Category: 8. Health

Schistosomiasis is a parasitic infection caused by helminths, a type of worm. Infection occurs during contact with infested water through activities like swimming, washing clothes, and fishing, when larvae penetrate the skin. Surprisingly, the worm often evades detection by the immune system, unlike other bacteria or parasites that typically cause pain, itching, or rashes.

In this new study, researchers from Tulane School of Medicine aimed to find out why the parasitic worm Schistosoma mansoni doesn’t cause pain or itching when it penetrates the skin. Their findings show that S. mansoni causes a reduction in the activity of TRPV1+, a protein that sends signals the brain interprets as heat, pain, or itching. As part of pain-sensing in sensory neurons, TRPV1+ regulates immune responses in many scenarios such as infection, allergy, cancer, autoimmunity, and even hair growth.

The researchers found that S. mansoni produces molecules that suppress TRPV1+ to block signals from being sent to the brain, allowing S. mansoni to infect the skin largely undetected. It is likely S. mansoni evolved the molecules that block TRPV1+ to enhance its survival.

“If we identify and isolate the molecules used by helminths to block TRPV1+ activation, it may present a novel alternative to current opioid-based treatments for reducing pain,” said Dr. De’Broski R. Herbert, Professor of Immunology at Tulane School of Medicine, who led the study. “The molecules that block TRPV1+ could also be developed into therapeutics that reduce disease severity for individuals suffering from painful inflammatory conditions.”

The study also found that TRPV1+ is necessary for initiating host protection against S. mansoni. TRPV1+ activation leads to the rapid mobilization of immune cells, including gd T cells, monocytes, and neutrophils, that induce inflammation. This inflammation plays a crucial role in host resistance to the larval entry into the skin. These findings highlight the importance of neurons that sense pain and itching in successful immune responses

“Identifying the molecules in S. mansoni that block TRPV1+ could inform preventive treatments for schistosomiasis. We envision a topical agent which activates TRPV1+ to prevent infection from contaminated water for individuals at risk of acquiring S. mansoni,” said Dr. Herbert.

In this study, mice were infected with S. mansoi and evaluated for their sensitivity to pain as well as the role of TRPV1+ in preventing infection. Researchers next plan to identify the nature of the secreted or surface-associated helminth molecules that are responsible for blocking TRPV1+ activity and specific gd T cell subsets that are responsible for immune responses. The researchers also seek to further understand the neurons that helminths have evolved to suppress.

Experts at the University of Edinburgh carried out a post-mortem brain examination on 25 cats which exhibited symptoms of dementia in life, including confusion, sleep disruption and an increase in vocalisation, in a bid explore new treatments for humans.

Previously, researchers have studied genetically modified rodents, although the species does not naturally suffer from dementia.

In feline dementia brains, a build-up was found of amyloid-beta, a toxic protein and one of the defining features of Alzheimer’s disease, leading to hopes of a “wonderful” breakthrough due to increased accuracy.

The breakthrough was hailed as a “perfect natural model for Alzheimer’s” by scientists who worked on it.

Microscopy images revealed a build-up of amyloid-beta within synapses of older cats and feline dementia, and scientists hope the findings offer a clearer idea of how amyloid-beta may lead to feline cognitive dysfunction and memory loss, offering a valuable model for studying dementia in people.

Synapses allow the flow of messages between brain cells, and losing these causes reduced memory and thinking abilities in humans with Alzheimer’s.

Researchers found evidence that brain support cells, astrocytes and microglia, engulfed the affected synapses, known as synaptic pruning, an important process during brain development but which contributes to dementia.

Experts believe the findings could contribute to the development of new treatments for Alzheimer’s disease, as well as help to understand and manage feline dementia.

Previously, scientists studying Alzheimer’s relied on genetically modified rodent models. However, studying feline dementia has the potential to help develop human treatments, due to increased accuracy, it is hoped.

The study, funded by Wellcome and the UK Dementia Research Institute, is published in the European Journal of Neuroscience, and included scientists from the Universities of Edinburgh and California, UK Dementia Research Institute and Scottish Brain Sciences.

Dr Robert McGeachan, study lead from the University of Edinburgh’s Royal (Dick) School of Veterinary Studies, said: “Dementia is a devastating disease – whether it affects humans, cats, or dogs. Our findings highlight the striking similarities between feline dementia and Alzheimer’s disease in people.

“This opens the door to exploring whether promising new treatments for human Alzheimer’s disease could also help our ageing pets.

“Because cats naturally develop these brain changes, they may also offer a more accurate model of the disease than traditional laboratory animals, ultimately benefiting both species and their caregivers.”

Professor Danielle Gunn-Moore, personal chair of Feline Medicine at the Royal (Dick) School of Veterinary Studies, said: “Feline dementia is so distressing for the cat and for its person.

“It is by undertaking studies like this that we will understand how best to treat them. This will be wonderful for the cats, their owners, people with Alzheimer’s and their loved ones.

“Feline dementia is the perfect natural model for Alzheimer’s – everyone benefits.”

Study design and participants

We conducted a retrospective cohort study that included 5,128 incident Chinese CAPD patients from seven PD centers in China between January 1, 2005, and May 31, 2023. Patients aged < 18 years or those with a follow-up time of < 3 months were excluded. Patients with malignant tumors or severe liver disease were excluded. Patients with missing data or abnormal values were excluded from this study.

Data collection and follow-up

We constructed the CUS scores to evaluate the prognosis of patients with CAPD. Each condition was assigned a score of 1, 2, 3, or 4 depending on the Charlson Comorbidity Index (CCI)¹⁴. Based on our previous studies^{7,8,9,15,16,17,18,19}, the CUS scores comprised nine conditions with relative mortality risks ≥ 1.2 or greater, and these conditions were also weighted based on their relative risks. Clinical conditions (common comorbidities and complications in patients with CAPD) and associated scores were as follows (1 point each): cerebrovascular disease, cardiovascular disease (myocardial infarction or congestive heart failure), peripheral vascular disease, diabetes mellitus, hypertension, hyperlipidemia, malnutrition (serum albumin < 3.8 g/dL), and anemia (hemoglobin < 11.0 g/dL). Patients aged 50 years or older received additional points: 18–49 years, + 0; 50–59 years old, + 1 point; 60–69 years old, + 2 points; 70–79 years old, + 3 points; and 80 years or older, + 4 points (Figure S1). The scores were summed to obtain the total score (CUS score), which was used to assess mortality in patients with CAPD.

Two well-trained nurses collected demographic data, comorbidities, and laboratory data one week (5.4 ± 1.1 days) before the start of PD in each facility, including age at study entry, sex, body mass index (BMI), current smoker, current alcohol use, comorbidities (DM, hypertension, a history of cerebrovascular disease, cardiovascular disease, or peripheral vascular disease, and hyperlipidemia), medication use (calcium channel blockers [CCB], β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers [ACEI/ARBs]), and laboratory measurements (serum albumin and hemoglobin). Weight was measured in the absence of peritoneal dialysis.

The primary outcome was all-cause mortality. Cerebrovascular and cardiovascular (CVD) deaths due to cerebrovascular disease, myocardial infarction, congestive heart failure, and peripheral vascular disease were recorded. The details of the CAPD follow-up have been previously described²⁰. The follow-up period was from the start of PD to the date of death, transfer to hemodialysis, renal transplantation, transfer to another dialysis center, loss to follow-up, or May 31, 2023. Patients who were lost to follow-up were censored on the date of the last examination.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki and received approval from the ethical and scientific review boards of Zhejiang Provincial People’s Hospital, approval number [QT2023233]. The ethical and scientific review boards of Zhejiang Provincial People’s Hospital have granted an exemption from requiring written informed consent.

Statistical analysis

Continuous variables are presented as means with standard deviations (SDs) for normally distributed data or medians with interquartile ranges (IQR) for skewed data. The normality of the parameters was examined using the Shapiro-Wilk test. Categorical variables are expressed as the number of patients. We first used restricted cubic spline plots to explore the nonlinearity assumptions between the CUS scores and the risk of all-cause mortality, fitting a restricted cubic spline function with four knots (at the 25th, 50th, 75th, and 95th percentiles)²¹. All patients were categorized based on the threshold value of the CUS scores (hazard ratio [HR] = 1.0) using restricted cubic spline plots for the primary analysis.

Survival was calculated using the Kaplan-Meier method, and differences in survival distributions were assessed using a log-rank test. We primarily used cause-specific hazard models to explore the association between the CUS scores and mortality risk. Patients who experienced events such as transfer to hemodialysis, renal transplantation, transfer to other centers, or loss to follow-up were censored, which impeded the occurrence of death. Thus, Transfer to hemodialysis, renal transplantation, transfer to other centers, and loss to follow-up before death were considered competing risks. We constructed subdistribution hazard models to confirm the associations observed in the primary analysis. The main difference between the two hazard models is that subjects experiencing a competing risk event remain in the risk set in the sub-distribution hazard model but are removed from the cause-specific hazard model^22,23. These models were constructed after adjusting for sex, BMI, current smoking status, current alcohol use, medication use, and centers. The results from the multivariable hazard models were presented as HRs and 95% confidence intervals (95% CIs). Stratified analyses were performed to assess the potential effects of sex modification.

To minimize the potential for reverse causation, we conducted analyses that excluded deaths in the first two years of follow-up. In addition, for patients with a short-term follow-up period, interesting outcomes may only be partially observed, with underreporting of mortality incidence. We further analyzed the association in patients with at least 24 months of follow-up to fully observe the outcomes. All analyses were performed using Stata version 15.1. (StataCorp, College Station, TX, USA).

Cats develop dementia similarly to humans, a study has shown.

Scientists at the University of Edinburgh examined the brains of 25 cats which exhibited symptoms of dementia – like confusion, sleep disruption and an increase in vocalisation – after their death, in a bid to find both treatments for both felines and humans.

A buildup of amyloid-beta, a toxic protein and one of the defining features of Alzheimer’s disease, was found in the examined brains, leading researchers to call the breakthrough a “perfect natural model for Alzheimer’s”.

Microscopy images revealed the amyloid-beta buildup within synapses of older cats. Synapses allow the flow of messages between brain cells, and losing these causes reduced memory and cognitive abilities in humans with Alzheimer’s disease.

Scientists are hoping the findings of the study provide a clearer idea of how amyloid-beta could lead to memory loss and feline cognitive dysfunction, as well as offer a model for studying dementia in people.

They previously relied on models studying genetically modified rodents, even though the species doesn’t naturally suffer from dementia.

The findings could contribute to developing new treatments for Alzheimer’s disease and help to manage feline dementia, experts said.

Read more from Sky News:
Blood test for dementia is highly accurate
Dementia: Sleep problems could ‘double risk’

Dr Robert McGeachan, study lead from the University of Edinburgh’s Royal (Dick) School of Veterinary Studies, said: “This opens the door to exploring whether promising new treatments for human Alzheimer’s disease could also help our ageing pets.

“Because cats naturally develop these brain changes, they may also offer a more accurate model of the disease than traditional laboratory animals, ultimately benefiting both species and their caregivers.”

The study, which included scientists from the universities of Edinburgh and California, the UK Dementia Research Institute and Scottish Brain Sciences, was funded by Wellcome and the UK Dementia Research Institute.

Dementia is becoming a growing concern in the US, and it’s not just something that affects “old age.” With an aging population and longer life spans, the number of people living with dementia is climbing fast. Alzheimer’s disease is the most common type, but there are other forms too, all impacting memory, thinking, and daily life. Experts say lifestyle factors like poor diet, inactivity, and even constant stress can raise your risk. The scary part? There’s still no cure. That’s why brain health tips, from staying active to learning new skills, are more important now than ever.A few months before, a neurologist trained at Mayo Clinic and University of Minnesota (as per his Instagram profile), shared an interesting information for all on social media. In a short video, the expert listed three habits that can help one reduce the risk of dementia and improve brain health and one among them was turning off GPS.“GPS makes our lives too convenient. Relying too much on GPS can weaken your brain’s spatial memory,” he said. Multiple studies have found that people who habitually use GPS navigation tend to have poorer spatial memory. When navigating without GPS, these individuals struggle more to remember routes, recognize landmarks, and form mental “maps” of their environment. The hippocampus, a brain region critical for memory and navigation, is less active when we follow turn-by-turn GPS instructions compared to navigating independently. Over time, relying on GPS means this area of the brain gets less “exercise”.Some research, including studies on London taxi drivers (who learn city layouts by memory), suggests that exercising navigation skills can actually increase the size and function of the hippocampus. In contrast, people who heavily use GPS may experience a lack of growth or even shrinkage in these regions as they age.“It’s interesting what you said about GPS. I have observed recently that UBER drivers in my city do not know their way around. Some can’t even follow the instructions on their GPS. I remember taxi drivers, in my younger days, really knew their way around the city,” writes one user. “When I was kid I could visualize exactly where I was and where I was going. I always new what direction I was facing (north,south etc) but these days I only know the sky is up cause it’s blue,” writes another.

Key takeaways

GPS reduces spatial memory and mental mapping abilities with heavy, long-term use. This is due to less engagement and exercise of the hippocampus.There is no evidence that GPS alone causes dementia. However, it may contribute to reduced cognitive reserve in the hippocampus, which could make the symptoms of dementia more apparent or severe if the disease develops.Maintaining navigation skills is important for brain health. Try occasionally navigating without GPS, paying attention to landmarks, or practicing new routes to challenge your brain.

The other two changes suggested by the doctor

Excessive intake of energy drinks, and sleeping with lights on are the two lesser known triggers of dementia he said. Energy drinks are loaded with caffeine and sugar, which might give you a quick buzz, but constant overconsumption can mess with your heart, blood vessels, and even brain chemistry. Over the years, that stress on your body could contribute to memory and cognitive decline. Then there’s the light-at-night problem — your brain needs darkness to produce melatonin, the hormone that helps you sleep and repair. If you’re snoozing with the TV glowing or the lights on, your sleep quality tanks, and your brain misses out on the deep rest it needs to stay sharp. Both habits might seem harmless now, but your future self could thank you for cutting back on the energy drinks and hitting the lights at bedtime.

Cesarean section between June 2024 and October 2024 in the Department of Perinatology, Health Sciences University, Etlik City Hospital, Ankara, Türkiye were prospectively included in the study.

The surgical teams consisted of an experienced specialist in obstetrics and gynecology (more than four years after graduation), a senior resident and a surgical nurse with at least four years of experience in assisting with cesarean sections. All surgical operations performed by the specialist. Operating room staff and surgeons were informed and trained on the collection procedures. Plastic baskets were placed in each operating room and the team members placed the used gloves in these baskets after the each operation. All used surgical gloves from the scrubbed surgical team were collected. Collected gloves were inspected visually for macro perforation just after placing in the basket. Patients were excluded from the study if any glove used by the scrubbed surgical team showed a macro-perforation either noticed intraoperatively or identified during immediate visual inspection after the surgery. The remaining gloves, which appeared visually intact, were examined using a water-fill test, right after the each surgery, in the concurrent operation room, during the operation room cleaning, according to the American Society for Testing and Materials [6]. Under standard operation room temperature, a 38 cm long plastic tube was used for the test. The gloves were attached to the distal end of the tube and 1000 ml of tap water was poured through the tube into the gloves. The perforation was recognized as water leakage or water jet from the glove surface or as droplet formation at the toe tip. The observation time was two minutes. Gloves with a positive water filling test were defined as the study group and negative gloves as the control group (Figs. 1 and 2).

Elective cesarean deliveries were defined as planned procedures performed before the onset of labor in clinically stable patients, whereas emergency cesarean deliveries included all other cases, including those with labor or clinical indications such as prolonged rupture of membranes, maternal fever, or fetal distress. Patients who were categorized as class 1 or 2 according to the American Society of Anesthesiologists (ASA) physical status classification were included in the study. The surgical site was cleaned by senior resident, with alcohol and combined with 4% chlorhexidine and waited some minutes for air-dried. The urinary catheter was placed preoperatively in the operating room. After skin antisepsis and urinary catheterization, the surgical area was draped using sterile, disposable surgical drape sets. Draping was performed by the senior resident in accordance with standard sterile technique protocols. Pfannenstiel skin incision, incision in the lower segment of the uterus, detachment of the placenta by fundal massage, exteriorization of the uterus for repair, single-layer uterine closure, suture closure of the subcutaneous layer if the subcutaneous tissue was thicker than 2 cm, subcutaneous closure with a Prolene suture, and the use of a blunt needle tip were established as standard surgical procedures in the study. Antibiotic prophylaxis (2 g cephazolin) was administered intravenously before skin incision. Single layer latex gloves were used for all procedures and double-gloved surgeries did not included to study. Early removal of the urinary catheter was performed routinely. Patients were physically examined daily during hospitalization and again in person on postoperative days 10 and 30 by the attending obstetrician.

The diagnosis of surgical site infection, diagnosed by specialist in obstetrics and gynecology, was based on the definition of the National Healthcare Safety Network of the United States Centers for Disease Control and Prevention [7]. Superficial surgical site infections were analyzed for the study. Deep incisions or organ/space infections did not occur in the study groups.

Subjects were excluded if they: (1) did not provide informed consent, (2) had a history of inflammatory disease or clinical chorioamnionitis, (3) had multiple pregnancies, (4) were classified as ASA class III or higher, (5) underwent midline skin incision, (6) had known allergies to chlorhexidine, antibiotics, or latex, or (7) were lost to follow-up.

All patients gave their informed consent to participate in this project. The study was approved by the institution’s ethics committee and was conducted in accordance with the Declaration of Helsinki.

Sample size

A priori sample size calculation was performed using G*Power version 3.1.9.7. In the absence of previous studies to estimate the effect size, a medium effect size (w = 0.3) was assumed. With α = 0.05 and power = 0.80, the required sample size for a chi-square test with 1 degree of freedom was calculated as 88 participants (44 per group). However, due to the naturally occurring frequency of glove perforation during the study period, only 32 patients could be included in the perforation group. The control group included 505 patients, reflecting the actual surgical population.

To evaluate the adequacy of this sample, a post-hoc power analysis was also conducted based on the observed effect size (w = 1.545). With α = 0.05 and a total sample size of 537 (n₁ = 505, n₂ = 32), the calculated power (1 − β) exceeded 99.9%, indicating sufficient statistical sensitivity to detect differences between groups.

Statistical analysis

All statistical analyses were performed using Jamovi version 2.6.26 (The Jamovi Project, Sydney, Australia). The variables were examined using visual (histogram, probability plots) and analytical methods (Kolmogrov-Simirnov/Shapiro-Wilk test) to determine whether they were normally distributed or not. The Levene test was used to assess the homogeneity of variance. Descriptive analyzes using medians and interquartile ranges (IQR) (Q1-Q3) were performed for the non-normally distributed numerical data. Mann-Whitney U-tests were performed to compare these parameters between the groups. For the categorical variables, descriptive analyzes were performed using frequencies and percentages. The relationships between the categorical variables were analyzed using the chi-square test or Fisher’s exact test. A p-value of less than 0.05 was considered a statistically significant.

Additionally, a multivariable logistic regression analysis was performed to evaluate the independent association between glove micro-perforation and surgical site infection (SSI). Known confounding variables including emergency cesarean section, diabetes mellitus, obesity, surgical duration, and intraoperative blood loss were included in the model to adjust for potential effects.

Oxytocin promotes social behaviors and helps maintain relationships. But clinical trials in patients with autism show variability in how consistently oxytocin improves these behaviors. Steve Chang, from Yale University, led a study to explore how oxytocin influences brain activity to shape social behavior in rhesus monkeys and why its effects are so variable. This work is featured in JNeurosci‘s Central Questions for Social Neuroscience Research Special Collection. 

The researchers focused on the basolateral amygdala (BLA) and the anterior cingulate cortex (ACC) because these brain areas process reward and integrate information during social decision-making. Delivering oxytocin directly into the BLA had state-dependent effects; when monkeys were socially motivated prior to oxytocin exposure, the hormone maintained socially beneficial decisions and social task behavior over a longer time period, but oxytocin didn’t influence the same monkeys when they were less motivated. Brain activity supported these results showing that oxytocin increased BLA and ACC activity only when monkeys were socially motivated. Activity in the BLA and ACC was also more coordinated during prolonged social states, suggesting that oxytocin may stabilize communication in this pathway to sustain social behavior. 

Says Chang, “We previously found that communication between these brain areas is important for social reward and behavior. So, the link between enhancement of this signal and prolonged social behavior was interesting to see.” Elaborating on clinical implications, Chang adds, “We have to be more careful and not just use a standardized approach. Even within individuals, there are variations in the effectiveness of oxytocin treatment! It may be important to individually tailor treatments.” 

Woodgreen

Woodgreen

Woodgreen

Physicians have long known there is a connection between mental health and physical health, but what was not recognized is that this anxiety can actually interfere with the outcome of certain cancer treatments. Most notably, emotional distress has a profound impact on the effectiveness of immunotherapy.

In a recent study published in Nature Medicine, researchers compared the outcomes of patients with non-small-cell lung cancer receiving immunotherapy to determine if emotional distress played a factor in their treatment outcome. They found patients without emotional distress had progression-free survival almost double that of patients suffering from emotional distress. Likewise, the objective response rate to immunotherapy was 46.8% for those with emotional distress, compared to 65% in those who did not suffer from this condition.

This data drives home the importance of early mental health screening and intervention to help improve patient outcomes.

For insight into this crucial mental/physical health connection, we turned to Shiyao Wang, MD, of the Cleveland Clinic Cancer Institute’s Department of Palliative and Supportive Medicine, who recently co-authored a paper in Translational Lung Cancer Research about this topic. A psychiatrist by training, Dr. Wang did his fellowship in consultation-liaison psychiatry at Thomas Jefferson University Hospital. He now works as a psychosocial oncologist at Cleveland Clinic Cancer Institute.

CQD: Thank you for taking the time to talk with us today. First, can you tell us a bit about what your team does?

SW: We offer comprehensive psychological and psychiatric mental health support for patients receiving cancer care at Cleveland Clinic. Our team includes two full-time psychosocial oncologists, three cancer psychologists as well as a psychologist in Florida. We also have a new psychologist starting at our site in Akron.

CQD: What sparked your interest in this study?

SW: The reason I got interested in this study is because we now know that cancer treatment outcomes will be negatively impacted if emotional distress is not properly recognized and treated. This opens the door for mental health professionals to talk with medical oncologists about the importance of treating mental health issues.

CQD: Can you explain specifically how emotional distress disrupts the effectiveness of immunotherapy?

SW: Yes, The whole point of immunotherapy is to make the immune system more robust to target cancer. When patients are going through distress, their HPA (hypothalamic-pituitary-adrenal) axis is dysregulated. Their CD-8 cells and NK cells, which are in charge of killing cancer cells, are less active.

People having chronic stress tend to have dysregulated sleep and decreased appetite and are less likely to follow recommended lifestyle modifications, which further impacts immune activity, so overall, their immunotherapy outcome appears less robust.

CQD: How do you define emotional distress? Wouldn’t most people with cancer have this?

SW: Yes, but it’s on a spectrum. Some people have milder emotional distress that is proportional to cancer diagnosis and treatment. They may have better coping skills and social supports and have learned ways to handle stress. In those cases, they may go through a shorter period of distress and then quickly focus on their care plan and how to move forward versus other people who feel more overwhelmed and have a hard time managing this in an effective way.

Cognitive functioning comes into this as well, because when we’re under duress, it’s harder to think clearly, be motivated to make your next recommended appointment or remember to take medications, for example. That makes the whole task of receiving cancer treatment more challenging.

CQD: Were there other findings in the study that stood out to you?

SW: Yes, the researchers found that poorer outcomes for those with emotional distress were universal across all subgroups, so no matter the patient’s age, gender, histology, smoking status or degree of metastases, we see a consistent negative outcome when patients are experiencing emotional distress. This data reinforces the point that this is something we need to screen for.

CQD: Your paper mentioned that there’s a mutually reinforcing relationship between cancer and emotional distress. Can you explain what that means?

SW: Getting a cancer diagnosis is inherently very overwhelming and stress inducing. When patients are going through this distress, it can sometimes get in the way of effectively engaging in their cancer treatment. If a person is too depressed or anxious to move forward and adhere to treatment recommendations, we tend to see worse outcomes and more suffering, which is likely to perpetuate anxiety and depression, so it’s a two-way street.

Coming to the hospital every single day for 35 days of radiation, for example, is very stressful and requires a lot of motivation, planning and coordination with the patient’s care team and family. That’s especially true for people who still have to work and take care of their family. Having all that stress can impact their ability to concentrate, impact their motivation and affect their desire to further engage with care.

In those cases, we talk about their values, identify their strengths and discuss how to support them and keep them going through this tough process.

CQD: What are the best ways to identify patients in emotional distress?

SW: I see more oncologists including mental health symptoms in their assessment, which is a very good sign. We have the General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9), which are scoring tools to help identify patients who are more vulnerable and may suffer from mental health symptoms. From there, a comprehensive psychosocial assessment may be beneficial to identify the existence and severity of mental distress. The social work team at Cleveland Clinic Cancer Institute works closely with the oncology and mental health teams in this process.

CQD: Can you share how the Clinic helps patients with cancer in these situations?

SW: The mental health team at Cleveland Clinic Cancer Institute takes referrals from oncologists, palliative care providers and sometimes inpatient psychiatrists. We assess what the patient’s needs are and provide recommendations to manage symptoms and help the patient achieve their goals.

Not everyone who’s experiencing emotional distress needs to see a psychiatrist. For example, someone may be having existential questions like what’s the point of going through chemo when I feel worse every day? In those cases, potentially talking with a cancer psychologist will help them process and accept their cancer diagnosis, identify their coping styles and skills and understand what their goals and values are. In other cases, there are biological factors that precipitate and/or perpetuate patient’s mental health symptoms, which can be intervened with pharmacological treatment.

CQD: What other types of supports does Cleveland Clinic offer?

SW: Through a good assessment, we can find out what is most beneficial for each patient. In some cases, housing, financial burdens and/or employment disruption are adding emotional distress. For example, for patients who live outside the area and are at Cleveland Clinic Cancer Institute for treatment, our social workers can help them find temporary lodging or provide financial assistance.

The Palliative and Supportive Care Teams provide symptomatic management for patients going through cancer, including pain, constipation, fatigue, nausea and diarrhea, and facilitate goal-of-care discussions. Cleveland Clinic Cancer Institute also offers patients and caregivers supportive services such as yoga, meditation, massage therapy as well as art and music therapy. There are other supporting services in the community that we often refer patients to, such as the Gathering Place and 4^th Angel program. They provide additional services to patients and their family, such as group therapy for certain types of cancer and peer support via a mentorship program.

CQD: What role does your team play in educating patients about the importance of mental health in their cancer care?

SW: For many patients, we are the first contact they’ve ever had with a mental health professional. Being able to help patients understand emotions and feelings they are going through is common. Working with them from an oncology care standpoint can be very helpful to de-stigmatize mental health services overall. Getting our team involved as part of the treatment team can be very beneficial for patients’ quality of life, overall well-being and treatment outcome.