Category: Academic

Categories
Academic Care and Recovery Patient Experiences

Emotion Work During Colorectal Cancer Treatments

read this paper
  • Silence -> seen as ‘not getting upset in front of each other’ -> preserves relationships in CRC oncology clinic
    • Silence as relational form of moral work that preserves others’ well-being
  • Studies show a lot of emotional distress among patients with and beyond CRC
    • 1/5 people affected by CRC has a post-cancer diagnosis of depression
  • Emotion work in surface acting vs. deep acting
    • Embodied emotional experiences and the performative role of emotions
  • The study follows participants through treatment pathway until there was no evidence of disease in their bodies or referred to hospices
    • Some focus on pragmatism/practicality rather than emotions
    • Many manage expressions of emotions continuously in front of others
  • Nurses are cognizant of emotional texture of cancer treatments

“We just try to open it up and give them an opportunity to talk about [what they are feeling]. It is often letting them be cross, or to be angry, or to be frustrated, because all are logical and normal emotions to have during cancer treatments”

A Filipina senior chemotherapy nurse.
  • Staff and health professionals also have to do some emotional labor -> keeping boundaries and maintaining balance between distance and closeness to patients while keeping their emotional peace
    • Nurses are expected to connect with patients to do emotional labor in contrast to physicians, many of whom decided to pursue a ‘happier’ field
  • Many patients in the CRC support group disclosed the need to do emotion work as to not ‘burden others’ in fear of damaging relationships with others
    • The relatives also experience this fear of being a burden
  • Existing norms surrounding emotional management of relatives -> to not be upset because expressing it would impact their loved ones

Silence: reconsidered as relational practice of moral work, not maladaptive coping behavior

  • Reflections/questions:
    • Silence as moral relational work connects to
Categories
Academic Culture Health Disparities Race and Ethnicity Socioeconomic

Colorectal Cancer in the United States and a Review of Its Heterogeneity Among Asian American Subgroups

READ THE PAPER here

The data aggregation problem and health disparities

  • Third most common cancer in the U.S
  • Asian American subgroups vary widely -> problem of data registries and research aggregating them into one group
    • Discussed by Wailoo’s book How Cancer Crossed the Color Line -> historically race and ethnicity has been defined arbitrarily by the dominant group (white) -> all other groups are aggregated in terms because they are ‘other’ to the white group, therefore being blind to each group’s own internal diversity
  • Heterogeneity in incidence -> related to country of origin, diet, screening, and lifestyle choices
    • Japanese Americans have the highest incidence, and all incidence are increasing among other groups except for Korean Americans
  • CRC incidence is highest among non-Hispanic black populations, lowest among Asians/Pacific Islanders
  • SEER program only started collecting data on Hispanic Americans and Asians/Pacific Islanders since 1990
    • What does this say about missing data and inability to create historical trends?
  • Gap between mortality rates among Black and White Americans have increased over the last 3 decades
    • Disparities exist between races but also within
  • Screening prevalence lower among ages younger than 65, non-White, less educated, without insurance, recent immigrants, Hispanic people, and those with language barriers
    • Asians are less likely to screen than non-Hispanic whites
A study finding that data aggregation of Asian American subgroups conceal health risks. Article found from here: https://dailybruin.com/2020/03/06/study-shows-aggregated-data-conceals-asian-american-subgroup-health-problems

Once again, the ‘Western’ diet as a risk factor?

  • Dietary chemoprevention -> cultural aspects of diet and lifestyle in Asian Americans in cancer prevention
    • unpolished Thai rice and reduced CRC risk because of high phytochemical contents
    • Sea cucumbers, abalones are both Asian delicacies are shown to have anti-tumor properties
  • Risk factor: Risk increases among Asian Americans as their diet becomes ‘Westernized’
    • Asians with longer immigration history parallel cancer risk patterns of U.S natives
    • Asians with more recent immigration history parallel cancer risk patterns of home countries
  • Reflections/questions
    • Emphasizes the need for more complete data (Flaws in databases and data collection methods: Primarily in English, did not capture populations with low English proficiency, vary in time frame/sample size/geography, SEER data is more recent on Asians)
    • Perhaps more data on cultural and behavioral factors that influence prevention and screening?
    • Potential: culturally tailored screening for subgroups, policy revisions and advocacy for immigrants dealing with insurance
Categories
Academic Communications and public perception Illness in Media Literature

Persuasive Effects of Linguistic Agency Assignments and Point of View in Narrative Health Messages About Colon Cancer

READ THE PAPER HERe
  • Communications surrounding, or about colon cancer, and how linguistic agency and point of view impacts narrative force.
  • Agentic language impacts people’s perception of the severity of health threats
    • Perceived susceptibility to colon cancer is highest when agency is assigned to people, not cancer.
    • Ex: ‘I developed cancer’ vs. ‘Cancer developed in me’
  • Use of temporal agency language in health messages -> assigning temporal agency to death rather than dying person -> greater fear
  • Possible: messages in narrative forms can transport readers to narrative world regardless of POV
    • Super important as it plays into cancer patients and survivors’ storytelling- it doesn’t all have to be in first person POV as long as the narrative form is there
  • Reflections/questions:
    • Important implications of health communication strategy especially in public health campaigns, social media marketing by corporations, and patient-doctor communications and messaging.
    • Affirms narrative power of storytelling by cancer patients and survivors -> to the level of sentence + word choice
    • How can this study and further research address Jain’s criticism of health messaging and language surrounding survivorship in media and popular culture?
Categories
Academic Care and Recovery Personhood Treatment

“I Didn’t Feel Like I Was a Person Anymore”: Realigning Full Adult Personhood after Ostomy Surgery

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  • Long term CRC survivors need temporary or permanent ostomies -> requiring the use of ostomy equipments and stoma bags
    • Parts of their intestines are removed and the remaining part is attached to an opening in abdoment where feces are discharged
    • More documented treatment-related challenges among survivors
  • Ostomies result in complex emotional, social and physical concerns
    • Adjustment to managing uncontrollable bowel movements is compared to second period of toilet training -> compromises adulthood
    • Erosion of adulthood due to physical disability
    • Relationships and sexual concerns
  • Surviving CRC with ostomy disrupts identity and adulthood -> loss of embodied self control
    • ostomy interferes with social roles and ideals
    • Western culture involves self responsibility
  • Narratives enables survivors to create continuity that reconnects them to social and cultural worlds
    • Hence why literature and art produced by cancer patients and survivors are so important
    • Cancer is very isolating and creating narrative is a way to reconnect

I didn’t feel like I was a person any more. I felt more like a non-person, you know, because you’ve got these things on you and then you’ve got this attachment, and not knowing how to care for this. We’d go places and we’d have to come home because I’d like overflow. … I guess that’s all in not knowing how to care for it.

A 62 year old divorced, ethnically mixed Filipina woman, discussing her difficulties and how they relate to personhood degradation.
An example ostomy bag
  • The women interviewed had common themes of technical difficulties, trial and error and the steep learning curve required to get used to living with an ostomy bag
  • Different techniques for regulating bodily functions and gaining control to realign with the ‘normal’ world to fit in and feel ‘normal’
    • Irrigation
    • Regulating timing of foods and dietary modifications
  • Reflections
    • Incorporate research similar to this study into nursing and other spheres of care -> rehabilitation efforts and follow-up efforts with health professionals to support these individuals
    • More interventions could help survivors living with impairments
    • Representations and discussions of ostomy procedures and bag can help make the process visible and negate stigma, such as this photoshoot

Categories
Academic Prevention Young People, Screening, Prevention, and Diagnosis

Western Style: A Recurring Theme?

read the paper

What does it mean when the risk of developing colon cancer is associated with a ‘Western’ diet and lifestyle?

  • ‘Western’ diet -> defined as high in red meats, fatty products, refined grains and desserts
    • The study found that those who closely follow this diet were more than 3x likely to relapse than those whose diets were at the opposite end of the scale
  • Authors stress that this study is observational and does not provide conclusive proof

“… people treated for locally advanced colon cancer can actively improve their odds of survival by their dietary choices”

Jeffrey Meyerhardt
When Googling ‘Western diet’, this is what I found on the image tab.

“Maybe the message is it’s never too late to change your diet” 

Andrejs Avots- Avotins
  • Reflections/questions:
    • What does this mean in context of socioeconomic status and other factors? Is it always feasible to change diet and improve outcomes/avoid cancer risks? How does diet interact with other factors?
    • Emphasis on individual lifestyle choices rather than broader contexts
      • Would this place blame on individuals rather than systems? (specifically, blaming individuals in the study who ascribe to the Western diets)
    • Taken out of context, this study could’ve been shown to others with the basis that diet is a very big factor that causes cancer rather than is associated with it (and still needs more research)
      • Boyer’s reflections in The Undying: The media, research, the Internet, and seemingly everything is telling cancer patients to try different things and to attribute survival on select few factors dependent on choice rather than to look at cancer more broadly at a societal level
Categories
Academic Health Disparities Prevention Young People, Screening, Prevention, and Diagnosis

Epidemiology of Colorectal Cancer: Incidence, Mortality, Survival, and Risk Factors

read this paper
  • Colorectal cancer (or CRC) is the third most deadly & fourth most commonly diagnosed cancer in the world
  • CRC incidence rising worldwide -> in developing countries with more ‘Western’ diets
    • In countries undergoing many developments -> higher incidences with increasing human development index (HDI)
      • Does this take into account completeness and effectiveness of cancer registries/databases, screening, and behaviors such as reporting?
Map with age-standardized incidences in 2018 across both sexes and ages.
  • Risk factors/behaviors
    • Obesity
    • Diabetes
    • Family history/hereditary disorders
    • Inflammatory bowel diseases
      • Ulcerative colitis + Crohn’s disease -> affect people with lower income and educational status the worst
    • Sedentary lifestyle
    • Red/processed meat consumption
    • Alcohol, tobacco
  • Reducing CRC mortality -> early detection screenings, treatment options, genetic testing, family history documentation
  • More incidence among men than women
    • (Why?)

  • Adults aged 20-49 (out of usual age ranges for screening) -> growing incidence

  • Dispel the myth that cancer is an ‘old people’ disease
    • Is this age-related incidence rising only happening to CRC or to other cancers as well?How are we documenting this?

    • Survival

    • Decreases in mortality could be due to early detection screenings and efforts (removal of polyps, colonoscopies, blood testing)
    • Five year survival rate depending on stages
      • Stage 1: 92%
      • Stage IIA: 87%, stage IIB: 65%
      • Stage IIIA: 90%, stage IIIB: 72%, stage IIIC: 53%
      • Stage IV (metastatic): 12%
        • Why are rates for stage IIIA and IIIB higher than the stage II?
    • Survival varies depending on race and status
    • Up to 30% of CRC patients have family history of neoplasm
      • Lynch syndrome and other hereditary risk factors -> genetic diagnosis are too costly -> family history remains in data-taking -> will this be effective in populations w/o access to care and consistent history-taking? (i.e rural populations lacking specialists/ PCP)

    More on Race

    -> Observation: racial identification/categorization in the above graph is unclear and confusing. This resonates with How Cancer Crossed the Color Line and its analysis of inconsistent demographic and racial categories in databases which influence statistics. In what way do numbers and statistics of cancer influence ontology? Historically race categorization has been fluid depending on the social views accepted at the time -> what are some other ways to report demographical data better?

    • African Americans and Native Americans have higher incidences of CRC and lower survival among all CRC stages

    Prevention

    • Screenings
    • Behavioral modifications
      • Diet: calcium, vitamin D, low-fat dairy, fibre, antioxidants -> reductions in CRC risk
      • Use certain medications (NSAIDSs) have protective effects against CRC
    • Reflections/questions:
      • Necessity of numbers in epidemiological studies -> yet, are cancer patients suffering ‘violence by abstraction’? (Jain, Malignant)
      • The Mortality Effect: immortal logic of science + data vs. individual mortality
        • Statistical logic and its dangers
        • Prognostic stats are at once transparent and confusing… it means everything and nothing at once, especially regarding survival
      • Ontology of cancer through numbers and trends: We derive our treatment and knowledge off of data, but how much is this data hidden/skewed, and how does that affect the way we understand and perceive cancer?
        • Fluid and ever-changing categorization of race as an example
    Categories
    Academic Biology and Research Immunotherapy Treatment

    Immunotherapy and Colorectal cancer: Where We are and What’s ahead

    Resource from here

    Example of a T cell
    • Immunotherapy uses immune checkpoint inhibitors, allow immune cells like T cells to target and attack cancerous cells
      • Pembrolizumab + nivolumab
    • Microsatellite instability-high colorectal cancer (MSI cancer)
      • Subtype of colorectal cancer
      • “deficient mismatch repair” (dMMR)
      • Many genetic mutations
      • More likely to be detected by immune system than other cancer cell subtypes
    • 3% are MSI/dMMR, most patients do not have this subtype
      • Require novel ways to overcome lack of immune response
    • Potential outcomes/legacy
      • Molecular subtype classification for more targeted, effective therapies
      • Tumor microenvironment -> critical
      • Other ways to trigger response in immune system -> oncolytic viruses, vaccines, cellular therapies (CAR T cell + CAR NK cell?)
    • Significance
      • Translational research & new avenues of therapies
      • Potential policy or ethical challenges?
        • Ex: genetic manipulations and testing, further funding for vaccines approach, conflicts of interest between different drug manufacturers
      • Is immunotherapy less ‘harsh’?
    Categories
    Academic Biology and Research Immunotherapy Treatment

    Beating Colorectal Cancer’s Immunotherapy Resistance

    Resource from here

    • Immune checkpoint inhibitors-> usually unleash immune response against cancer and has been used in cancer treatments (immunotherapy)
    • Many colorectal cancer does not respond to immunotherapy
    • Liver metastases are very resistant to immune checkpoint blockade
      • Lack dendritic cells -> can’t activate cytotoxic T lymphocytes -> can’t activate killing of cancer cells
    • Potential outcomes and legacy
      • Benefits of orthotopic tumor models
      • More research should be done on dendritic cells’ immune functions
        • Unless there already are some?
      • New therapies for resistant colorectal cancer -> clinical trial using immune checkpoint inhibitor + dendritic growth factor Flt3L

    When the team augmented the number of dendritic cells within liver metastases…. the treatment led to an increase in cytotoxic T lymphocytes within the tumors and caused the tumors to become sensitive to immune checkpoint inhibitors.

    https://news.harvard.edu/gazette/story/2021/10/new-way-to-overcome-colorectal-cancers-resistance-to-immune-response/
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