A Calendar of Diseases
2002; Wolters Kluwer; Volume: 24; Issue: 1 Linguagem: Inglês
10.1097/01.cot.0000315316.85288.7e
ISSN1548-4688
Autores ResumoAs the New Year begins, so does the now familiar cycle of months, weeks, and days that single out specific diseases for special recognition. In January the focus is on Alzheimer's disease, but few, if any, months go by any more without calling attention to at least one medical condition, and usually more. Oncology and oncology-related fields are exceedingly well represented in this redrawn calendar. The idea, which was the brainchild of the American Cancer Society, began in the 1970s with Cancer Recognition Week. Gradually the concept grew and broke up into separate campaigns for various kinds of cancers. Other advocacy organizations, recognizing a good media hook when they saw one, quickly jumped on the bandwagon. It wasn't long before the calendar was so crowded that it became necessary to share the limelight and compete for attention. September, for example, is not only National Prostate Cancer Awareness Month, but also National Bone Marrow Awareness Month and National Ovarian Cancer Awareness Month. With a finite number of weeks and months in a year and with no central clearinghouse, this kind of overlapping was unavoidable. The duplication concerns advocates who fear that the public will be distracted and media attention (a major goal of these efforts) will drop off. “We're always worried that reporters will lose interest in an important subject because they feel they're being manipulated by organizations and campaigns rather than writing about things because they are newsworthy,” said Joann Schellenbach, the ACS's National Director of Medical and Scientific Communications for the ACS. When the awareness movement began, sponsoring organizations would ask Congress to issue an official declaration. More recently, however, they have just gone ahead and announced it themselves, according to Ms. Schellenbach. Breast Cancer Month Leads the Way National Breast Cancer Awareness Month in October is the leader of the awareness month pack, followed by the Great American Smokeout the third Thursday in November. “Breast cancer has been the most dynamic and successful cancer month, and it remains so,” Ms. Schellenbach said. “This has something to do with the way the disease itself resonates with the American public, particularly women. “It also has become quite attractive to corporate sponsors who see it as an effective way to do business and establish a relationship with customers,” she remarked. A recent survey bears out that has indeed been a win-win situation. In October 1999 and 2000, one in four women purchased a product or service related to the disease, according to the Cone Breast Cancer Awareness Trend Tracker. This achievement is largely due to the many imaginative and seemingly endless tie-ins. Last year, for example, there was a sweepstakes; countless fundraising runs; an auction of celebrity artworks by stars such as Liza Minnelli and Jane Seymour; a video game heroine, Ms. Pac-Man; and a support kit for couples affected by the disease funded by Samsung and Sprint. There was even a pink Awareness bra to remind women to do breast self-examination. Wacoal, the manufacturer, donated a portion of the month's proceeds from sales of the bra to the Susan G. Komen Breast Cancer Foundation. Many other manufacturers made similar donations. A Day Without Tobacco Another hugely successful campaign is The Great American Smokeout, which has been held every November for the past 25 years. The Smokeout has succeeded in large part by forsaking the usual solemnity that marks these kinds of efforts and opting instead for humor and originality. “Just give it a shot for one day and see if you can pull it off” is the basic attention-grabbing message. It's a brilliant concept,” Ms. Schellenbach maintained. “It isn't preachy, it doesn't talk about the evils of tobacco, it just invites people to quit for a day and ask themselves how they ever got into this situation. It's colorful, amusing, and really captures media attention.” The ACS hasn't tried to determine how many people have actually quit for good as a result of the program, but it is clear that a larger goal has been achieved. “The program's greatest success is the important role it has played in denormalizing smoking,” Ms. Schellenbach observed. It isn't clear just who started the Smokeout. It seems to have begun in the early 1970s in a couple of small communities in California, was taken up by the state's branch of the ACS in 1976, and went national the following year. “The focus is on captivity of the individual to tobacco,” Ms. Schellenbach said. “Instead of talking about the evils of tobacco, it highlights what people who smoke go through and challenges them to free themselves. This made the tobacco companies extremely nervous.” The Smokeout is always scheduled for a workday so that the entire workplace is involved and smokers have an opportunity to test their habit in a supportive atmosphere. The campaign marked the beginning of a major cultural revolution. Whoever would have predicted 25 years ago that smoking on airplanes would be prohibited, that restaurants would either have no-smoking sections or ban smoking entirely, or that workers who smoke would have to do so outside their office buildings rather than alongside their non-smoking colleagues? In short, that smoking would no longer be considered a normal thing to do? “No one expected the Smokeout to go on for this long,” Ms. Schellenbach noted. “But tobacco politics kept it interesting, and people had fun with it. It's quite the thing, and it continues to be.” Learning About Lung Cancer While the Great American Smokeout tries to persuade smokers to quit for at least one day, the sponsors of Lung Cancer Awareness Week devote the week to those for whom that message unfortunately comes too late. It should not be confused with Lung Cancer Awareness Month, which is also held in November. The sponsors are: Cancer Care, Inc; the Oncology Nursing Society; the Wellness Community; and The Chest Foundation. Why the breakoff from Lung Cancer Awareness Month? “We wanted to focus on the needs of people with lung cancer, which are not as recognized as they should be,” said Diane Blum, ACSW, Executive Director of Cancer Care. “We felt that insufficient attention is paid to the prevalence of lung cancer in women, and we also wanted patients to know about the progress being made in treatment and symptom management. They need to be more aware of the existence of medical oncologists and what they can do for them.” The annual event, which began in 2000, has a problem unique to medical advocacy. Lung cancer is a stigmatized disease in which the illness is seen as the fault of the patient. This inhibits efforts to recruit celebrity spokespersons, which, in turn, makes it harder to get media attention. The first spokesperson was S. Epatha Merkerson, who stars on the television series “Law and Order,” and saw two close friends die of lung cancer. Last year, it was the supermodel Christy Turlington, whose father died of the disease. Ms. Blum said she believes that the week has been a success in terms of educational outreach. She noted that the campaign's Web site had more hits, and calls to its toll-free information line went up in the wake of both week-long efforts. A third goal of the campaign is to secure more resources for lung cancer education and patient support. “People with this disease feel stigmatized and isolated,” she said. “This effort is not going to be a quick fix, but with more visibility it will have a positive impact.” Measuring Success As the designated weeks, and months become increasingly crowded, is the concept of disease awareness losing its usefulness?Figure: Joann SchellenbachFigure: Diane Blum, ACSW“The reality is that this approach still works,” Ms. Blum said. “Admittedly, it's overused and somewhat formulaic, but we still see more media coverage when we have an awareness campaign. When someone famous is known to have a particular medical condition, coverage zooms. But people with lung cancer don't have a long time to live, and they are usually too sick over the course of their illness to take part in educational campaigns. We have to use whatever tools are available to make the lives of people with lung cancer a little better.” A Sampling of Cancer-Related Awareness Months, Weeks, & Days JANUARY Cancer Awareness Week Cervical Cancer Awareness Month MARCH Colorectal Cancer Awareness Month Lymphedema Day APRIL Cancer Control Month Cancer Fatigue Awareness Day Head and Neck Cancer Awareness Week Minority Cancer Awareness Week Testicular Cancer Awareness Week MAY Brain Tumor Awareness Week Melanoma/Skin Cancer Detection and Prevention Awareness Month Melanoma Monday Oncology Nursing Month JUNE Cancer Survivors Day Leukemia Awareness Month SEPTEMBER Bone Marrow Awareness Month Childhood Cancer Awareness Month Gynecologic Cancer Awareness Month Leukemia Awareness Month Oral Cancer Awareness Week Ovarian Cancer Awareness Month Prostate Cancer Awareness Month OCTOBER Breast Cancer Awareness Month Lymphoma Awareness Week Mammography Day NOVEMBER Marrow Awareness Month Mouth Cancer Awareness Week The Great American Smokeout Lung Cancer Awareness Week Lung Cancer Awareness Month National Family Caregivers Month Pancreatic Cancer Awareness Month Hospice Month The Business of Palliative Medicine Recognizing today's medical realities, the Center to Advance Palliative Care held several sessions on financing at its most recent annual meeting. In one such presentation, Mellar P. Davis, MD, Medical Director of the Horvitz Center for Palliative Medicine at the Cleveland Clinic, described the successful program he runs at the Clinic's Taussig Cancer Center. “Palliative medicine is cost effective within the acute inpatient tertiary setting, if structured properly,” he said. In order to avoid common pitfalls that influence program development and impede effective financial management, he made the following recommendations: ▪ Do not settle for a partial program, such as a consultative service alone, because they fail to directly manage symptoms and patient care. “Consultative-only services are not financially viable,” Dr. Davis said. “They put dispositions at the mercy of the primary service unless arrangements are made for shared responsibilities.” He said that without an outpatient program, repeated hospitalizations, and loss of continuity of care are inevitable. ▪ Avoid a reputation as a “dying” or “end-of-life service,” which leads to patients being received within their last 24 hours of life. Dr. Davis called such late-in-the-day management “admirable but frustrating.” Without earlier involvement, most patients are highly symptomatic at the end of life. Also, this kind of reputation leads doctors to defer timely referrals and discourages patients from entering the program early on. ▪ Create a multidisciplinary team consisting of a social worker, discharge coordinator, and chaplain. “A coordinated effort reduces hospitalization,” Dr. Davis noted. ▪ Establish a clearly defined plan of care for each patient within one or two days of admission. ▪ Conduct a family meeting within 72 hours of admission, followed shortly thereafter by discharge planning. ▪ Document diagnosis-related group (DRG) and relative weights in order to reflect the unit's case mix index. ▪ Use a decision support system. ▪ Conduct daily team meetings to shape the goals of the care plan.
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