Latest / Morning Medical with Dr. Chow / New cancer treatments, RPM for seniors, and the mental health benefits of Wordle

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New cancer treatments, RPM for seniors, and the mental health benefits of Wordle · Morning Medical with Dr. Chow

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Good morning, and welcome to another episode of Morning Medical with Doctor Chow.
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I am your host, Doctor Chi-Ming Chow.
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Today, we have a fascinating lineup of topics that are sure to peak your interest.
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We will be discussing new search that suggests cancer patients often do better with less
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intensive treatment.
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We will also explore how technology is transforming senior health care and examine
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whether Wordle is having an impact on our mental health.
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So grab your cup of coffee or tea and let us dive into today's medical Our first story comes
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from the American Society of Clinical Oncology annual meeting held recently in Chicago.
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Researchers have found that scaling back treatment in certain cancers can make life
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easier for patients without compromising outcomes.
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This represents a significant shift from the aggressive treatment approaches of the past.
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The cancers involved in these studies were ovarian cancer, esophageal cancer, and Hodgkin
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lymphoma.
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30 years ago, the focus in cancer research was predominantly on doing more.
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For example, women with advanced breast cancer was subjected to massive doses of chemotherapy
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and bone marrow transplants, which often pushed them to the brink of death.
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Unfortunately, this aggressive approach did not yield better results compared to standard
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chemotherapy and patients suffered from severe side effects.
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Today, the focus has shifted towards optimizing cancer care by questioning whether all the
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treatments used in the past are necessary.
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Doctor Tatiana Kolevska, medical director for the Kaiser Permanente National Cancer
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Excellence Program, emphasized the importance of continually asking this question.
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One of the key reasons why less intensive treatments can be as effective is due to the
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development of improved drugs.
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According to Doctor William G Nelson of Johns Hopkins School of Medicine, cancer treatment is
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not only becoming more effective, but also easier to tolerate with fewer short term and
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long term complications.
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At the conference, Several studies were highlighted to demonstrate this trend.
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Let us delve into the specifics of these studies.
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In the case of ovarian cancer, French researchers conducted a study to determine
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whether it is safe to avoid removing lymph nodes that appear healthy during surgery for
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advanced ovarian cancer.
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The study involved 379 patients, half of whom had their lymph nodes removed.
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While the other half did not.
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After 9 years of follow-up, the results showed no difference in survival rates between the two
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groups.
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Moreover, those who underwent less extreme surgery experienced fewer complications, such
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as the need for blood transfusions.
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This study was funded by the National Institute of Cancer in France.
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In another study focusing on esophageal cancer, German researchers examined 438 patients with a
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type of esophageal cancer that can be treated with surgery.
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The patients were divided into 2 groups, One group received a common treatment plan that
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included chemotherapy and surgery, while the other group received chemotherapy surgery and
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radiation.
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Both treatment methods are considered standard, and the choice often depends on where the
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patient is treated.
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After 3 years, 57% of the patients who received chemotherapy and surgery were alive.
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Compared to 51% of those who received the additional radiation.
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This study was funded by the German research foundation.
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Finally, a study on Hodgkin lymphoma compared 2 chemotherapy regimens for advanced stages of
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the disease.
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The less intensive treatment proved to be more effective in controlling the blood cancer and
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caused fewer side effects.
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After 4 years, the less harsh chemotherapy kept the disease in check-in 94% of patients
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compared to 91% for those who underwent the more intense treatment.
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This trial included Vonfau 100 and 82 patients from 9 countries, including Germany, Austria,
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Switzerland, the Netherlands, Denmark, Sweden, Norway, Australia, and New Zealand.
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The study was funded by Takeda Oncology, the maker of 1 of the drugs used in the gentler
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chemotherapy regimen.
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As the population in the United States continues to trend older, including the massive
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generation of 73,000,000 baby boomers, The ability to offer high quality senior care is
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becoming more important than ever for health care organizations.
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Technologies such as remote patient monitoring or RPM is transforming the way in which health
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care is delivered, offering patients and providers a convenient way to stay connected
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outside of regular doctor's appointments.
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Using information collected from wearable devices or smart home systems, remote patient
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monitoring brings a proactive and efficient method of health management.
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Through continuous tracking of biometric data, providers can identify issues earlier, enabling
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immediate interventions and treatment alterations.
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With improved patient access, remote patient monitoring can help eliminate the need for
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frequent in person visits.
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It also reduces the overall cost of delivering care by minimizing hospital admissions and
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readmissions.
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During the pandemic, remote monitoring became essential for managing and tracking health
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conditions in real time, offering a more comprehensive and proactive approach to care.
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Devices like weight scales and blood pressure cuffs became important tools that enabled
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providers to track health metrics and vital signs.
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Post pandemic, patients still want accessibility and convenience, and the
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traditional healthcare models reliance on periodic in person visits no longer meets their
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expectations.
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To meet the shifting needs of modern health care, The industry is integrating more remote
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patient monitoring offerings alongside telehealth services established during COVID
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19.
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Within New Jersey, several networks, including virtual health, Atlantic Health System, Holy
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Name Medical Center, and Hackensack Meridian Health, now have some type of remote monitoring
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service available for patients.
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The majority of programs launched across the United States within the last two years are
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already yielding a positive return on investment.
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A December 2023 survey by MD Revolution shows increased patient and clinician satisfaction,
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reduced overall expenses, improved outcomes, and new revenue sources.
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According to the survey, remote patient monitoring is primarily deployed for chronic
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disease populations, including those with hypertension, diabetes, heart conditions,
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chronic obstructive pulmonary disease, mental health issues, and surgical recovery.
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Looking ahead, most respondents plan to increase or maintain their remote patient
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monitoring budget this year.
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By 2030, remote patient monitoring is expected to become a $3,400,000,000 market.
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Products that contract blood pressure, oxygen levels, glucose, weight, dehydration, abnormal
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heart rhythm, shortness of breath, and more are already making their way into patients' homes.
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Remote patient monitoring has quickly become a way to meet the need for patient centric,
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accessible, and efficient health care for seniors particularly those who wish to age in
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place.
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One of the biggest concerns for seniors who wish to remain at home and independent is the
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ability to ensure they are staying healthy and safe.
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After launching a program a year and a half ago, Englewood Health physician network found
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it not only improved outcomes for seniors, but it also made them feel more empowered and in
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control of their health.
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According to doctor Steven Brohnquist, president of Englewood Health Physician
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Network, remote patient monitoring has been a helpful tool for managing one of the most
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common conditions in seniors, hypertension.
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The percentage of Americans on blood pressure medicine goes up with age.
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If we are lucky enough to be ninety years old, 90% of ninety year old Americans are on blood
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pressure medicine.
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It is just one of those things that goes up with age, but it is also one of the things that
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medicine has been most successful at.
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And that is managing blood pressure, he said.
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Through Englewood's program, patients with chronic conditions receive a portable device
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that sends health data, like blood pressure or glucose readings, to nurses in a 20 fourseven
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command center, manned by RPM Healthcare.
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A Florida based health care technology company.
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Doctor Birquell explained if the numbers are high, they will reach out to the patient and
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ask them what is going on.
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Are they taking their medicines?
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What is going on with your diet?
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Are you exercising?
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What else is going on in your life?
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Additionally, patients have a dedicated care coach to support their health goals, he said.
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The data from daily readings is also securely transmitted to a doctor at Inglewood and
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integrated into the patient's electronic medical record.
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From there, they can determine if medication or lifestyle changes are needed, all without the
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patient setting foot in the office.
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Since Englewood partnered with RPM Healthcare a year and a half ago, doctor Brunkwell said the
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program has about 2000 patients enrolled, and a 95% patient satisfaction rating.
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Since the program is approved for Medicare funding, About 85% of participants are seniors,
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though some commercial insurance providers also participate, he said.
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Doctor Brunkwell said about a third of our patients were hypertensive.
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Over 50% of those became controlled within 60 days without a change in their medications.
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That is the single outcome that I was most astounded by the number of people who got
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better without getting another prescription.
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That is the easy thing to do.
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I can write up another prescription, but they were getting the goal without me intervening.
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Which I just thought was great.
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He continued.
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It was just a little bit of behavior modification, some coaching, and some awareness
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on the part of the patient about what they can do to manage their pressure without a
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prescription or in addition to a prescription.
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One is regular exercise and walking would be just fine.
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The second is keeping your weight as close to ideal body weight as possible.
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And the 3rd is reduction of dietary salt, particularly from processed foods.
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I think it made people a little bit more aware and that is part of the reason that some of
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these people got controlled, Doctor Brunkwell said.
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They realized that there is more to just taking a pill in the morning and that they need to
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take care of themselves.
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It was more successful than I thought it would be.
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And their feedback was great.
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They enjoyed the coaching.
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They felt sort of attached and supported.
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Somebody else was caring about their blood pressure issues.
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A lot of them really liked the interaction that somebody else was interested in their health
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and checking in with them, he said.
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As our society is becoming more electronic, we also still need personal touch.
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Doctor Brunquell continued.
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Some of my own patients in the office would call the nurse coach by name.
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They would be like, oh, Diane checks in with me once in a while.
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And I really found her very helpful, and I really like her.
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It is just nice to see that personal connection too.
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He went on to say, also, the fact that they did not have to add another prescription to an age
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group that already is on a lot of prescriptions was equally rewarding both for them and for us
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as providers.
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Polypharmacy is an issue with the geriatric crowd.
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The rule of thumb in this country is that you are taking 2 prescriptions a day for every
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decade over the age of sixty.
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So the average eighty year old is now on 6 prescription medicines every day.
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And at some point, the number of medicines becomes a problem by itself.
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So we would like to try and keep that number down and away from the side effects,
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interactions, and all those other things, he said.
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And by the way, sometimes the pressures were going too low so we reduced medicines.
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People's pressures can be a little higher when they come to the office.
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But we discovered that sometimes people were actually lower than we thought and did not need
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as much medicine.
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With technology adoption for more senior age groups growing every year, doctor Brunquell
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said providers should not underestimate older adults ability to embrace remote monitoring
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programs.
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According to the Pew Research Center, the number of adults in the United States over the
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age of sixty five who have a smartphone has grown from 13% in 2012 to 61% in 2021.
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Overall, about 61% of the age sixty five plus set on a cell phone.
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Tablet use is also on the rise for that age group from 6% in 2012 to 44% in 2021.
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As telehealth became an integral part of the health care landscape during the pandemic,
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older adults recognize the role that technology can play in enabling a healthy life,
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particularly for those over the age of seventy, according to AARP.
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Englewood is very electronic and very digital already, and there is a smaller and smaller
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percentage of our seniors who are not electronic.
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Doctor Brunkul said, their only reluctance was with the initial phone call.
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And as we have all become accustomed to do, when they do not recognize the telephone
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number, they do not answer the call.
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So we wound up having to send them emails saying, so and so is going to call you because
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this is what your doctor recommended.
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We had a little bit of trouble getting people to pick up the phone initially he recalled.
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To get the word out about remote patient monitoring, Doctor Brunkwell said Engelwood
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Health gathered from its electronic medical record system, which patients carry a
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hypertension diagnosis and contacted them about the program.
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We let them know they are eligible for it, and it is something that their doctor is supportive
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of, he said.
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Englewood Health will soon extend its blood pressure program to pregnant women at risk of
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developing pre eclampsia according to doctor Brunkwell.
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Then we would be able to detect when their blood pressure is starting to go up and
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intervene quickly.
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He said, It is not large numbers, but there are women who get in trouble with this, and then
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their babies are at risk.
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We have also toyed with using it in obesity medicine too, with all the new drugs.
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I mean, this is a way of just kind of checking in, getting some coaching, getting some
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support, and maybe getting to your goal.
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He said.
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He went on to say, we are trying hard to make it as easy as possible.
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It is just the way we are all living these days.
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Yes.
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There has to be a person available when there is a problem, but the more we can do online and
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facilitate people's care, the more likely they are to get that care.
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Chow let us turn our attention to a topic that has captured the interest of many, the impact
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of the popular game, wordle on our mental health.
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Initially designed as a fun distraction during the pandemic, Wordle has grown into a global
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sensation.
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However, recent reports suggest that the game may have some unintended consequences on our
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mental well-being.
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Wordle, which was created by Josh Wardle, and later sold to the New York Times in January
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2022 requires players to guess a five letter word in 6 tries.
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The game provides feedback after each attempt, with green tiles indicating correct letters in
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the correct spots, yellow tiles for correct letters in the wrong spots, and gray tiles for
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incorrect letters.
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While many people enjoy the challenge, some mental health professionals are raising
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concerns about its impact.
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According to a recent report by the daily beast, The need to complete or win these types
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of games can interfere with our daily lives.
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Doctor Clifford Sussman, a psychiatrist specializing in internet and gaming addiction,
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explained that our brains have not evolved to keep up with the rapid advancements in
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technology.
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Technology today is essentially a shortcut to everything, and our brains can't resist that.
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And the shortcut to a sense of accomplishment while playing one of these online games
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releases dopamine into the brain.
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Seeking dopamine release could lead to compulsive and sometimes problematic behaviors,
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he said.
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New York psychologist, Jennifer Giddelmann, also noted that she has encountered patients
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who struggle to complete their everyday tasks because of the time they spend playing games
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like Wordle.
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This sentiment is echoed by many users on social media who have shared their experiences
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of how the game affects their mental health.
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One tweet read, I just lost Wordle today.
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Be right back.
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Need to call in a mental health day.
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Another user wrote, taking a break from Wordle to focus on my mental health.
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Some people even discussed the game during their therapy sessions.
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Halley Kritzas, a licensed therapist, an avid wordle player, mentioned that it is usually her
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younger clients, who struggle with anxiety or perfectionism who find wordle challenging.
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They like having structure and routine, And when they are not able to successfully complete
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the Wordle, it sets them off on the wrong course for their day, Kratzis explained.
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Kritz has also pointed out that for some people, the need to complete the game correctly
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can lead to cheating.
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Which in turn can cause feelings of disappointment and self doubt.
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For some of the people who have a bit higher levels of anxiety, Not being able to complete
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it, obviously, brings some sort of sense of disappointment that you couldn't complete the
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puzzle she added.
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The issue is not limited to wordle alone.
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Other games such as connections and the mini crossword from the New York Times also have the
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potential to affect mental health negatively.
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Critrisas noted that these games can trick players with words that seem to belong
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together.
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Causing frustration and self comparisons based outweigh the positives, critics offer some
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practical advice.
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Setting a time limit for playing the game each day can help manage the compulsion.
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Set a time limit that says I'm only going to give myself 5 minutes or 10 minutes to do it.
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And if I haven't finished, then I'm done for the day.
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She suggested.
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This concept can be applied to other activities on the internet, including social media.
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Data from California State University shows that an estimated 10% of Americans are addicted
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to social media.
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Which can have negative effects on mental health.
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For teenagers, this is particularly concerning with high rates of cyberbullying and self
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esteem issues linked to social media usage.
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Criticism also recommends discussing the issue with a therapist or a loved one if the game is
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affecting your mental health.
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Opening up the conversation can lead to healthier habits and alternative ways to spend
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your time.
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I do think it's a great thing to utilize at any point of the day, especially in the morning, to
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get our brains up and running.
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But if it's going to be harmful, we probably shouldn't be playing it.
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She advised.
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She emphasized the importance of maintaining a healthy perspective on the game.
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We should just acknowledge that it's a game and it's something that should be fun.
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And no one's going to know whether we solve the wordle or the connections are solved.
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Critza said.
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Despite these concerns, it is important to note that the negative impact of these games is not
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universal.
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Krit says mentioned that while some of her clients do discuss the game during therapy, it
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is not a widespread issue.
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I don't get the overwhelming perception that this is a huge, huge thing.
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I think the games are wildly popular.
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I think most of us either do it when we're at work and on the computer and we have a break or
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have the New York Times app and just have it in our hands.
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But for the majority, I don't think it's as distressing as maybe some of the articles are
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reading it out to be, she said.
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That wraps up today's episode of Morning Medical with Doctor Chow.
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I hope you found our discussion enlightening and informative.
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From the evolving approaches to cancer treatment, to the transformative power of
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technology in senior care.
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And finally, the intriguing impact wordle on mental health, we have covered a lot of ground
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today.
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Thank you for joining me, and I look forward to bringing you more medical news and insights in
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our episode.
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Stay healthy and take care.