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For Your Health: Seven Hacks for an Active Winter

For Your Health Graphic 2020



Even with the excitement of kicking off a new year, winter can be tough for physical activity. The days are cold, the nights long. And that cozy spot on the couch seems to call your name.

COVID-19 hasn’t helped. On top of other demands on our energy and time, we’ve had to modify our exercise routines with safe, at-home workouts and physically distanced walks and runs. These were essential changes, of course, but after nearly a year they can start to feel a bit stale.

The physical and mental benefits of exercise remain really important, though. So, try to freshen up your routine and boost your motivation with these seven simple tips:

Colditz

Make a small change. Sometimes just a minor change to your routine can renew your outlook. Try a new walking route, exercise at a different time or find a new online video instructor.

Chat with friends (virtually). Friends and family can keep us on track. While most in-person meet-ups are still unsafe because of the pandemic, a regular group chat via text, video or app can be nearly as good, allowing us to share goals, successes, frustrations and special tricks to stay motivated. You can even synchronize your digital chats and your solo walks, so you can virtually walk together but be safely apart.

Give it five minutes. The hardest part of any activity can be getting started. When you just don’t feel like lacing up your workout shoes, commit to just five minutes. That’s all. After that, stop if you want. With the hardest part behind you, though, many times you’ll want to keep going.

Sign up for a virtual event. It’s been a rough year if you like in-person gym classes and 5K races. But one benefit of coronavirus restrictions has been an explosion in the number of virtual events. From virtual dance retreats to walking distance challenges, most any type of in-person event you’ve thought about is available virtually. Search online and see what sparks your interest.

Try mid-day. Working out when it’s dark is just part of winter, and it can be nice. But switching things up and fitting in a walk, run or even a yoga video when it’s still light outside can be a great change of pace.

Layer up. When it’s safe, exercising outside in winter can be a lot of fun, especially if you dress correctly for the conditions. Wearing layers allows you to take off or put on pieces of clothing as needed. For extra safety if you head outside when it’s dark, add reflective gear – for you and your pets.

Leave little reminders. Whether it’s a sticky note on the bathroom mirror or a stack of exercise clothes by the front door, leaving reminders for yourself about your exercise goal can be the nudge you need to make it happen.

With the distribution of highly effective and safe coronavirus vaccines, there’s hope that life will begin to feel more normal this spring or summer. As we gradually make progress against the pandemic, it’s still important that we keep up physical distancing and other safety measures. It’s also important that we continue to look after ourselves. And staying active is a big part of that. It may take more creativity than normal, but you can do it.

It’s your health – and your New Year. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Jump-start your New Year

For Your Health Graphic 2020



It’s safe to say many of us are excited about a new year. I know I am. 2020 has been strange and challenging, and while the pandemic will continue to affect us for a while, news of highly effective vaccines offers real hope that we may return to more normal times later in 2021.

Traditionally, this rollover to the New Year is a time when many of us focus on health and wellness goals. While this has been anything but a traditional year – including extended lockdowns, medical scares and job stresses – it’s likely many people will still set goals for 2021. Health has certainly been top of mind the world over.

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If you’re considering making a New Year’s resolution, some simple steps can improve your chances of success. It begins with how you choose what to work on.

“Pick one goal to start,” says Liz Salerno, a biobehavioral scientist at Washington University School of Medicine in St. Louis. “And keep it SMART.”

That’s an acronym for “specific, measurable, attainable, relevant and time-based.” It’s a guide that can help us avoid common pitfalls when choosing a health goal, like making a goal too broad or too hard.



“For example, a SMART goal for getting more exercise could be, ‘I want to increase my number of daily steps from 5,000 to 7,000 by the end of February,’ ” Salerno said. “The goal is specific about the type of exercise, measurable in steps, attainable by being a reasonable increase, relevant to exercise and time-based with an end date.”

You can apply the SMART approach to almost any health goal, whether it’s a new activity or a behavior you want to maintain or build upon. Setting goals also lets us harness unique experiences from the past year and turn them into long-term lifestyle changes. Maybe you’ve gone on more family bike rides during the pandemic; you can set a goal to keep that up three times a week. Or maybe you’ve been cooking at home more and want to eat more plant-based foods; you can set a goal to add one meat-free dinner to your week.

Once you’ve chosen your goal, the next step is to start working toward it. Salerno suggests these tips:

  • Track your progress regularly, and adjust your goal up or down over time. “Recalibrating is necessary and important; it prevents us from getting discouraged,” she said.
  • Recruit a friend so you can enjoy working toward the same goal and hold each other accountable. Just remember physical distance and other safety guidelines.
  • Remind yourself why you chose your goal. For example, to keep up with the grandkids or to lower cancer risk. When things feel tough and you wonder “Why am I doing this?” you’ll have an answer.

On top of its health benefits, setting a new goal and working toward it can be fulfilling, even uplifting. That can help pave the way for a more positive 2021. Yet, even as we work toward our health goals, it’s important not to lose sight that the pandemic can continue to challenge us day-to-day.

“It’s critical that we show ourselves grace if we fall short of our goals during this public health crisis,” Salerno said. “Be patient with yourself and others. We’re all in this together.”

It’s your health – and your New Year. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Getting a flu shot is more important than ever

For Your Health Graphic 2020



“It’s September, and I’ve already had my flu shot.”

If you want to know how important it is to get the flu vaccine this year, that note from a friend last month may help. Each year, he puts off his flu shot as long as possible and sometimes even skips it, against good advice.

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But he knows this year is different, very different. With the coronavirus outbreak ongoing, and the height of flu season just around the corner, getting the flu vaccine is more key than ever. And it’s not just important for personal health; it’s also important for the health of our neighbors and a health-care system overtaxed from a pandemic.

So far, more than 7 million Americans have been infected with COVID-19, and more than 200,000 have died. And in recent seasons, the flu has led to millions of illnesses and thousands of deaths. Until we have a coronavirus vaccine, getting a flu shot will be one of the best and easiest ways we can soften the combined impact of these two diseases.

The flu vaccine is extremely safe, and although it doesn’t 100 percent protect against the flu, it does lower the risk of contracting it. The vaccine also can make the flu less severe if you do get it. On top of this, the flu vaccine helps protect others by making it less likely you’ll get the flu and then pass it on to family, friends, co-workers or others.

Keeping flu numbers lower in a community helps reduce strain on hospitals and health-care providers, which is especially important as cases of both COVID-19 and flu are likely to increase the further into fall and winter we move. In the 2018-2019 season alone, the flu vaccine prevented more than 2 million flu-related doctors’ visits and nearly 60,000 hospitalizations.

If more people get vaccinated, fewer people overall will need medical care. Plus, fewer people will arrive at doctors’ offices and medical centers who need to be tested to rule out COVID-19, since the two illnesses share some similar symptoms, like fever, chills, headache, cough and fatigue.

The Centers for Disease Control and Prevention (CDC) recommends an annual flu shot for almost everyone age 6 months and up. And, for most people, the vaccine is pretty easy to get. It’s available at many doctors’ offices, pharmacies, workplaces and local health departments. Some facilities even offer drive-through clinics. Depending on where you live, though, children may need to be vaccinated at a health-care provider’s office.

Most shots are free if you have insurance. Without insurance, they can cost about $30-$40, with some types being more expensive. Contact your state or local health department for information on flu shot locations and affordability. Vaccinefinder.org is another good tool for finding flu shots near you.

With so much focus on COVID-19, it’s easy to forget about the flu since we deal with it year after year.

But the reality is, because of the pandemic, it’s very important to do what we can to make this as quiet a flu season as possible.

So, whether you get a flu shot every year, or you’ve never had one, follow my friend’s example and make it a real priority this fall. Let’s all just roll up our sleeves and get it done.

It’s your health. Take control.


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Preparing for healthy holidays

For Your Health Graphic 2020



The crisp fall days let us know that Thanksgiving is getting close. It’s a wonderful holiday for enjoying comforting food and connecting with family and friends. It’s also the first major holiday this season that will feel different because of the pandemic.

With COVID-19 rates remaining high, it’s important to keep our families, our friends and ourselves as safe and healthy as possible through the coming holidays. Below are tips to consider as you start making plans and to-do lists. Some relate directly to the coronavirus, others to health in general.

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Celebrate safely

Thanksgiving often means a big sit-down meal with close family, distant cousins and old friends. But a classic indoor gathering also increases the risk of spreading the coronavirus. If just one person has the virus – even if he or she doesn’t feel sick – it can easily spread to others. A safer way to celebrate is to have a smaller Thanksgiving meal just with family members who live together. You can connect with others by coordinating and enjoying your mealtime over a group phone call or video chat. Record it for those who can’t take part. It won’t be the same, but you can still show you’re thinking of them. Other safety guidelines and ideas from the Centers for Disease Control and Prevention are at bit.ly/HolidaysCDC and bit.ly/ActivitiesCDC.

Check in on your family’s health

“The holidays are a time when we check in with extended family members, even if we can’t be together in person,” said Bettina Drake, Ph.D., M.P.H., associate director of community outreach and engagement at Siteman Cancer Center at Washington University School of Medicine in St. Louis. Part of that can be catching up on their health and well-being. Drake suggests three ways to do that:

  • Ask relatives (and friends) how they’re doing, especially if they live alone, and see if there’s anything they need.
  • If some have missed doctor’s appointments or screenings because of the pandemic, encourage them to contact their health-care providers about getting back on track. Help them make an appointment, even.
  • If you haven’t recently, update your family health history for your relatives to share at their next doctor visits. If a disease like cancer or heart disease runs in the family, there may be steps that can help reduce or manage your risk.

Keep up with healthy behaviors – and look after yourself

Combine the busy holidays with shorter, colder days – plus a global pandemic – and it’s really easy to get knocked off our regular health and self-care routines. But for our well-being, it’s important to stay physically active, eat healthy food, get enough sleep and just take some time for ourselves. It’s not always easy to do – and can take some creativity these days – but it can also have real benefits.

It’s safe to say most of us are tired of pandemic life, and with some of our favorite holidays coming up, it’s tempting to take a break from precautions and celebrate like we would normally. But it’s important that we keep taking steps to stay safe and healthy and to curb the coronavirus outbreak. Yes, the holidays will be different this year. But different doesn’t have to mean worse. With a little extra effort, they can still be special, meaningful and offer a chance to connect with loved ones.

It’s your family’s health. Take control.

Additional resources

Bettina Drake, Ph.D., M.P.H., associate director of community outreach and engagement at Siteman Cancer Center, recommends these other websites for more information:

Family history basics: bit.ly/FamHistoryCDC

Cancer screenings and COVID-19: bit.ly/ScreeningsAndCovidACS

Healthy behaviors: 8ways.wustl.edu


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Remember cancer screenings and other important health care

For Your Health Graphic 2020



After a few months that felt like summer, we’re heading into a fall that will be different than most of us imagined. The coronavirus outbreak continues to impact our daily lives – and, unfortunately, will likely do so for a while.

So, as we keep up our efforts to stay safe from COVID-19, it’s important that we not forget to look after other aspects of our health as well. This means keeping up with things like exercising, eating healthy food, connecting (virtually) with friends and getting enough sleep. It also means getting back on track with any medical care we’ve missed.

Since the coronavirus outbreak took hold in the U.S., there’s been a major drop in the number of people getting cancer screenings, vaccinations and other key care.

Dr. Graham Colditz Headshot
Colditz

That’s not surprising, of course. In March and April, doctors’ offices and hospitals across the country stopped or limited non-essential care to curb spread of the virus and to prepare to treat infected patients. At the same time, many people have avoided appointments to try to reduce their risk of infection. And, now, with new spikes in COVID-19 in parts of the country, we’re seeing some variations of this play out again.

Yet, we know that missing regular medical care can impact health, especially the longer it’s delayed. Skipped cancer screenings can lead to the disease being diagnosed later, when it’s harder to treat. Missed vaccinations can make children and adults more susceptible to serious infectious diseases. And delayed follow-up for chronic conditions like unhealthy blood cholesterol, diabetes and high blood pressure can increase the risk of heart attack and stroke.

“It’s important to make sure you still get recommended cancer screenings, even during the pandemic,” said Dr. Jean Wang, professor of medicine at Washington University School of Medicine in St. Louis. “Taking action now to prevent cancer and other serious illnesses will help keep you much safer and healthier in the long run.”

The specifics of doing that, though, can vary from person to person and from region to region, depending on the status of the COVID-19 outbreak and the capacity of facilities to see patients.

The best approach is to contact your health-care providers and, together, discuss plans for safely getting back on track with the care you need. This may mean scheduling in-person appointments, meeting remotely through telehealth, or checking back with them sometime in the near future.

Importantly, any urgent concern about your health should be addressed immediately. “If you are having symptoms, do not delay getting care,” Wang said. “Since hospitals have adapted to the coronavirus epidemic by taking necessary precautions, it is very safe to come in to get evaluated.”

If cost of care is an issue because of a lost job, lost health insurance or other reason, some resources may help. Healthcare.gov has information about eligibility for Medicaid or health plan enrollment. Another option, Wang adds, includes federally qualified health clinics, “which are available all across the country to care for people regardless of their ability to pay or their insurance status.” Contact your providers, hospital or local health department, or visit findahealthcenter.hrsa.gov, for additional information on accessing care.

While much of our focus remains on combating the coronavirus outbreak, let’s not lose sight of the important goal to stay healthy overall. Cancer screenings and regular medical appointments can be an essential part of that. So, for ourselves and our families, it’s a good time to make a plan to get back on track.

It’s your – and your family’s – health. Stay in control.


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

For Your Health: Continuing to stay socially connected while physically distanced

For Your Health Graphic 2020



If you feel that time has been moving at a different pace during the coronavirus pandemic, it seems you’re not alone. A study published last month in the journal PLOS ONE found that most respondents to a questionnaire reported experiencing a distorted sense of time during lockdown. For some, days and weeks seemed to pass more quickly than normal. For others, more slowly.

One factor that was linked to perception of time was participants’ satisfaction with their levels of social connection. Those who reported being more satisfied with their social interactions felt time moved faster during lockdown. Those who reported being more dissatisfied felt time moved slower.

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This is one example of how social connections may affect our experiences during this prolonged disruption to our daily lives. And while it’s too early to know for certain how the pandemic has influenced the long-term mental and emotional health of people, we do know that – outbreak or not – most people generally do better when they have regular social connections and social support. We are social animals, after all.

So, as the pandemic continues to stretch on and physical distancing, work from home and other stay-safer guidelines remain in place for many parts of the country, it can be important that we also keep working to stay socially connected – safely. Below are suggestions for staying in touch with family and friends.

Keep it virtual – The safest way to socialize remains virtual, connecting through our phones and computers. That can be frustrating to read, but it’s likely to be especially important as the weather turns cold and we spend more time indoors, where we know the virus spreads much more easily.

Try something different – While it’s hard to replace in-person connections, one way to make virtual socializing more appealing is to mix things up. Tired of video calls? Try group message chats and phone calls. Maybe even send a handwritten note in the mail. For something more cutting-edge, host a movie night, where you and friends can individually stream the same movie and chat about it in real time. New options to stay connected launch regularly. Explore what’s available, and keep things fun and engaging.

Make it a priority – Of course, even with the latest technology, it can be easy to let our social connections slide. That’s only natural when our normal routines have been upended, and for such a long time. If staying connected is important to you, one way to make it happen is to schedule it. Set up regular times to connect with people. Maybe Sunday night is the time you call your family. Tuesday evening you play online trivia with co-workers. And Friday night you have a long video chat night with close friends. When it’s planned for a specific day and time, and someone is expecting to get together, you’re less likely to skip.

These are difficult times for many people, for many different reasons. And mental health can take a particular hit from extended periods of social isolation and loneliness. If you need help, reach out to a health-care provider, or visit the National Alliance for Mental Illness (nami.org) for resources. If you ever feel you’re in crisis, call 911 and the National Suicide Prevention Lifeline (1-800-273-8255) immediately.

Half a year into the pandemic, we’re all probably more than a little tired of it. But we need to keep doing what we can to get things under control. Even as we keep up physical distancing and other guidelines, however, we can still safely maintain our important social connections – with some creativity and patience. We’ll get through this – together.

It’s your health. Take control.


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

Siteman Cancer Center named among top U.S. cancer centers

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine has been named among the top cancer centers nationally by U.S. News & World Report. The recognition is part of the overall ranking of Barnes-Jewish and Washington University, which are No. 18 on the news magazine’s 2020-21 “Best Hospitals” list, released today.

Siteman was named No. 11 in cancer care, based on a review of 899 hospitals. Health-care facilities are chosen largely on patient outcomes and other data and a national survey of physicians.

In addition to their national rankings, Siteman and Barnes-Jewish each were ranked No. 1 in the St. Louis region and No. 1 in Missouri in their respective categories.

“Being recognized as one of the nation’s top cancer programs is an honor,” said Timothy J. Eberlein, MD, Siteman’s director and the Spencer T. and Ann W. Olin Distinguished Professor and head of the Department of Surgery at the School of Medicine. “More importantly, it speaks to the extraordinary care we provide to our patients, care that’s built on one of the top cancer research programs anywhere.”

Siteman’s “Best Hospitals” listing follows recent recognition by the National Cancer Institute (NCI), the principal federal agency for cancer research and training. Based on the NCI’s review of Siteman research programs, the cancer center received the agency’s highest possible rating, “Exceptional.”

Siteman is Missouri and southern Illinois’ only NCI-designated Comprehensive Cancer Center and the only cancer center in that area to be nationally ranked by U.S. News & World Report. The cancer center treats more than 75,000 patients, including 12,000 newly diagnosed patients, every year. Care is provided at six locations in the St. Louis region: on the Washington University Medical Campus and at Northwest HealthCare, part of Christian Hospital; Barnes-Jewish St. Peters Hospital; Barnes-Jewish West County Hospital; Siteman Cancer Center-South County; and Memorial Hospital East in Shiloh, Ill. Siteman also partners with Siteman Kids at St. Louis Children’s Hospital in the treatment of pediatric patients. The facilities all are affiliated with BJC HealthCare.

Barnes-Jewish Hospital and its Washington University physician partners also are part of U.S. News & World Report’s top 20 honor roll of hospitals that excel in complex specialty care.

To determine its rankings, U.S. News & World reviews 16 specialties. Rankings for 12 of them, including cancer, are based on a mathematical model combining mortality rate for particularly challenging cases, patient experience and other data, as well as on the expert opinions of specialized physicians nationally. Learn more about the methodology here.

The 2020-21 “Best Hospitals for Cancer” list is available at https://health.usnews.com/best-hospitals/rankings/cancer. Rankings also will appear in U.S. News & World Report’s “Best Hospitals 2021” guidebook, available Oct. 6.

For Your Health: Helping kids stay healthy this summer

For Your Health Graphic 2020



The strange times continue. After finally getting back to a semblance of pre-pandemic life in many parts of the country, we’re seeing safety orders extended or put back in place as the coronavirus shows just how formidable it is.

Children, thankfully, haven’t been as directly impacted by COVID-19 as adults. They can still get infected with the virus but will often show little or no sign of illness. Many children, though, have been affected in other important ways. Their daily lives have changed, and in a manner not always good for long-term health.

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While much of this is out of our control, there are simple steps we as parents – or grandparents or guardians – can take to support the well-being of children in our lives, on top of those steps that also protect against the coronavirus.

While each of these was important before the pandemic hit, they are even more so now as our new normal is likely to continue for a while.

Try to reduce screen time. Even as economies have opened up, many of us are still spending more time at home than we normally would, especially during summertime. Streaming videos and playing on the phone can be a fun way for kids to fill that time. Keeping such screen time to a reasonable amount, though, can give kids the chance to move around more and explore other fun activities. That variety can be good for both their mental and physical health. General health recommendations are to keep screen time to two hours or less per day. That may not make sense during this time of pandemic, with all that kids and parents are going through. Any drop in the amount of screen time, though, is a good place to start.

Stock up on healthy snacks and keep them in the open. The in-person school day can provide healthy structure for children. When that goes away in summer, we know that some children’s eating and activity habits can change for the worse. And when many schools moved to remote at-home learning this March, those summer behaviors had time to take hold even earlier in the year. One way to help children build on healthy eating habits instead is to stock up on healthy snacks and keep them where they’re easy to find – on the counter, or at eye-level in the fridge or cupboard. Good options include fruit, cut-up vegetables, whole-grain cereals and crackers, low-salt nuts and fizzy water. And try to cut way back on the unhealthy snacks in the house. This includes things like sugary soda, energy drinks, chips, cookies and ice cream. If food security is ever an issue, contact your local food pantries or feedingamerica.org.

Try to be active every day. With safety orders in place and normal schedules upended – for children and parents – it can be harder than it used to be for kids to get their recommended 60 minutes of daily physical activity. That activity, though, can be very beneficial for children’s well-being. Try to think of ways to help get your children moving during the day. Have them come with you on your morning walk, follow along with an exercise video or go to a park to play soccer with friends – if it’s safe and allowed by health orders.

Make a plan to get back on schedule with vaccines. As the nation largely shut down this spring, health-care visits for childhood vaccinations plummeted. But as we’ve learned how to get patients back into hospitals and medical offices more safely, it’s a good time to contact your health-care provider or local health department to talk about getting back on track with your child’s vaccinations, so they’re protected against measles, mumps, HPV and other serious diseases.

Look after yourself. In normal times, parenting can be challenging. These days of coronavirus can make it even harder. So, it’s important that you take time to look after your own well-being. As parents, the better we feel, the more energy we can bring to caring for our children. The pandemic has affected people in many different ways, and if you need help, seek it out. A web search or call to your local health department or human resources office at work can be a good place to start.

It’s your family’s health. Take control.


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

Blood test for metastatic prostate cancer could suggest better treatment options

A blood test developed at Washington University School of Medicine in St. Louis could help determine next steps for patients whose prostate cancer has spread despite treatment.

The test is designed to help doctors determine if a patient’s disease can’t be effectively treated with a newer therapy called androgen receptor (AR) targeted therapy. Knowing this, a patient could decide whether to pursue a more traditional, and potentially more beneficial, therapy.

Results of a study evaluating whether the test can accurately predict treatment resistance suggest the technology is promising, and the researchers are continuing to refine it.

Chaudhuri
Aadel Chaudhuri, MD, PhD

Called EnhanceAR-Seq, this “liquid biopsy” test involves looking for fragments of DNA in the blood called “cell-free DNA.” This yields helpful information otherwise available only with a more invasive biopsy of the tumor, itself. If the blood test predicts resistance to drugs that target the AR pathway, a patient can be guided to pursue another type of treatment, said researcher Aadel Chaudhuri, MD, PhD, an assistant professor of radiation oncology at the School of Medicine and a radiation oncologist at Siteman Cancer Center.

Maher Christopher
Christopher Maher, PhD

“EnhanceAR-Seq predicted survival in metastatic prostate cancer patients who were treated with AR-targeted treatment,” he said. “Every single patient who was found to be positive by EnhanceAR-Seq developed treatment resistance, and unfortunately these patients were much more likely to die from their disease.”

Russell Kent Pachynski Md
Russell Pachynski, MD

The findings were published online in JCO Precision Oncology, a flagship journal from the American Society of Clinical Oncology. Chaudhuri shares senior authorship with Christopher Maher, PhD, an associate professor of medicine and assistant director of the McDonnell Genome Institute, and Russell Pachynski, MD, an assistant professor of medicine and a medical oncologist at Siteman. Ha Dang, PhD, an instructor of medicine, and Pradeep Chauhan, PhD, a postdoctoral scholar in radiation oncology, both at the School of Medicine, are lead authors. Chaudhuri, Maher, Pachynski and Dang are Siteman research members.

Second leading cause of cancer death

Prostate cancer is the second leading cause of cancer death in American men, and it is estimated that one in every 41 will die of prostate cancer. The most deadly form of the disease is treatment-resistant metastatic prostate cancer, which grows despite treatment and may not be sensitive to drugs that target the androgen receptor pathway. One way to identify these high-risk patients is by tracking an alteration in the blood called AR-V7.

“Although noninvasive, this previous approach has suboptimal sensitivity, meaning that it missed some patients with treatment-resistant metastatic disease,” Chaudhuri said.

The current research builds on prior work by Chaudhuri, and by Dang and Maher. Chaudhuri previously showed that cell-free DNA-based liquid biopsies can detect minimal areas of cancer that remain, after treatment. Dang and Maher showed that advanced prostate cancers have distinct tumor genomic profiles. Together, they embarked to develop a test combining their expertise, which resulted in EnhanceAR-Seq.

“We believe our strategy significantly advances the field by monitoring the most impactful mutations to predict treatment response while maximizing the patient population that may benefit from EnhanceAR-Seq,” Maher said.

The researchers compared results from EnhanceAR-Seq with the AR-V7 blood test and showed that EnhanceAR-Seq was far more sensitive.

“While the clinical blood test for AR-V7 was an important advancement in the prostate cancer biomarker world, our EnhanceAR-Seq really takes liquid biopsies to the next level,” Pachynski said. “With vastly improved sensitivity and specificity over the current standard-of-care AR-V7 test, we are able to better detect resistance to treatment earlier.”

“EnhanceAR-Seq was good at detecting secondary resistance too,” Chauhan said. “Sensitivity of detection went up further as we monitored some patients over time, suggesting this could really help the clinician.”

The researchers believe that their method, which requires a simple blood draw, could be made even simpler in the future.

“EnhanceAR-Seq could potentially be adapted to urine too, something we are investigating in the lab,” Chaudhuri said.

“Ultimately, our goal with this is to personalize prostate cancer treatment choices at the earliest time points, to improve outcomes for these patients,” Pachynski said. “I see EnhanceAR-Seq as playing an important role, though future studies need to be done to validate our work here and show that it improves clinical decision-making for our high-risk metastatic patients.”


Participant samples were analyzed as part of the “Circulating Tumor DNA (ctDNA) for Early Treatment Response Assessment of Solid Tumors” study (ClinicalTrials.gov Identifier: NCT04354064). This work is supported by the Alvin J. Siteman Cancer Research Fund, National Cancer Institute, Cancer Research Foundation, an American Cancer Society Institutional Research Grant, a Sidney Kimmel Scholar Award, the Galen Hoskin and Dina Wolkoff Giving Fund and the Prostate Cancer Foundation.

For Your Health: Being sun-safe when getting back outside

For Your Health Graphic 2020



With the warm summer months finally here, and stay-at-home restrictions starting to ease, many of us are enjoying the chance to get outside more often. The fresh air alone can feel wonderful after many weeks of being holed up in our homes for longer than many of us imagined we’d be. Add in the physical activity and opportunity to just add something new to our days, and it can provide a real physical and mental boost.

Of course, in our excitement to get outside, it’s important not to forget the physical distancing and other coronavirus safety measures that have helped keep infections in check in many parts of the country. Another step that will help keep you and your family healthy when heading outdoors after so much time inside: protecting yourself from the sun.

Dr. Graham Colditz

This can feel like a small thing in the face of a pandemic, but we shouldn’t neglect our overall health even while working to curb the spread of the coronavirus. And sun safety is no exception. More than three million people in the U.S. each year are diagnosed with skin cancer caused primarily by exposure to sunlight and other ultraviolet light, including about 100,000 with deadly melanoma. And even less-serious skin cancers can require treatment that leaves scars and impacts quality of life.

Steps that help protect against skin damage from the sun will no doubt sound familiar: use sunscreen, find shade and wear sun-protective clothing, like hats and long-sleeved shirts. But, with this spring and summer unique in so many ways, it may be important to keep a few additional things in mind to help you and your family stay safe in the sun.

In a usual year, springtime provides us a slow transition to outdoor activities. By the time the long, sunny days of summer arrive, we’ve had a chance to build our sun-safety routines. This spring has been very different. After so much time spent sheltering in place, many of us are essentially skipping spring and heading outside straight into peak summer sun. So, try to be aware of this and take extra care. Think about all the things you’ll need. Find those hats and long-sleeved shirts, and make sure you have enough sunscreen, checking expiration dates for good measure.

Being in the shade is one of the best ways to protect yourself from the sun. But shade may be harder to come by this summer with physical distancing. Staying six feet apart from others can limit free space under shade trees or park pavilions. Also, some outdoor areas remain open only for exercise, meaning relaxing in the shade isn’t officially allowed. Plan accordingly. You may need to shorten your time outside, so you’re less exposed to direct sun, or you may need to get out early or late in the day, when the sun is low in the sky and less intense.

With daycare closed and most schools moving to remote instruction this spring, many families have had a lot of together time already this year. And that trend is likely to continue this summer as childcare, summer camps and other programs are canceled or offering reduced services. Heading outside with the family is a great way to help fill the day with antsy kids. At the same time, it’s important to be mindful of protecting them from the sun, particularly if they’re taking more trips outside than they might normally.

Sun damage in youth plays an outsized role in skin cancer risk later in life. So, be sure to slather kids up with sunscreen, reapplying when needed, and having them wear sun-protective hats and clothes. And nearly as importantly, try to be a good sun-safe role model yourself.

While our daily lives are not back to where they were pre-coronavirus, the joy of getting outside during the summer months certainly helps things feel more normal. And with just a few easy steps, we can help make those outings as sun-safe as they are enjoyable.

It’s your health. Take control.


Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.