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November 12, 2009 Volume VI, No. 26

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Excess body fat and high cholesterol are risk factors for certain types of cancers, as explained in this week's DM Update.

Learn when a bedside visit is warranted for the frail elderly, and how an osteoporosis prevention plan can help reduce the national rate of hip fractures.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Excess Body Fat and Cancers
  2. Low Cholesterol and Prostate Cancer Risk
  3. Healthcare Reform's Losers and Winners
  4. Maintenance Visits for the Frail Elderly
  5. Healthcare Trends & Studies
  6. Osteoporosis Prevention Plan
  7. Reducing Hospital Readmissions

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Excess Body Fat Alone Causes Over 100,000 Cancers in U.S. Each Year

Approximately 100,500 cancers occurring in the U.S. every year can be attributed to excess body fat, according to estimates released by the American Institute for Cancer Research (AICR). The figure underscores the central role that overweight and obesity are now understood to play both in the development of cancer and in cancer survivorship, said researchers.

According to AICR, the estimated number of cancers that are linked to excess body fat include:

  • 49 percent of endometrial cancers = 20,700 cases/year
  • 35 percent of esophageal cancers = 5,800 cases/year
  • 28 percent of pancreatic cancers = 11,900 cases/year
  • 24 percent of kidney cancers = 13, 900 cases/year
  • 21 percent of gallbladder cancers = 2,000 cases/year
  • 17 percent of breast cancers = 33,000 cases/year
  • 9 percent of colorectal cancers = 13,200 cases/year
One researcher highlighted emerging evidence of the link between excess body fat and cancer. Some of the strongest evidence suggests that excess body fat increases the body's level of sex steroids and other hormones that are linked to cancer growth. For example, fat tissue produces estrogen; studies have shown that estrogen promotes cell proliferation in breast tumors that contain receptors for the hormone, the so-called ER positive tumors.

Another researcher presented evidence that overweight and obesity continue to play a negative role after cancer has been successfully treated. The researcher stressed, however, that there are two ways of looking at data linking higher Body Mass Index (BMI) to poorer survival, and she prefers the one that encourages survivors to get active. "It's true that higher BMI is associated with poorer outcomes. Now we need to ask why this is the case," she said. "An increasing number of studies suggest that regular physical activity improves cancer survival, even among survivors who are overweight or obese." The researcher reviewed data showing that although obesity increases risk of death among cancer survivors, some factors that influence obesity, such as physical activity, have also been shown to have an impact on survival that is independent of BMI. A growing number of publications, for example, have reported that increasing physical activity after diagnosis, especially among those who were inactive before they were diagnosed, is associated with an improvement in survival.

To learn more about this research, please visit:

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Low Cholesterol May Shrink Risk for High-Grade Prostate Cancer

Men with lower cholesterol are less likely than those with higher levels to develop high-grade prostate cancer, an aggressive form of the disease with a poorer prognosis, according to the results of a Johns Hopkins collaborative study. In this prospective study, epidemiologists say they now have evidence that having lower levels of heart-clogging fat may cut a man's risk of this form of cancer by nearly 60 percent. For the study, researchers analyzed data from 5,586 men aged 55 and older enrolled in the Prostate Cancer Prevention Trial from 1993 to 1996. Some 1,251 men were diagnosed with prostate cancer during the study period.

Men with cholesterol levels lower than 200 mg/dL had a 59 percent lower risk of developing high-grade prostate cancers, which tend to grow and spread rapidly. High-grade cancers are identified by a pathological ranking called the Gleason score. Scores at the highest end of the scale, between eight and 10, indicate cancers considered the most worrisome to pathologists who examine samples of the diseased prostate under the microscope. Cholesterol levels had no significant effect on the entire spectrum of prostate cancer incidence, only on those that were high-grade.

Elizabeth Platz, Sc.D., M.P.H., associate professor at the Johns Hopkins Bloomberg School of Public Health and co-director of the cancer prevention and control program at the Johns Hopkins Kimmel Cancer Center, cautions that, while the group took into account factors that could bias the results, such as smoking history, weight, family history of prostate cancer and dietary cholesterol, other things could have affected their results. One example is whether men in the study were taking cholesterol-lowering drugs at the time of the blood collections, a data point the researchers expect to analyze soon.

To learn more about this research, please visit:

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Predicting Healthcare Reform's Biggest Losers and Winners

William DeMarco Jim Knutson
William DeMarco Jim Knutson
A forecast of 2010 healthcare trends would not be complete without some prognostication on the fate of healthcare reform. The Healthcare Intelligence Network asked William DeMarco, president and CEO of DeMarco and Associates, and Jim Knutson, risk manager and human resources director, Aircraft Gear Corporation, to predict the winners and losers from the controversial legislation — as well as the delivery date of the much-debated package.

To listen to this complimentary HIN podcast, please visit:

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Frequency of Maintenance Visits for the Frail Elderly

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Gregg O. Lehman, Ph.D., president and chief executive officer of Health Fitness Corporation and former president and CEO of INSPIRIS, Inc., where he is a member of its board of directors.

Question: If risk level determines the frequency of maintenance visits for the frail elderly, what are some criteria used to do that stratification?

Response: Look at historical claims going back about one year. This information is used to prioritize the order of the clinical assessments. The stage-two stratification is the bedside clinical assessment. You work with the patient’s chart for their clinical history, including chronic conditions, medication usage, recent hospital utilization and advance directives from family members. Next, look at scored assessment tools that determine fall risk, skin integrity and the Geriatric Depression Scale, and conduct a mini mental status exam. Those steps determine the acuity level, which will determine how many visits per month the patient needs.

It’s important to note, however, that the attending nurse practitioner (NP) can override this. Often there’s a lot of volatility in working with the frail elderly. A status can change weekly or even daily. If the patient suddenly experiences an acute situation — for example, if they experience skin reddening, which is a precursor to skin ulcers for a diabetic patient — they would increase the number of visits. Although the claims guidelines are important, the NP’s training and expertise is equally important.

For more information on reducing readmission risk for the elderly, please visit:

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Changing Lives with Lifestyle Management — Taking the Pulse of Population Health Programs

Numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:

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Nation’s Hip Fracture Rate Could Drop with Aggressive Osteoporosis Prevention Plan

Aggressively managing patients at risk for osteoporosis could reduce the hip fracture rate in the United States by 25 percent, according to a Kaiser Permanente study published in the November issue of The Journal of Bone & Joint Surgery. The first step must be a more active role by orthopedic surgeons in osteoporosis disease management, researchers say. This study, the largest to look at osteoporosis management in men and women over 50 years old, followed 650,000 men and women in Kaiser Permanente’s osteoporosis management program and found hip fractures dropped by 38 percent, preventing 970 hip fractures in 2007.

The prospective observational study examined the effectiveness of the Kaiser Permanente Southern California’s Healthy Bones Program from 2002 to 2007. Kaiser Permanente HealthConnect®, the world’s largest civilian electronic health record (EHR) database, was used to collect data on patients that included anti-osteoporosis medication usage, bone density scans and fragility fractures. The Healthy Bones Program aggressively targets people at risk for hip fractures by identifying them through KP HealthConnect to ensure they get the bone density screenings and medications they need. The multidisciplinary team includes orthopedic surgeons and providers from endocrinology, family practice, internal medicine, rheumatology, gynecology, physical therapy, disease/care management, radiology and nursing education.

In this study, researchers found that annual bone density screening rates increased by 263 percent from 2002 to 2007. In 2002, there were 21,557 scans a year. In 2007, there were 78,262 scans. The number of people on anti-osteoporosis medications increased by 153 percent from 33,208 in 2002 to 84,155 a year in 2007.

To learn more about this research, please visit:

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Reducing Hospital Readmissions

The frequency and financial impact of Medicare readmissions, the posting of readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your organization's efforts by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.

To participate in this survey and receive its results, please visit:

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