Health Topics – Johns Hopkins Medicine Podcasts

Anchor lead: Treatment with radiation for many cancers is easier than ever, Elizabeth Tracey reports

When some women with breast cancer had surgery, a single dose of radiation in the OR proved as effective as a more lengthy course after the procedure, a recent study found. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says improvements to radiation therapy are key.

Nelson: The ability to very selectively target where the radiation goes is beginning to impact on how the dose is given. Now that the aiming can be much more precise that safety margin is substantial now, and it’s enabled the radiation oncologist to begin thinking about can you deliver radiation at a fraction that’s more effective in treating the cancer perhaps, and actually may be even more convenient, and I think that’s what you see here for breast cancer.  :27

Nelson says use of radiation therapy for many cancers is transitioning to much shorter courses of treatment, and these are not only more convenient for patients but also result in outcomes that are at least as good, and sometimes better than more lengthy treatment. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Can a mailed in screening test for colon cancer work? Elizabeth Tracey reports

Sending people colon cancer screening kits where they can simply send in a fecal sample they collect themselves at home is cost effective and acceptable, a new study finds. The test relies on the presence of either blood in the stool or cancer DNA, and may also increase the number of people who are willing to be screened. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, comments.

Nelson: I think what we’ve learned is if you have this kind of a test in a serial manner you get it year after year after year, if you have three or more consecutive tests for blood or for cancer DNA, you’re probably in pretty good shape. I think there’s going to be more work on exactly which test to use when and the most cost effective and effective way, but the bottom line at this point is we’re talking about two approaches that have a great deal of effectiveness.   :27

Nelson says if the screening test identifies a problem, colonoscopy to further evaluate and possibly treat is indicated. He notes that colon cancer rates among those younger than 50 have been increasing, and urges people to ask their primary care physician about screening. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Among those with cancer, Covid infection affects those with leukemia most, Elizabeth Tracey reports

If you have leukemia, you may be at high risk for severe Covid-19 disease, a recent study found. Yet William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says delaying your treatment is really not an option.

Nelson: The problem with leukemias is that they are very often highly aggressive diseases that have to be met with significant treatment quickly. There’s very little in the way to get around that. As agents that can treat the viral infection improve and the outcomes with leukemia and in the setting of this infection will likely improve as well. But this business of delaying some of these approaches, there is a significant worry that this will have longer term consequences.  :26

Nelson says that with regard to Covid-19 transmission, no studies have shown that people in hospitals and many other healthcare facilities are at greater risk of contracting the infection, and in point of fact, may be at reduced risk because of intensive infection control practices, so he urges people not to put off cancer treatment for this reason. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A new targeted agent in certain cancers proves very beneficial, Elizabeth Tracey reports

People with a mutation in their cancers abbreviated RET may benefit from an agent called selpercatinib, two studies in the New England Journal of Medicine report. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: They reported on two different studies. One of them for a rare-ish kind of cancer, it’s called a medullary thyroid cancer it very often arises as part of an inherited syndrome, where people get more than one cancer of the endocrine kind of organs, in that one the responses were stunning. The other trial that was reported there are defects in these RET genes, acquired defects, in many different cancers although its not a very common one, one group of them were so-called non-small cell lung cancers, and in that case the drug was also incredibly effective for those people.   :32

Nelson says the number of drugs that target specific mutations is increasing, and that’s good news for people with cancers of all types and argues for genetic analysis of tumors.  At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: The Academy of Medicine updates its view of the nursing profession, Elizabeth Tracey reports

The National Academy of Medicine has updated its report on the state of nursing as a profession. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says the original report is the most downloaded report ever by the academy, and notes that this version once again advocates for a more educated nursing workforce.

Davidson: Because we know that nurses with baccalaureate education in working in institutions there is less mortality and better patient outcomes. In essence we’ve seen the other side of the equation in the Covid-19 pandemic. Where in residential age care facilities where there’s only one registered nurse on duty for eight hours a day that we have had the ravages of Covid-19. And that has been a phenomenon across the world.   :28

Davidson says more education enables nurses to implement things like infectious disease transmission prevention strategies in their workplace, and that helps patients as well as clinicians stay safe. At Johns Hopkins, I’m Elizabeth Tracey. 

Anchor lead: Should you choose a hospital with a hospital at home program? Elizabeth Tracey reports

Hospital at home, where hospital level care is delivered to people in their own home, is burgeoning nationally. Bruce Leff, a gerontologist at Johns Hopkins and hospital at home expert, says the data are compelling.

Leff: In terms of patient and caregiver experience lots of data from studies we’ve done, randomized controlled trials done around the world, probably one of the best studies models out there consistently better patient and caregiver experience at home compared with hospital. Covid has changed a lot in healthcare delivery, so hospital A has it and hospital B doesn’t, and you have something that hospital A has hospital at home, and could probably put you in hospital at home for, and you have a favorable attitude towards getting that care at home, you should go to hospital A that has it.  :32

Leff predicts that as people become more aware of this option, more will choose hospital at home in lieu of admission to a bricks and mortar hospital. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Hospital level care at home is getting a boost across the country, Elizabeth Tracey reports

Let’s say you needed to be hospitalized but you were given the option to receive your care at home rather than a hospital. So-called ‘hospital at home’ programs are growing by leaps and bounds nationally. Bruce Leff, a gerontologist and expert in this area at Johns Hopkins, explains.

Leff: A lot of the patients that come into hospital at home are patients that are getting diverted from the emergency room and are going directly home. Covid created a strong incentive for hospital at home programs to start to transfer people out of the hospital early. They’re still going to need hospital level care so the hospital has to be a partner in this. The hospital really, truly has to not want to fill a bed, either because we’re in a capacity situation, and don’t want to invest more to build more beds because it costs about, depending on where you live in the United States, two to five million dollars to capitalize a hospital bed.  :33

Leff says as Medicare examines reimbursement he expects more and more such programs to open. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: What do ALS and a common form of dementia have in common? Elizabeth Tracey reports

ALS and a common form of dementia known as ‘frontotemporal’ share a defect, research by Jeffrey Rothstein, an ALS expert at Johns Hopkins, and colleagues has shown. It’s a place inside cells where materials are transported into the cell’s center, or nucleus. They do so via an opening called a pore, Rothstein explains.

Rothstein: What we learned is that of these 30 different proteins that make up the pore we literally analyzed almost every single one of them and we said well which one is being screwed up? We learned that eight of them seemed to drop out of the pore, the pore is still there but they’re missing elements so think of a Lego complex with a hole here, a hole there. And that affects transport through it. So why are they missing? Turns out what we learn is that one of them is like the domino, you take that one away and the pore disassembles. And conversely if you put that one back in, it reassembles, which no one had done before.  :31

Rothstein says the proteins that make up the pore usually remain in the cell for years, so they are also of interest in aging. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: Should people with ALS ask about a new drug combination? Elizabeth Tracey reports

When a disease is always fatal, the bar for attempting new therapies is lower than that for more chronic conditions, and such is the case for ALS. A new trial has shown that the rate of decline in people with ALS using a two drug combination can be slowed. Jeffrey Rothstein, an ALS expert at Johns Hopkins, is all in.

Rothstein: There’s no question I would put patients on this drug. Absolutely. There is nothing negative I saw in terms of the side effect profile. There’s no reason not to. What gets complicated is one, they should be on this drug but they should be on previous drugs because for example riluzole, which is the first drug we studied back in 95, that drug has been repeatedly shown to be positive. Tiny effect. Way back then we did survival not this functional rating scale, so if patients say should I take this instead of riluzole the answer should be no, take both of them. Just like in cancer begin to combine these drugs.  :30

Rothstein says for now, the company is continuing to provide the drug combination to people who participated in the trial, and additional studies are ongoing. At Johns Hopkins, I’m Elizabeth Tracey.

Anchor lead: A drug combination slows progression of ALS, Elizabeth Tracey reports

A two drug combination tested in people with ALS, also called Lou Gehrig’s disease, has slowed their rate of decline compared with those who did not receive the drug, a study in the New England Journal of Medicine reports. Jeffrey Rothstein, an ALS expert at Johns Hopkins, comments.

Rothstein: The trial was successful. It’s based on the use of a reportable scale that rates how people are doing. The FDA often likes not just a biochemical marker they often want how do people function, and this is a functional rating scale. Previously in ALS especially in the 90s trials were based on survival with ALS being a fatal disease, but those are long trials, and in the end they don’t tell the patient have you done better or not? Have you slowed your disease down? So this trial used the ALSFRS and surprisingly, and excitingly found that it could slow down the disease. That’s very good.  :32

Rothstein says he’s heartened by the findings and is still on the hunt for even more efficacious drugs and possibly a cure. At Johns Hopkins, I’m Elizabeth Tracey.