CANCER IN CHILDREN

Oct 3, 2018 | Healthy Tips

Key facts

Cancer is a leading cause of death for children and adolescents around the world and approximately 300,000 children aged 0 to 19 years old are diagnosed with cancer each year. [1]

The most common categories of childhood cancers include leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumour. [1-2]

In high-income countries, more than 80% of children with cancer are cured, but in many low- and middle-income countries (LMICs) only about 20% are cured. [2-3]

Childhood cancer generally cannot be prevented or screened.

Improving outcomes for children with cancer requires early and accurate diagnosis followed by effective treatment.

Most childhood cancers can be cured with generic medicines and other forms of treatments including surgery and radiotherapy. Treatment of childhood cancer can be cost-effective in all income settings. [2]

Avoidable deaths from childhood cancers in LMICs result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.

Childhood cancer data systems are needed to drive continuous improvements in the quality of care, and to drive policy decisions.

The problem

Cancer is a leading cause of death for children and adolescents worldwide.  In high-income countries, more than 80% of children with cancer are cured, but in many LMICs, only 20% are cured [2-3].

The reasons for lower survival rates in LMICs include an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and excess relapse, in part due to lack of access to essential medicines and technologies addressing each of these gaps improves survival and can be highly cost-effective [2-3].

What causes cancer in children?

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or a tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.

Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and other pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.

Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Ongoing research is needed to identify factors impacting cancer development in children.

Improving outcomes of childhood cancer

Because it is generally not possible to prevent cancer in children, the most effective strategy to reduce the burden of cancer in children is to focus on a prompt, correct diagnosis followed by effective therapy.

Early diagnosis

When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care. A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy.

Early diagnosis consists of 3 components:

awareness by families and accessing care

clinical evaluation, diagnosis and staging (determining the extent to which a cancer has spread)

access to treatment

Early diagnosis is relevant in all settings and improves survival for many cancers.⁶ Programmes to promote early and correct diagnosis have been successfully used in countries of all income levels, often through collaborative efforts of governments, civil society, and non-governmental organizations, with vital roles played by parent groups. Childhood cancer is associated with a range of warning symptoms that can be detected by families and by trained primary health care providers.⁶

Screening is generally not helpful for childhood cancers. In some select cases, it can be considered in high-risk populations. For example, some eye cancers in children can be caused by a mutation that is inherited, so if that mutation is identified in the family of a child with retinoblastoma, genetic counselling can be offered and siblings monitored with regular eye examination early in life. Genetic causes of childhood cancers are relevant in only a handful of children with cancer. There is no high-quality evidence to support population-based screening programmes in children.

Treatment

A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world.

However, a cure is possible for more than 80% of children with cancer, in most cases with inexpensive generic medications that are listed on the WHO List of Essential Medicines (EML). WHO EML for children, defined as those meeting the priority health care needs of the population, includes 22 cytotoxic or adjuvant medicines and 4 hormone treatments for childhood cancer. Children who complete treatment require ongoing care to monitor for cancer recurrence and to manage any possible treatment-related toxicity.

Palliative care

Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Paediatric palliative care should be appropriately considered as a core component of comprehensive care starting when the illness is diagnosed and continued regardless of whether or not a child receives treatment with curative intent.⁷

Palliative care programmes can be delivered through community- and home-based care to provide pain relief and psychosocial support to patients and their families. Adequate access to oral morphine and other pain should be provided for the treatment of moderate to severe cancer pain, which affects more than 80% of cancer patients in the terminal phase.

WHO response

In 2018, WHO launched the Global Initiative for Childhood Cancer with partners to provide leadership and technical assistance to support governments in building and sustaining high-quality childhood cancer programmes. The goal is to achieve at least 60% survival for all children with cancer globally by 2030. This represents an approximate doubling of the current cure rate and will save an additional one million lives over the next decade. The objectives are to:

Increase capacity of countries to deliver best practices in childhood cancer care

Prioritize childhood cancer and increase available funding at the national and global levels

WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to:

increase political commitment for childhood cancer diagnosis and treatment;

support governments to develop high-quality cancer centres and regional satellites to ensure early and accurate diagnosis and effective treatment for children with cancer;

develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care inclusive of the needs of childhood cancers;

improve access to affordable and essential medicines and technologies;

support governments to safeguard families of children with cancer from financial ruin and social isolation as a result of cancer care.

This initiative is part of the implementation of the World Health Assembly Resolution Cancer Prevention and Control through an Integrated Approach (WHA70.12), which urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan and 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer.

References

Steliarova-Foucher E, Colombet M, Ries LAG, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719-731.

Gupta S, Howard SC, Hunger SP, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. In: Disease Control Priorities, volume 3.  http://dcp-3.org/chapter/900/treating-childhood-cancers-low-and-middle-income-countries

Howard SC, Zaidi A, Cao X, et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol. 2018;19(5):e252-e266.

Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, et al. Germline Mutations in Predisposition Genes in Pediatric Cancer. N Engl J Med. 2015 Dec 10;373(24):2336-2346.

CANCER IN CHILDREN

DIABETIC DIET: 16 FOODS THAT HELP REGULATE BLOOD SUGAR

Sep 26, 2018 | Healthy Tips

BY SBG-TV

Diabetes can be sneaky, with symptoms that are not always obvious but that cause lasting damage.

Prevent problems by incorporating these 16 foods to regulate your blood sugar levels, as recommended by Healthline and WebMD.

Protein

Protein is a great food choice for diabetics because it doesn’t affect blood sugar levels. It also creates a feeling of fullness while it builds and repairs your body. Protein sources to consider for blood sugar control include Greek yogurt, cottage cheese, eggs and lean meats.

Vegetables

Whether you prefer them raw, cooked or roasted, vegetables do more than just add color to your plate. Choose diabetic-friendly, low-carb veggies like mushrooms, onions, eggplant, tomatoes, Brussels sprouts and zucchini.

Low-carb greens

Popeye had it right. Spinach, chard and kale are powerful foods with a low-carb punch. Pack your diet with these time-tested foods, and you will bring real power to the fight against high blood sugar.

Sour cherries

Fruits are sometimes frowned upon in the diabetic community, but there are some with a low glycaemic index. Food with low GI scores won’t raise blood sugar and can prevent a spike. Sour cherries have a low GI and a chemical called anthocyanins. The National Institutes of Health has shown that anthocyanins may reduce your risk of developing diabetes and obesity. Anthocyanins inhibit some digestive enzymes and slow down digestion. They also help reduce blood sugar spikes following starch-rich meals.

Blackberries and blueberries

Sour cherries aren’t the only fruits you can add. Blackberries and blueberries won’t raise blood sugar levels as much as their fruity friends. These berries are high in fibre and have the highest concentrations of anthocyanins.

Low-calorie drinks

While water is your dietitian’s drink of choice, spruce it up by infusing it with nutrients from vegetables and fruits. Add lemons and cucumbers to water for flavor and to slow your reach for sugary drinks.

Apple cider vinegar

Healthline.com recommends drinking 20 grams of apple cider vinegar in 40 grams of water before a meal to prevent blood sugar spikes. The acetic acid in it reduces certain enzymes in the stomach and can improve insulin sensitivity after meals.

Eggs

Eggs get a bad rap because of their link to high cholesterol. However, eggs can provide satiety and curb cravings without raising blood sugar levels. Both prediabetics and diabetics can benefit from the protein and nutrients.

Whole grains and high-fibre

Fasting insulin rates after eating whole grains are 10 percent lower, according to a report by The American Journal of Clinical Nutrition. The high content of fiber, phytochemicals, and nutrients found in whole grains work to regulate blood sugar.

Beans

Legumes like dried beans, peas and lentils help you feel full longer while providing a low-glucose alternative. Soft-style beans can be combined as a dip with other vegetables to add variety.

Healthy fat

While the wrong kind of fat can be harmful, good fats are essential. Some good fat choices are olive oil, avocado and fish (salmon, halibut, albacore tuna, mackerel and trout).

Polyunsaturated and monounsaturated fatty acids

Polyunsaturated fatty acids and monounsaturated fatty acids improve insulin sensitivity. These fatty acids trigger feelings of satiety while positively impacting blood pressure and inflammation levels. Avocados, peanut butter, other nuts and seeds are sources of monounsaturated fatty acids.

Garlic

A study shows how garlic can lower blood glucose levels. Garlic supplements, raw or cooked garlic, or aged garlic can all help.

Chia seeds

They may be small, but chia seeds are loaded with healthy fats, omega-3s, calcium, fibre, and antioxidants. They help lower LDL cholesterol and triglycerides.

Cacao

Cacao is a foundational ingredient for chocolate and cocoa butter. High in antioxidants and a flavanol called epicatechin, cacao seeds help control blood glucose production by activating key proteins. Cacao also balances blood sugar — even in those who already have diabetes.

Almonds

These tasty, protein-rich nuts help control blood sugar levels following meals. Consuming 2 ounces of almonds per day lowers levels of fasting glucose and insulin.

DIABETIC DIET: 16 FOODS THAT HELP REGULATE BLOOD SUGAR

HOW A STROKE CAN CHANGE YOUR PERSONALITY

Sep 14, 2018 | Healthy Tips

By Heidi Moawad, MD 

A stroke can produce major life-altering changes, such as vision and diminished physical strength and coordination. In addition to the obvious physical handicaps of a stroke, a stroke can also produce significant personality changes. If you are a stroke survivor, your post-stroke behavioural changes can hit you and your loved ones by surprise if you suddenly do not act like “yourself” anymore.

Once you learn how to identify the most common personality changes after a stroke, you can begin to gain a sense of reassurance, knowing that there is an explanation for why you or your loved one might be acting a little different. Recognizing personality changes can be a huge step in modifying unwanted behavior as you purposefully work towards getting back some of the personality traits that make you feel more like “you.”

Depression

After a stroke, it is very common to experience a sense of unhappiness and sadness. In fact, as many as 60 percent of stroke survivors report prolonged depression, which is depression that is more severe and long lasting than routine sadness.

Post-stroke depression results from a combination of biological and situational factors. First of all, the obvious effects of a stroke, such as weakness, vision loss, and coordination problems may cause a sense of sadness if you feel disempowered by your handicap. Additionally, after a stroke, you might worry about your health or experience anxiety about your own mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.

And the stroke-induced damage to the brain can produce changes in the way the brain functions, resulting in altered biological activity that leads to depression.

Despite all of these elements that contribute to the development of post-stroke depression, post-stroke depression is usually treatable with a combination approach that includes medication and counseling.

Many people, however, are reluctant to seek treatment for depression. Some stroke survivors hesitate to take on the label of depression out of concern that it can be a self-fulfilling prophecy. Others do not trust the medical system to deal with emotional issues, and others view depression as a sign of weakness.

However, if you or your loved one has lingering feelings of sadness or hopelessness, you can get effective help for this problem. The recognition that your depression is not your fault and is not a sign of weakness is an empowering step towards getting the right medical treatment.

Loneliness 

After a stroke, isolation can occur if you are no longer able to do the same things you used to do. If you have to leave your job after a stroke, or if you are no longer a part of your regular social life, this can lead to a sense of loneliness.

Some stroke survivors have severe disabilities that make it difficult to drive, leave the house or even get out of bed. Extreme disability may necessitate moving into a new living environment, in part to obtain more assistance with daily living, and in part to reduce isolation and loneliness. Each stroke survivor can overcome the post-stroke sense of loneliness in his or her own unique way.

Loss of Cognitive Skills

The loss of cognitive skills after a stroke can happen after a stroke in almost any region of the brain, but most often in the frontal lobe, the parietal lobe or the temporal lobes.

Changes in cognitive skills include trouble with problem-solving, reading difficulties, and trouble with simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, or losing things or forgetting to take care of important tasks. Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.

The loss of cognitive skills can be very distressing for stroke survivors, and many stroke survivors may be in denial, making excuses for frequent mistakes, or even lying about errors to avoid embarrassment.

Building up cognitive skills is a challenge, but just as physical disability can improve with physical therapy, cognitive disabilities can improve with dedicated cognitive therapy.

Emotional Instability

Many stroke survivors find themselves becoming very emotional or inappropriately crying or laughing. Some stroke survivors experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable emotional expressions.

Lack of Motivation

A stroke can lead to a lack of motivation, which is called apathy. Apathy occurs after most types of brain injury. There are several reasons for post-stroke apathy.

The decline in cognitive abilities (problem solving and thinking skills) after a stroke can make many tasks seem too challenging and unsolvable. Additionally, the development of post-stroke depression, having less responsibility to deal with after the stroke, and sometimes the feeling that “nobody will notice” what you do, can all lead to apathy.

Lastly, apathy may also occur due to changes in the structure and function of the brain secondary to the stroke itself.

Aggression 

Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive. Aggression, like the other behavioural and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.

Aggression is particularly noticeable in stroke survivors who have a stroke pattern that produces vascular dementia. Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain, and resulting in a distinctive type of dementia. Vascular dementia is characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.

Denial of a Stroke: Anosognosia 

Anosognosia describes a stroke survivor’s inability to recognize that he or she has had a stroke. Anosognosia is manifest by an interesting overconfidence and unawareness that there is anything wrong after a stroke. In fact, a person who has anosognosia may express surprise and bewilderment at the fact that there is any medical care being administered at all.

Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers, who try to offer assistance and care, often with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.

Lack of Empathy

The lack of empathy after a stroke is caused by brain damage that affects regions of the right side of the brain. A lack of empathy is a behavioural change that is usually upsetting for friends and loved ones, but is typically unnoticed by the stroke survivor.

It is not easy to predict whether a lack of empathy will improve after a stroke, as some stroke survivors can show improvement, while others do not.

Loss of Sense of Humour 

A sense of humour requires insight and the quick thinking. Humour is often based on the recognition that dissimilar ideas do not belong together and that they are funny and amusing when placed together.

Many types of stroke can diminish a stroke survivor’s sense of humour. A stroke survivor who was previously funny might not be able to construct jokes and a stroke survivor who would have been able to recognize and laugh at jokes might not be able to do so anymore.

A loss of sense of humour can be difficult to recover from because this stroke effect is caused by a loss of cognitive skills. However, understanding that the lack of humour is the result of a stroke, and not a personal rejection, can help in preventing hurt feelings and misunderstandings when a stroke survivor does not respond to light-hearted joking as expected.

Loss of Social Inhibitions

Some stroke survivors may behave in ways that are considered socially inappropriate after a stroke of the right or the left frontal lobe. Behaviours such as taking food from a stranger’s plate, insulting people out loud or even undressing or urinating in public, may pose challenges for the caretakers and family members who are primarily responsible for the safety and care of a stroke survivor.

Generally, a stroke survivor who displays socially unacceptable behavior does not have the insight to understand that the actions are not acceptable, and is unlikely to apologize or try to correct the behavior.

The language or insults of a stroke survivor who has suffered from a frontal lobe stroke are not necessarily consistent with a person’s ‘normal’ pre-stroke personality or beliefs. And it is very important to be aware that mean statements are not reflective of what a stroke survivor ‘really feels, deep down inside,’ but are more likely to be phrases that he or she heard in a completely unrelated setting, such as in a book or on a television show.

The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.

Jealousy 

A rare type of stroke causes a syndrome called Othello Syndrome, which is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships. This syndrome can affect stroke survivors as a result of brain injury affecting areas of the right cerebral cortex.

A Word from Verywell

A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you’ve lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.

However, if a stroke survivor and loved ones understand that the source of the behavior comes from stroke-induced brain damage, it can reassure everyone in knowing that the unpleasant behavior is not premeditated or intended to be personally insulting. High functioning stroke survivors who learn about the typical post-stroke behavioural changes can gain enough insight to be able to make some changes, which can result in more satisfying interpersonal relationships.

HOW A STROKE CAN CHANGE YOUR PERSONALITY