Tester s Newsletter. Published by the Lung Association of Saskatchewan Spring Spotlight on Lung Disease

Transcription

1 SAIL Home Oxygen Program Tester s Newsletter Published by the Lung Association of Saskatchewan Spring 2009 Inside End Stage Palliative Oxygen Benefits...3 Third Hand Smoke 4 New Research...5 Tester Tips...6 From the Good People at SAIL Phone Numbers 8 Spotlight on Lung Disease Lung Cancer Lung cancer is the leading cause of death due to cancer in Canada. It ends more lives than colon, prostate, lymph and breast cancer combined. Worldwide more that 1 million people die from lung cancer each year. Ironically, most lung cancer deaths could have been prevented. At least 85% of the people with lung cancer have a smoking history. Exposure to other carcinogenic agents such as radon, asbestos, and second hand smoke can also cause lung cancer. Incidence In 2007 approximately 23,300 Canadians developed lung cancer. Of these new cases, 52%will be over 70 years old, and only 5% will be younger than 50. The incidence rate for men has decreased, while the number of women developing lung cancer has steadily increased. This newsletter is produced by the Lung Association of Saskatchewan through a contract with Saskatchewan Health. Home Oxygen Workshop Telehealth Conference cont d page 2 Any questions or comments may be directed to Marion Laroque at ext 241 or marion.laroque@sk.lung.ca Thursday, April 30, pm - 4 pm Interested? Talk to your manager about signing on. Sign up deadline is April 23, 2009.

2 Lung Cancer continued from page 1 Pathophysiology Individual cells in an organ may respond differently to exposure to carcinogenic agents. As a result, several different types of cancer can occur in an organ. The majority of lung cancer develops in the lining membrane of the airway. This is the area with the greatest exposure to carcinogenic agents. Exposure to smoke damages the cilia which line the bronchi of the lungs. This reduces the lung s ability to quickly and effectively remove inhaled particles trapped in the lung s protective mucus. As a result, the lung cells are exposed to carcinogenic agents for longer periods of time. This increases the odds of the cells being altered. These altered cells in turn give rise to cancer cells. There are two broad categories of lung cancer: non-small cell and small cell cancer. Non-small cell lung cancer includes: Squamous cell cancer, the most common form accounting for 40-45% of all cases. Large cell undifferentiated cancer, 5-10% of lung cancer. Adenocanceroma, which may occur in non-smokers and occurs in outlying areas of the lung. This accounts for 25-30% of lung cancer cases. Small cell cancer spreads rapidly from a central location. Approximately 15-20% of the people with lung cancer have this type. Surgery is seldom an option for this group. Chemotherapy may have promising results. Symptoms Unfortunately, lung cancer doesn t cause signs and symptoms in its earliest stages. In more advanced stages symptoms may include: A new cough that doesn t go away Changes in a chronic cough or smoker s cough Coughing up blood, even a small amount Shortness of breath Chest pain wheezing hoarseness Diagnosis Some or all of the following can be used to diagnose lung cancer: Chest X-ray or CT scan Sputum cytology Bronchoscopy, mediastinoscopy, CT guided needle biopsy Treatment There are 3 treatment options: surgery, radiation, chemotherapy. These may be used on their own, or in combination. Prognosis Almost 60% of people diagnosed with lung cancer die within a year. Of course, people diagnosed at the earliest stages have the greatest chance for a cure. Tester s Newsletter Page 2

3 End Stage Palliative Oxygen Benefits Clients suffering from terminal illnesses such as lung cancer may have oxygen prescribed to ease their suffering. Palliative oxygen coverage does not require testing. Clients do need to be part of the palliative case load, and must have a palliative assessment done. The SAIL criteria for palliative coverage requires that the client have a Victoria Hospice Society Palliative Performance Scale rating of 30%. The description of that rating is: Ambulation: totally bed bound Activity and evidence of disease: unable to do any activity, extensive disease Self-care: total care Intake: normal or reduced Conscious level: full or drowsy, +/- confusion Coverage is for 4 months and covers the cost of a concentrator plus 10 tanks per month. Coverage may be renewed at the end of the 4 month period. Reminder Exertional oxygen coverage is available for stable patients only. Exertional testing should not be done on a hospitalized patient. The patient must be out of the hospital for 30 days before exertional testing can be done. At rest testing for continuous oxygen coverage can be done on a hospitalized patient who is ready for discharge. Testing should be done within 48 hours of discharge. This testing can be either an arterial blood gas (preferred) or by oximetry. Did you know? An E size cylinder, the most common size, will last 5.7 hours at a flow of 2lpm. The same cylinder with an oxygen conserving device (OCD) could last up to 17.2 hours, depending on the client s breath rate. SAIL Stats - November 2008 Continuous Exertional Nocturnal Infants...15 Total Lung Association Stats Nocturnal tests completed 379 Waiting list 75 Waiting time....3 months Tester s Newsletter Page 3

4 Pulse Oximeters If you need repairs or maintenance on your N-20P oximeter, please call: Covidien (formerly Tyco Healthcare) and press #5 to speak with a representative For reordering printer paper you can call: Schaan Healthcare Products, Saskatoon or Current price for a box of 12 rolls is $65.90 plus tax Part # is Third-Hand smoke Third-hand smoke is a new name for an old problem the toxic chemicals in smoke that stick around even after the smoker has put out the cigarette, cigar, or pipe. Third-hand smoke gets trapped in hair, skin, fabric, carpet, furniture, and toys. It builds up over time. Each time someone smokes, more smoke gets trapped in the fabric, furniture, walls, and other things around them. The chemicals from the trapped smoke pollute the air and get into people's lungs and bodies. If you are in a room or car where people usually smoke, even if they aren't smoking right then, you are exposed to third-hand smoke. This means you are exposed to toxic chemicals like lead and arsenic. Third-hand smoke also gets into household dust, which babies swallow when they put their hands in their mouths. 1 Babies take in more third-hand smoke chemicals because they breathe more quickly and because they spend more time on the floor. Babies can take in 20 times more third-hand smoke than adults. 2 References 1 Matt GE, Quintana PJ, Hovell MF, Bernert JT, Song S, Novianti N, Juarez T, Floro J, Gehrman C, Garcia M, Larson S. Households contaminated by environmental tobacco smoke: sources of infant exposures. Tob Control Mar;13(1): Winickoff JP et al. (Beliefs about the health effects of "thirdhand" smoke and home smoking bans. Pediatrics, 2009: 123(1):e74-9. Tester s Newsletter Page 4

5 Patient First Review Patient First is an independent review of the Saskatchewan health care system, commissioned by the Government of Saskatchewan. It is led by the commissioner, Tony Dagnone. This review will focus on the system, what works well and how the system fails people. Input from patients, focus groups and administrations will be gathered in the next few weeks. Patients and family members of patients have an opportunity to tell their stories, both good and bad through an on-line workbook. This can be accessed through the website at Hard copies of the guide can be mailed to those without easy access to the internet. These can be obtained by calling People wishing to tell their stories need to hurry, the deadline for submissions is February 28. The final report is scheduled to be completed by the end of June. Update on Home Oxygen Tester s Workshops The change in delivery of the workshops from direct delivery to a Telehealth broadcast has been very positive. A total of 20 sites signed on for the spring session. This reached 52 testers. The fall broadcast reached 15 sites and had an audience of 59 people. If you have staff members who wish to become testers, or wish to review the testing protocols, encourage them to sign up for the spring session. This will be held on April 30 from 13:00 to 16:00. More information will be available through the Telehealth network. New Research Common Food Additives linked to Lung Cancer The January issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society contains a study conducted on animal models. This study suggests that a diet high in inorganic phosphates may speed up the growth of lung cancer tumors. Inorganic phosphates may also contribute to the development of lung cancer tumors in individuals predisposed to the disease. Inorganic phosphates are found in a variety of processed foods including meats, cheeses, beverages and bakery products. The author of the study, Dr. Cho, noted that in the 1990 s phosphorous-containing food additives contributed an estimated 470mg per day to the average adult diet. Today that intake may be as high as 1000mg per day due to the increased use of phosphorous. Recertify on-line It only takes 15 minutes! You should recertify every 2 years. Go to the Lung Association of Saskatchewan web site at choose especially for and then oxygen testers. Tester s Newsletter Page 5

6 2009 Chronic Disease Prevention & Management (CDPM) Provincial Conference June 18 & 19 Sheraton Cavalier, Saskatoon Keynote Speaker: Dr. Jean Bourbeau MD, MSc, FRCPC McGill University Purpose: to provide health care practitioners, policy makers, administrators, organizations, and individuals committed to prevention and living well with chronic disease an opportunity to share ideas, practise and initiatives. Contact: Lois Crossman, Conference Coordinator Tester Tips An inaccurate pulse reading on the pulse oximeter may mean that the S p 0 2 will also be inaccurate. Try to find a finger, or ear lobe with a better pulse. Sometimes warming the hand can help. Remember that a pulse oximeter is accurate within 2%. Clients with borderline results, for example 89%, may qualify with a blood gas sample. If your client has S p 0 2 levels less than, or equal to 87% at rest, he has qualified for continuous oxygen coverage. There is no need to also do exertional testing. Nocturnal oxygen coverage requests must also include the client s diagnosis which has lead to the low oxygen levels. Exertional testing must show improvement in oxygen saturations as well as an improvement in exercise tolerance of 20%. That means if the client walked 100 feet during the room air test, he must walk at least 120 feet during the test with oxygen in order to qualify for exertional coverage. If there is no improvement in exercise tolerance, there is no real benefit to having oxygen therapy. Home oxygen therapy will not necessarily improve a client s shortness of breath. It will however, increase his life expectancy. Questions, or concerns about home oxygen testing procedures will be gladly answered by Marion Laroque. She can be reached to ext 241 or her at marion.laroque@sk.lung.ca. Tester s Newsletter Page 6

7 From the Good People at SAIL Frequently SAIL receives oximetry test results that they don t know what to do with. When sending tests and requisitions to SAIL, please include: The tester s name The test date The patient s name and HSN. A requisition with a prescription. An identifiable physician. It s quick to fax! It s fair to ask questions! Thank you, from SAIL. Please be sure your name and tester number is on the tests, and please sign them. This validates them. If the date is incorrect or not on the oximetry strip, please date them. The Health Services Number identifies a specific person. Many people use names that are variants of their health card names. Please include the Health Services Number. Without a prescription, no oxygen will be funded. Please do not send in tests separately. Please print the doctor s full name on the requisition if it is not there. Let physicians know that requisitions and tests can be sent to SAIL by fax at (306) The originals can be retained for records. Sometimes you receive requests for testing that you know is wanted primarily for SAIL qualification but you are not sure what is needed. It s fair to call SAIL, if you are asked to retest, and find out whether and which tests might be needed for renewal. Phone # (306) For all the work that goes into this testing. Your tests do make a difference! Update on Home Oxygen Tester s Workshops The change in delivery of the workshops from direct delivery to a Telehealth broadcast has been very positive. A total of 20 sites signed on for the spring session. This reached 52 testers. The fall broadcast reached 15 sites and had an audience of 59 people. If you have staff members who wish to become testers, or wish to review the testing protocols, encourage them to sign up for the spring session. This will be held on April 30 from 13:00 to 16:00. More information will be available through the Telehealth network. Tester s Newsletter Page 7

8 Phone Numbers Saskatchewan Aids to Independent Living (SAIL) Contact: Anne Bosgoed 3475 Albert Street Regina, SK S4S 6X6 Phone: Fax: Oxygen Supply Companies Airgas Puritan Medical Prince Albert: or Regina: or Saskatoon: or Medigas A Praxair Company Regina: or Saskatoon: or Swift Current: or Prairie Oxygen Ltd. Regina: or Saskatoon: or Provincial Home Oxygen Inc. Estevan: or Lloydminster: (780) or Prince Albert: or Regina: or Saskatoon: or VitalAire Healthcare Lloydminster: Regina: or Saskatoon: or th Street East Saskatoon, SK S7H 0S5 Ph: Ext. 241 or LUNG