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Native Cancer 101: Module 9: Chronic Conditions and Cancer
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  1. Native Cancer 101: Module 9: Chronic Conditions and Cancer Kathleen Ragan, BS, CHES Linda Burhansstipanov, MSPH, DrPH (Cherokee Nation of Oklahoma) Native American Cancer Initiatives, Incorporated Linda U. Krebs, PhD, RN, AOCN, FAAN, Oncology Consultation, Education and Advocacy Network (OCEAN) Kerri Lopez, BS, Tolowa Nation, Northwest Portland Area Indian Health Board Paulette Baukol, BS, Mayo Clinic, Rochester, MN Dana Kontras,RN, Mayo Clinic, Jacksonville, FL

  2. Audience Response System (the Keypads)(TP)

  3. Turning Point Keypads Lanyard that goes around your neck These are NOT calculators and need to be returned to the faculty at the end of the session please

  4. Audience Response System (ARS) – keypads This is how we vote on different items and issues Although the keypads are “anonymous” (we don’t know who uses which keypad); but we would like you to use the same one throughout the workshop You do not need to “point” the keypad (like a TV remote control) You will see a counter on the screen that shows how many people have “voted” on any item You press the number on the keypad that best describes your answer (use “0” for “10” on the keypad)

  5. Demographic items(TP, 6)

  6. What is your gender? • Male • Female • Don’t want to answer

  7. About How Old are You? 81 and older 65-80 50-64 41-49 31-40 21-30 13-20 Under 12 Don’t want to answer brthyr5

  8. What is Your Primary Race? American Indian / Alaska Native (AIAN) Pacific Islander Asian African-American Non-Hispanic white (Caucasian) Other Don’t know / Don’t want to answer

  9. Are you Hispanic, Latino or Chicano? • Yes • No • Don’t Know / Not sure • Don’t want to answer

  10. How Much Schooling have You Completed? Elementary (kindergarten to grade 6 / grade school) 7th , 8th , or 9th grade (middle school) 10, 11, or 12th grade (no degree) High school graduate / GED Technical school /apprentice training Some college (no degree) College AA degree College BA, BS degree Masters’ degree Doctorate or more

  11. Community leader Community member Student Teacher / Faculty Researcher / Scientists Healthcare provider (MD, RN, etc.) Outreach recruiter Cancer patient, survivor Other Don’t know / Don’t want to answer Which of the Following Bests Describes You? Role2

  12. 4 Pre-Session Knowledge Items

  13. Which is an example of an “acute” condition? • Cancer • Arthritis • Trauma (car accident) • Diabetes • Don’t know / Not sure

  14. What is the cause of most (~90%) of all cancers? • Family history • Smoking for 5 years • Being exposed to radiation • Lifestyle and physical environment • Don’t know / Not sure

  15. If a “breast” cancer cell spreads to the kidney, what is the new cancer called? • New primary cancer • Recurrent breast cancer • Breast cancer • Kidney cancer • Don’t know / Not sure

  16. Which is NOT part of the “triple triple” threat of diabetes among American Indians? • ~ 3 times the risk of cancer • ~ 3 times the risk of heart disease and stroke • ~3 times the risk of kidney failure • ~3 times the risk of death • Don’t know / Not sure

  17. Cancer 101Basics and Background

  18. QUESTION: Why do you think we are taking time to talk specifically about cancer? • Because cancer is now the 2nd leading cause of death for AIs over 45 years old. • Cancer is continuing to increase with AIANs even through the disease is becoming less common among whites. • The primary reason for our continued increase is due to our daily behaviors • What we eat, drink and smoke • How we get physical activity Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  19. AIAN Patterns of Cancer • Different Types of Cancer by Geographic Region and Tribal Nation; such as: • Prostate cancer among northern plains comparable to African Americans and Whites • More stomach, kidney and gallbladder among Southwestern tribal nations • More CRC, breast and lung among AK, northern plains and southern plains Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  20. Examples of Different Patterns of Cancer Sites and Access • More cancers among AIANs who live in Alaska, Northern Plains and Southern Plains • BUT, even in Southwest, selected types of cancer continuing to increase and there are significantly more AIs living in SW than in other regions of US • Burden of disease is extreme • Average interval from biopsy (diagnosis) to initiation of cancer care is 6 months for AIAN women and 9 months for AIAN males Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  21. QUESTION: What is cancer? • A group of over 100 diseases in which abnormal cells • Divide without control • Don’t die when they should (Apoptosis) • Cancer: • Is primarily a disease of older people • Occasionally occurs in young people (e.g., childhood leukemia, cervical, testicular) • But, the majority of cancers appear in people who are older (over 45) Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  22. What is cancer? (continued) • Cancers are identified by the place they originate within the body. For example: • Breast • Cervix • Colon • Prostate • Pancreas • Stomach • Brain • Bladder Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  23. Normal Cells Excerpt from the Kansas State University “coloring book” Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  24. Cancer Cells Excerpt from the Kansas State University “coloring book” Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  25. Cancer (CAN-sir) • Cancer cells have the ability to spread from one part of the body to another part of the body • When cancer cells go to another body part, they can begin to grow without control in the new location • But a breast cancer cell in the liver is still “breast cancer” (primary site) Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  26. Metastasis (ma-TAS-sta-sis) • This means that cancer cells have spread from one body part to another • The cancer cells spread from the "primary site" to other organs by traveling through the blood vessels or lymph vessels QUESTION:What is the lymphatic system? Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  27. Ruby Wells Cherokee Nation of OK Dx. breast 2001 Diagnosis (die-egg-NOH-sis) • The process and result of determining if the symptoms or evidence of cancer is really cancer • QUESTION: What type of information does the provider need to make a diagnosis? I had a mammogram 6 months prior to finding a lump and thought I was in the clear. … I give myself a self-breast exam and I located a knot. I went to the doctor and they proceeded with tests. …. they thought it was a cyst, but I still never thought it could be cancer…when the surgery was over the doctor told me it had grown to 9 cm. Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  28. suspicious Diagnosis (die-egg-NOH-sis) • The Provider… • Asks about symptoms • Asks about medical history • Performs a physical exam • Orders tests and imaging procedures • Performsbiopsy--to determine whether cancer cells are present Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  29. Biopsy (bye-OP-see) • The physician takes a piece of tissue (a group of cells) from the growth or cyst • Sometimes these cells are cut, and other times they are "sucked" out with a needle (fine needle aspiration) • These cells are examined by a "pathologist” • A biopsy is a sure way to make a diagnosis Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  30. QUESTION: What is a Tumor (TOO-mer) • Normally, cells grow and divide to produce more cells only when the body needs them • This keeps the body healthy • Sometimes cells keep dividing when new cells are not needed • Or the cells do not know how to die (apoptosis) • These extra cells form a mass of tissue, called a growth or tumor Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  31. Tumor (TOO-mer) • This is a growth or mass formed by excess cells • A "benign" tumor is not cancer and it does not “become” cancer. It just stays “benign” • 8 out of 10 tumors are not cancer (they are "benign") • A "malignant" tumor is cancer and can spread to other parts of the body Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  32. Benign tumors: not cancer can often be removed in most cases do not come back do not spread to other parts of the body rarely a threat to life Malignant Tumors are cancer cells abnormal cells divide without control or order enlarge “mass” metastasize Two types of tumors: Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  33. Cancer Develops Over Time • It is a result of a complex mix of factors related to: • Lifestyle (daily behaviors) • Environment • Heredity (~5-10%) • These are called risk factors • See Breast Risk / Health Protection Shield on NACR web site http://www.NatAmCancer.org Cancer 100 “Overview of Cancer” (Burhansstipanov) Native Navigators and the Cancer Continuum (NNACC) [NCMHD R24MD002811]

  34. Examples of “Risk Factors” • Foods and drinks we consume • Tobacco use • Lack of physical activity • Exposure to environmental contaminants • Spiritual distress • Social distress (dysfunctional families, neighbors or work settings) “Once an Elder asked me what I smoked. So, I took out a cigarette. He measured it and said, ‘It’s such a small thing that you let control you.’ I quit smoking that day.” - Edward McCarty, Cherokee Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  35. Behaviors that help “protect” the shield of health against cancer include: • Daily physical activity • Healthy, low fat diet • high fruits and vegetables • Maintain recommended body weight • Limited to no alcohol • No store-bought tobacco use • limit tobacco to ceremonial use only • Follow cancer screening guidelines • Knowing your personal risk factors • ex. history of polyps, exposure to cigarette smoke, or your family’s history

  36. “Cancer 101” Bear (True) vs. Coyote Trickster (False) 5 items Native American Cancer Research 303-838-9359 Fact vs. Fallacy

  37. Ceremonial tobacco use is just as dangerous as habitual cigarette smoking. Coyote / False The lifestyle our ancestors lived put them more at risk for getting cancer. Coyote / False If a “breast” cancer cell spreads to the kidney, the new cancer is still referred to as “breast cancer” • Bear of Truth Native American Cancer Research 303-838-9359 Fact vs. Fallacy

  38. About 30% of all cancer deaths are directly related to habitual smoking. Bear / True Cigarette smoking is the single most preventable cause of cancer in the US. About 25% (1/4) of all cancers are inherited from your parents. Coyote / False – Answer: 5-10% Native American Cancer Research 303-838-9359 Fact vs. Fallacy

  39. Introduction to Chronic Conditions

  40. I want my grandchildren to live long, healthy lives like our ancestors. Today we forget how to act in ways that honor those who came before us. Our ancestors didn’t have these diseases. Anonymous AI, 2011 QUESTION: Why is Understanding Chronic Conditions Important to AIANs? • Leading causes of death among adult AIANs • Leading causes of conditions that interfere with our daily quality of life Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  41. Objective 1: Distinguish between a health condition that is acute versus one that is chronic. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  42. Definitions • Acute (uh-KYOOT) condition:   • A condition or disease that begins and worsens quickly. • Usually lasts less than a year. • If managed well will resolve (or improve and become chronic). • What would be an example of an acute illness? Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  43. Examples of Common Acute Conditions Cold or flu Infection Trauma (car accident, broken leg) Allergic reactions Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  44. Definitions • Chronic (KRAH-nik) condition: • A condition or disease that persists or progresses over a long period of time. • May have previously been acute • Can be managed, but usually does not go away completely • What would be an example of a chronic condition? Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  45. Examples of Common Chronic Conditions Heart Disease Cancer Diabetes High blood pressure (hypertension) Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  46. Characteristics of Chronic Conditions • Lasts 1 year or longer • Requires ongoing medical care • Limits daily activities • Often interferes with one’s quality of life “We tell each other what our blood sugar readings are. And, we remind each other to take our medicine.” – Gwen Barnett Muscogee (Creek) Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  47. Objective 2 Identify at least 3 common chronic conditions in AIAN communities.

  48. Common Chronic Conditions • The most common, costly, and preventable chronic conditions in the U.S. are: • Heart disease • Cancer • Diabetes • Arthritis • Obesity • This is true for AIANs too Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  49. Examples of Other Chronic Conditions • Stroke • Substance abuse and addiction disorders • Mental illness • Dementia • Cognitive impairment disorders • Developmental disabilities NOTE:Heart disease, cancer and stroke account for ½ of all deaths each year. Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605] ; Northwest Portland Area Indian Health Board; Native American Cancer Initiatives, Incorporated (NACI)

  50. Burhansstipanov, Native American Cancer Initiatives, Inc. (NACI) subcontract to Mayo Clinic’s “Spirit of EAGLES Community Network Programs 2” [P.I. Kaur; U54CA153605]; Northwest Portland Area Indian Health Board Indian Health Service, Regional Differences in Indian Health, 2002-2003. Data from 1999-2001