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Risk of Multiple Sclerosis High in Urbanites due to Air Pollution

Air pollution could be a risk factor for the development of multiple sclerosis (MS) among urbanites, says researcher

Air pollution may up multiple sclerosis risk in urbanites. Pixabay

Air pollution could be a risk factor for the development of multiple sclerosis (MS), say researchers, adding that MS risk was 29 per cent higher among people residing in urbanised areas.

Multiple sclerosis (MS) is a disease in which the immune system eats away at the protective covering of nerves. Whilst MS can be diagnosed at any age, it frequently occurs between the ages of 20-40 and is more frequent in women.

Symptoms can change in severity daily and include fatigue, walking difficulty, numbness, pain and muscle spasms. The study, presented at the European Academy of Neurology (EAN) Virtual Congress, detected a reduced risk for MS in individuals residing in rural areas that have lower levels of air pollutants known as particulate matter (PM).

According to the researchers, it is well recognised that immune diseases such as MS are associated with multiple factors, both genetic and environmental. “We believe that air pollution interacts through several mechanisms in the development of MS and the results of this study strengthen that hypothesis,” said study lead researcher Professor Roberto Bergamaschi from the IRCCS Mondino Foundation in Italy.

Particulate matter (PM) is used to describe a mixture of solid particles and droplets in the air and is divided into two categories. PM10 includes particles with a diameter of 10 micrometres of smaller and PM2.5 which have a diameter of 2.5 micrometres or smaller.  Both PM10 and PM2.5 are major pollutants and are known to be linked to various health conditions, including heart and lung disease, cancer and respiratory issues.

Air pollution could be a risk factor for the development of multiple sclerosis. Pixabay

The analysis was conducted in the winter, given that this is the season with the highest pollutant concentrations, in the north-western Italian region of Lombardy, home to over 547,000 people.

For the findings, the research team included over 900 MS patients within the region, and MS rates were found to have risen 10-fold in the past 50 years, from 16 cases per 100,000 inhabitants in 1974 to almost 170 cases per 100,000 people today. Whilst the huge increase can partly be explained by increased survival for MS patients, this sharp increase could also be explained by greater exposure to risk factors.

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“In the higher risk areas, we are now carrying out specific analytical studies to examine multiple environmental factors possibly related to the heterogeneous distribution of MS risk”, Professor Bergamaschi said. (IANS)

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COVID-19 Makes it Difficult to Manage Cancer Care: Oncologist

Dr Abhishek Shankar said that coronavirus has made it difficult to manage the cancer care delivery system

pink-ribbon-cancer care
Coronavirus outbreak has made it difficult to manage cancer care. Pixabay

By Dr. Abhishek Shankar

A recent report– ‘Cancer Care Delivery Challenges Amidst Coronavirus Disease – 19 (COVID-19) Outbreak’ published in the journal of Asian Pacific Journal of Cancer Prevention has pointed out that cancer patients are more susceptible to coronavirus than individuals without cancer as they are in an immunosuppressive state because of the malignancy and anticancer treatment. Oncologists should be more attentive to detect coronavirus infection early, as any type of advanced cancer is at much higher risk for unfavorable outcomes.

Author, Dr Abhishek Shankar, assistant professor in the department of radiation oncology at Lady Hardinge Medical College said that coronavirus has made it difficult to manage the cancer care delivery system.

“As we are having a lockdown in the whole country, patients can’t travel from one place to another. About 95 percent of the cancer care services are restricted to the urban areas but we also know that 70 percent of the people live in rural areas. So, there is a lot of disparity in cancer care. For cancer patients, stress is more disturbing for the patient rather than cancer itself,” Dr Shankar told ANI.

Cancer care
Dr. Shankar added that in this situation, it is very difficult to manage these people as they are unable to come to the hospital as we are running only emergency services. Pixabay

Also Read: Having a Child with Cancer Doesn’t Impact Parents’ Separation: Researchers

He added that in this situation, it is very difficult to manage these people as they are unable to come to the hospital as we are running only emergency services.

Talking about the report, Dr Shankar said, “We have published the paper on cancer care delivery, although guidance is that you shouldn’t delay and you should continue with the treatment. But there are many challenges that are coming right now. We have also advised cancer patients about the precautions they should take. Also, patients need to verify social media messages coming in from a credible source like the Indian Council of Medical Research (ICMR) and WHO.”Furthermore, he suggests that persons suffering from cancer should get treated from nearby hospitals and try avoiding the delay.

The cancer specialist remarked that it is a dilemma for healthcare professionals as well as patients because there is an issue regarding what to follow and what not to. “To date, there is no scientific guideline regarding the management of cancer patients in the backdrop of coronavirus outbreak,” Dr Shankar informed.

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Having a Child with Cancer Doesn’t Impact Parents’ Separation: Researchers

Being parents to a cancer patient kid doesn't trigger separation, say researchers

cancer seperation
Chldhood cancer may not trigger seperation among parents according to researchers. Pixabay

Contrary to traditional belief, researchers now say that having a child with cancer did not appear to impact parents’ risk of separation or divorce or affect future family planning.

Childhood cancer can cause feelings of fear and uncertainty among parents and burden them with many practical challenges related to caregiving and work-related obligations, according to the study published in the journal Cancer.

For the findings, the research team from the Danish Cancer Society Research Centre examined data from several registries in Denmark, linking information on parents of children diagnosed with cancer in 1982-2014 (7,066 children and 12,418 case parents) with parents of children without cancer (69,993 children and 125,014 comparison parents).

Parents were followed until 10 years after diagnosis, separation or divorce, death, emigration, or the end of 2017, whichever came first.

Overall, parents of children with cancer had a four per cent lower risk of separation and an eight per cent lower risk of divorce compared with parents of children without cancer.

Among parents of children with cancer, those who were younger had less education, and were unemployed had elevated risks for separation and divorce.

The findings showed that risks were also higher among parents of children diagnosed at a younger age.

Parents of children with cancer had a four per cent lower risk of separation. Pixabay

The investigators also evaluated how the diagnosis of cancer in a child affects parents’ decisions on having another child.

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They expected that parents of a child with cancer would have fewer children than parents of children without cancer and that they would postpone having another child.

This was not the case, however, as the researchers found that the childhood cancer experience did not negatively affect parents’ future family planning in Denmark.

The researchers noted that health care providers should communicate these reassuring and encouraging findings to parents, but that support should be offered if needed to improve family life in the long term. (IANS)

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Addressing Concerns and Dilemma of Cancer Patients In A Lockdown

For many cancer patients, this situation is a living nightmare as they face not only the threat of Covid-19, the pressure of lockdown restrictions but also intense uncertainty regarding the future of their cancer treatment and its associated outcome

Due to lockdown restrictions cancer patients face intense uncertainty regarding the future of their treatment. Pixabay
By Dr. Abhishek Shankar and Dr. Deepak Saini

The newly emerged Covid-19 virus has changed our lives in many ways. The lockdowns imposed by many countries have closed all but essentials services to prevent community transmission of the virus, with more stringent steps threatened as case numbers and mortality data grow by the minute.

Healthcare, an essential service at any time but never more so than in a crisis such as this, has been severely affected as the primary focus is shifted to the management of the crisis and other health emergencies rather than routine care.

Many elective surgeries are being deferred or delayed and patients are being advised to avoid non-essential hospital visits and switch to tele-consultation for arising problems.

For many cancer patients this situation is a living nightmare as they face not only the threat of Covid-19, the pressure of lockdown restrictions but also intense uncertainty regarding the future of their cancer treatment and its associated outcome.

Cancer patients are facing a stark choice regarding continuing treatment or delaying it to mitigate the Covid-19 risk. Many cancer patients in India travel huge distances to receive treatment but right now they cannot access treatment even if they wish to proceed as airlines and rail services are not operating.

Understandably, patients want concrete answers about when they can start cancer treatment, what the implications are if there is a gap in their treatment on their chances of recovery and the risks for their safety if they do attend the hospital.

There is no one-size-fits-all answer to these questions.

The psychological impact on patients and their families is starting to reveal itself.

Cancer treatment
Cancer patients are facing a stark choice regarding continuing treatment or delaying it to mitigate the Covid-19 risk. Pixabay

The son of a recently diagnosed patients wrote to us: “My father has been diagnosed with kidney cancer with lung metastasis 21 days ago. His immunohistochemistry sample could not be processed in this lockdown and he was advised to stay at home considering his age of 83 years. I am worried about his cancer but at the same time this infection too.”

Another patient’s family wrote: “Is it safe to visit hospital for PET-CT as I have heard that cancer patients are more prone to catch infection?” His mother has colorectal cancer and is post-surgery and post four cycles of chemotherapy. She was scheduled for PET-CT for evaluation but was frightened to approach to the hospital in the lockdown.

In ordinary times, cancer patients face uncertainty and have to fight on many fronts to deal with the economic, social, family and personal challenges that a cancer diagnosis brings. During active treatment cancer patients require frequent hospital visits, pre-operative & post-operative stays, chemotherapy sessions, laboratory tests and radiological imaging, daily appointments for radiotherapy sessions (often over weeks). Extended hospital visits mean that cancer patients, many of whom are immunocompromised as a result of the side-effects of treatment, are more likely to be exposed to infection.

Data emerging from many countries affected by the pandemic suggests that the majority of the Covid-19 patients who require hospitalisation are suffering from heart disease, respiratory disease, diabetes, hypertension or cancer.
Here we have tried to address many of the concerns of cancer to minimise the fear and uncertainly related to cancer treatment and its outcome amidst this Covid-19 crisis.

Which cancer patients are at high risk for coronavirus infection?

Cancer patients who are older (more than 70) and having one or more associated co-morbidities, i.e., cardiovascular diseases, hypertension, diabetes, and lung diseases are at high risk for coronavirus infection.

What are the symptoms of coronavirus disease in cancer patients?

Coronavirus diseases are associated with symptoms which include fever, a new persistent dry cough, difficulty in breathing, fatigue, sore throat. New evidence suggests some patients are experiencing the loss of smell and taste. Presentation of the disease is not different in cancer patients but chances of progression to severe or critical diseases are more common with cancer patients.

For many cancer patients the COVID situation is a living nightmare. Pixabay

What are the chances of getting coronavirus infection if cancer patients come to hospital for their treatment?

Chances of getting coronavirus infection does increase with frequent hospital visits. It has been reported between 10 – 30% in reports from different hospitals in China where Covid-19 patients were getting treatment.

Should I visit the hospital?

In this present scenario, the best advice is to minimise the hospital visits for cancer patients and that tele-consultation can be a good alternative to avoid direct contact between patients and cancer care provider for the vast majority of routine appointments.

I am currently having cancer treatment. Should I continue my treatment or stop it as I have to go to hospital frequently for my treatment.

No cancer patients should halt, postpone or cancel their treatment as stated in guidelines from various cancer institutions/societies/hospitals. Patients who are in hospital must adopt the contact and droplet precautions, which means wearing a mask, covering outdoor clothes and extra sanitation steps. Hospital staff should be following the same guidelines. Discuss how to minimise visits with your healthcare provider or if any procedures can be done at home.

My cancer doctor has advised to me delay the surgery/chemotherapy/radiotherapy. Should I follow my doctor’s advice or get surgery/chemotherapy/radiotherapy done at another hospital?

There is a time limit on how long someone can delay cancer treatment without it impacting their recovery. Patients need to have a discussion with their cancer care provider about their unique circumstances. One size does not fit all. In some cases, patients may be reasonably advised to switch to other treatment modalities. If there is an issue related to transportation and stay, patients are encouraged to start the treatment at the nearest cancer centre where appropriate treatment is available rather than travel.

What precautions should cancer patients take amidst the coronavirus crisis?

Cancer patients are advised to practice social distancing, maintaining at least a two-metre distance from anyone who does not share their home. Regular handwashing with soap or alcohol-based hand rub is a necessity. If a member of your household develops Covid-19 symptoms such as cold, cough or fever they should self-isolate as much as is reasonably practical. Patients are advised to avoid crowded places and stay in well-ventilated rooms. Patients are advised not to shake hands and organise longer prescriptions for regular medicines well in advance of running out.

I have been receiving information on WhatsApp, Facebook and other sources about coronavirus prevention and treatment. How can I confirm what is real and what is fake?

A lot of incorrect information has been circulating leading to fear and uncertainty. There are trustworthy information sources available, being updated regularly as new evidence emerges and is evaluated by experts such as the World Health Organization (WHO) and the Indian Council of Medical Research (ICMR). Patients and their caregivers should use these and not rely on social media.

Also Read: Snapchat Brings ‘Lensathon’ to India

In conclusion, cancer patients and caregivers are facing difficult decisions to understand and weigh up the risk and benefits of continuing treatment in its current form in this crisis.

Although current guidelines support the continuation of treatment where possible, patients must talk to their individual cancer care provider to explore if their treatment should be reasonably modified in the ways outlined above to reduce their individual risks of exposure to Covid-19.

(Dr. Abhishek Shankar is Assistant Professor in Radiation Oncology at Lady Hardinge Medical College & SSK Hospital, Delhi. Dr. Deepak Saini is Project Officer at Cancer Control and Prevention Division of Indian Society of Clinical Oncology, Delhi. Views expressed are personal.)