smoking cessation relative to people who continue to smoke,” Duncan said. “And so that’s a huge benefit.”

When a lot of people think about smoking, they don’t think about these heart risks – they think about cancer. And indeed, cigarette smoking is linked to about 80 to 90 percent of lung cancer deaths, according to the Centers for Disease Control and Prevention. 

Cancer is what Tim Dunn thought about initially. He was at the Kentucky State Fair looking at tobacco leaves on Saturday. 

“I mean, there’s people who smoke every day of their life and don’t get cancer — and then there’s people who’ve never smoked and have cancer,” Dunn said. “So that’s the way I look at it. It’s kind of the luck-of-the-draw thing for me.”

Dunn said he isn’t a cigarette smoker, though he occasionally smokes cigars. But he also acknowledged that people who smoke are generally not as healthy as people who have never smoked. 

“Obviously, if you smoke, you’re not gonna be in good health as a nonsmoker, but I guess at the same time, it’s your decision,” Dunn said. 

But his opinions on smoking are also nuanced: he said he wouldn’t want his daughter to smoke. 

Shaping What Doctors Say

Duncan at Vanderbilt said doctors and other health providers should consider the study when treating patients. For instance, medical advice might change for a patient who quit seven years prior. 

“That falls within that time of like — well, the risk calculator said that by now that risk should have diminished — but these findings suggest that maybe they haven’t,” Duncan said. “Physicians really want to err on the side of caution. They may want to say, ‘For up to 10 years, we’re going to consider you to be at higher risk.’” 

In that case, a health provider might still advise changes to diet and exercise that could decrease risk.

The risk calculator is a tool health providers use to determine a patient’s likelihood of developing health conditions. Duncan said there needs to be more research before her study’s finding is conclusive. 

“It would be really premature to say that calculators should be updated based on these results alone,” Duncan said. 

The data she used is from the Framingham Heart Study, which started in 1954. That study followed a generation and gave participants a medical exam every few years. In addition, another generation of people was enrolled starting in the 1970s and also examined every few years. The 8,770 people in the dataset are predominantly white and live in a community outside Boston. And though it’s a huge data set, Duncan said that means the study has limitations. 

“We don’t know that this extends to other races or ethnicities,” Duncan said. 

Next up for Duncan and her team is an experiment with the existing heart risk calculator. They’re using the current algorithm for the calculator, and adding in questions about the time since a person quit and how heavily they smoked. The hypothesis is that making those additions might line up the risk calculations with her study results. 

“We want to see if … adding just those two variables to the calculator helps in aiding risk prediction among former smokers,” Duncan said. 

Gilda’s Club CEO talks expansion and why she gets up every day Monday, Jul 22 2019 

Gilda's Club Kentuckiana ribbon cutting

At the end of a particularly long day at a Gilda’s Club camp for children touched by cancer, Karen Morrison was feeling a bit weary, but her spirit was lifted by the kids. “We had a camper who’s been living with cancer for a long time say, ‘I look forward to this week all year […]

UofL expert touts cancer breakthroughs with immunotherapy Thursday, Jul 18 2019 

Portrait of Dr. Jason Chesney

The director of the University of Louisville’s James Graham Brown Cancer Center has a lofty goal — to make cancer a disease of the past. “I think we are close to that happening,” Dr. Jason Chesney told a packed house at Holsopple Brewing in Lyndon Wednesday night. “If I had said that five or 10 […]