Work I did with colleagues at Washington University in St Louis was released ahead of print in the journal Cancer Causes and Control. Eight ways to stay healthy after cancer is a patient-focused set of messages, with an accompanying brochure, on staying healthy after a cancer diagnosis.  Focused on choices patients can make it includes, avoiding tobacco smoke (including secondhand), maintaining a healthy weight, being physically active, a healthy diet, alcohol in moderation (if at all), social support and regular health check-ups.

Also out this week are the NCCN practice guidelines for survivorship.  More focused on what health care providers need to know after treatment ends, though acknowledging the role that family members and caregivers play, the NCCN guidelines center on eight areas as well: anxiety and depression, sleep disorders, cognitive function, fatigue, exercise, pain, sexual function, and  immunizations and immune function.

Both guidelines acknowledge that dissemination to stakeholders and implementation into routine care remain significant challenges.

Loyola University Chicago has an outstanding commitment to reducing the global burden of preventable disease, improving international health, and decreasing health disparities.  The community surrounding the Stritch School of Medicine disproportionately suffers from high rates of obesity and preventable chronic diseases, including heart disease and cancer.

The Public Health Programs at Loyola are truly multidisciplinary, drawing from faculty in medicine, nursing, ethics, health policy, environmental health, statistics, social work and communication.

This move will allow my lab to continue its commitment to cancer prevention and survivorship, improving health outcomes in medical and community settings and addressing the needs of the underserved.

The quality of life benefits are real.  I should know, as one of my earliest published research articles was on the benefit of exercise for quality of life.

It is great to see the dialog about exercise starting to change – to get people to focus on the immediate benefits of exercise.  You feel better.  You sleep better.  Kudos to Jane Brody for highlighting it this week in the NY Times.

If you need some more reasons to exercise today, hop over to Twitter and check out the #reasontoexercise tag from my colleague Dr. Sherry Pagoto.

I think a big part of it is that I grew up this way and I learned how to do it from an early age.  My grandmother was a home economics teacher in a small rural town, married to a dairy farmer.  Money was tight and so was time.  My grandmother planned the menu for the week every week. That meant she only bought what she needed at the store and she didn’t have to figure out what to make when she got home.  I remember the menu (& running grocery list of items she’d run out of) being posted on her fridge long after she’d retired and my grandfather sold his cows.  When my mom and her sister got old enough (and at an age far younger than we seem to put them to the task these days), dinner preparation fell to them.  They knew exactly what they needed to do, because it was all laid out for them.  They’d also both grown up in the kitchen, watching and learning.  I have no doubt this is why both are such great cooks now.  I dare anyone to roast a more perfect turkey than my mom or make a better pecan pie than my aunt. This approach wasn’t highly unusual for my grandmother’s generation.  My Dad’s mom knew what she was cooking for the week too!

Growing up, my mom did the same thing as my grandmother.  That meant as a kid I remember, she too came home from a long day of work, got our whole family fed a nutritious tasty meal and then went off to graduate school classes (yes, she WAS super mom!).  My mom took me grocery shopping with her.  I learned how to read nutrition labels to figure our how many grams of sugar were in each and I could pick any cereal with 6 grams or less.  I learned how to balance a checkbook from her after watching her write the check each week.

When I got to junior high, I took home economics and shop (though we called it something funny, like technology, though the most technologically advanced thing in the room was the VCR brought in on days when we had a substitute).  We learned to read a recipe, cook and sew in home economics (things I already knew but many of my classmates did not).  But menu planning wasn’t part of home ec, nor was budgeting.  Nutrition was, sort-of, part of health and banking was, sort-of, part of social studies.  I guess because we were all expected to go to college, we somehow didn’t need to know how to manage a household?  My husband grew up halfway across the country.  He had a class called “Foods” where he learned to cook, but as with me, little else of what my grandmother’s home ec taught.

Many schools have long lost home ec – it was an early victim of budget cuts (though some have retained it and modified it to meet the times in just the ways I suggest). With obesity rates among kids sky rocketing, we need to think about the critical life skills kids need to learn.  Historically, home economics was exactly the transdisclipinary integrated applied course we talk about being novel in education: nutrition, economics, math, chemistry (what do you think baking is?), medicine.  And if you’re lucky, you end up with apple pie. What could sound better (or more American) than that? Just don’t cut PE to pay for it.

Check it out the blog and the report!

I am not going to sit here and pretend that there aren’t limitations to observational studies – there are and I know them well – that’s what the foundation courses in epidemiology teach you – the limits of each study design.

But let’s be perfectly clear about something else, randomized trials aren’t perfect either.  They aren’t perfect when perfectly conducted and almost none are perfectly conducted.  They can’t be.  Randomized trials are done on people, who are imperfect.  So that means people don’t comply with randomization and they quit the study.

This isn’t news.  If we thought the (THE) randomized trial was perfect, we’d only do one.  So we wouldn’t have need for meta-analyses of randomized trials, which proliferate in the literature.

Randomized trials are subject to interpretation.  One need only to compare how the same set of studies can be interpreted quite differently by the thoracic surgeons  and gastroenterologists when each group issues treatment guidelines.

Does this mean randomized trials are no good?  Absolutely not! In fact I recently wrote a paper with my colleague Graham Colditz about the importance of intervention trials specifically in cancer survivors, though we also noted the limits to what such trials can show.

We need to remember that we can’t (and never will) base all of our health and medical decision making on trial data.  I will continue to trust in the value of parachutes, despite the alarming findings of this analysis of trial data from the esteemed British Medical Journal.

My colleagues at Cancer News In Context & Washington University School of Medicine have put together a nice graphic on the pros and cons of observational versus randomized trial data.  I think it is a nice summary of how BOTH study designs add value to our understanding of health.  Which one is “best” is VERY dependent on the specific question of interest!