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Shared Decision Making

What is Shared Decision Making?

Colorectal (Colon) Cancer

What is Colorectal Cancer?

Colorectal Cancer is the second leading cancer killer in the United States, but it doesn’t have to be. If everyone aged 50 years or older had regular screening tests, at least 60% of deaths from this cancer could be avoided. So if you are 50 or older, start getting screened now.

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Why Should I get screened?

Colorectal Cancer Can Start With No Symptoms Precancerous polyps and early-stage colorectal cancer don’t always cause symptoms, especially at first. This means that someone could have polyps or colorectal cancer and not know it. That is why having a screening test is so important.

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Screening Tests-at-a-Glance

The U.S. Preventive Services Task Force (USPSTF) recommends colorectal cancer screening for men and women aged 50–75 using high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened. The benefits and potential harms of the recommended screening methods vary. Discuss with your doctor which test is best for you. Getting screened could save your life!

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Additional Resources

Additional resources and education regarding this topic can be found on the CDC page for Colorectal (colon) Cancer. CDC Site

Prostate Cancer

What is Prostate Cancer?

There are several types of cells in the prostate, but nearly all prostate cancers start in the gland cells. This kind of cancer is known as adenocarcinoma. Some prostate cancers can grow and spread quickly, but most of the time, prostate cancer grows slowly. Autopsy studies show that many older men (and even younger men) who died of other diseases also had prostate cancer that never caused a problem during their lives. In many cases neither they nor their doctors even knew they had it

Who has a higher risk for prostrate cancer?

•Men who are 50 years old or older.
•African-American men.
•Men whose father, brother, or son had prostate cancer

What Screening Tests Are There?

Two tests are commonly used to screen for prostate cancer—

•Digital rectal exam (DRE): A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
•Prostate specific antigen (PSA) test: Measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others. PSA levels also can be affected by—

•Certain medical procedures.
•Certain medications.
•An enlarged prostate.
•A prostate infection.

Because many factors can affect PSA levels, your doctor is the best person to interpret your PSA test results.

What Are the Symptoms?

Different people have different symptoms for prostate cancer.

Some symptoms are –

•Difficulty starting urination.
•Weak or interrupted flow of urine.
•Frequent urination, especially at night.
•Difficulty emptying the bladder completely.
•Pain or burning during urination.
•Blood in the urine or semen.
•Pain in the back, hips, or pelvis that doesn’t go away.
•Painful ejaculation.

If you have any symptoms that worry you, be sure to see your doctor right away. Keep in mind that these symptoms may be caused by conditions other than prostate cancer.

How is Prostate Cancer Treated?

Different types of treatment are available for prostate cancer. You and your doctor will decide which treatment is right for you. Some common treatments are—

•Active surveillance. Closely monitoring the prostate cancer by performing prostate specific antigen (PSA) and digital rectal exam (DRE) tests regularly, and treating the cancer only if it grows or causes symptoms.
•Surgery. A prostatectomy is an operation where doctors remove the prostate. Radical prostatectomy removes the prostate as well as the surrounding tissue.
•Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer. There are two types of radiation therapy— ◦External radiation therapy. A machine outside the body directs radiation at the cancer cells.
◦Internal radiation therapy (brachytherapy). Radioactive seeds or pellets are surgically placed into or near the cancer to destroy the cancer cells.
•Hormone therapy. Blocks cancer cells from getting the hormones they need to grow.

Other therapies used in the treatment of prostate cancer that are still under investigation include—

•Cryotherapy. Placing a special probe inside or near the prostate cancer to freeze and kill the cancer cells.
•Chemotherapy. Using special drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through your veins, or, sometimes, both.
•Biological therapy. Works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.
•High-intensity focused ultrasound. This therapy directs high-energy sound waves (ultrasound) at the cancer to kill cancer cells.

Complementary and Alternative Medicine-

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor before you start any kind of complementary or alternative medicine.

Which Treatment Is Right for Me?

Choosing the treatment that is right for you may be hard. Talk to your cancer doctor about the treatment options available for your type and stage of cancer. Your doctor can explain the risks and benefits of each treatment and their side effects.

Sometimes people get an opinion from more than one cancer doctor. This is called a “second opinion.” Getting a second opinion may help you choose the treatment that is right for you

Additional Resources

CDC Site
US Preventative Task Force
Mayo Clinic PSA Test Basics
Cancer.Gov Prostate Cancer Info

InfoGraphics

CDC Infographic
Cancer.Gov Infographic
PSA Test Options Infographic
Prostate Enlargement Inforgraphic

Chronic Pain Pathway

Chronic Pain Pathway at Physicians Medical Center:

Physicians’ Medical Center has created the Pain Pathway in concordance with upcoming state guidelines and CDC recommendations. Any new patient entering the practice with an established chronic pain treatment plan that includes opioid or narcotic medications (including but not limited to: hydrocodone, oxycodone, morphine, tramadol, fentanyl) should be aware of the following:

Safety:

CDC reports that almost 2 million Americans age 12 or over either abused or were dependent on opioid pain relievers in 2013, and 16,000 people died in the US from overdose related to opioid pain relievers – four times the number in 1999.
In 2012, Oregon had the highest rate of non-medical use of prescription pain relievers in the nation.
Drug Overdose Report
Prescribing Guideline

PMC Requirements for chronic narcotic use:

•Up to quarterly office visits to review pain, function, and medication

•Random urine drug screens with minimum two yearly

•One individual visit with behavioral health consultant

•Participation in 4 Pain School classes

•Controlled Substance Agreement

•Pain medications from PMC only and use one pharmacy

•Bring pill bottles with you to every appointment

•No marijuana use with narcotic prescriptions

Be prepared to not receive your narcotic prescription refill on your first visit
PMC Goals of Pain Pathway:

•Maintain patient safety at all times

•Enhance function with appropriate pain control

•Use of lowest possible dose of any narcotic prescription

Refill request policy:

•Narcotic refills need to be requested 48 hours in advance

•Prescriptions are to be refilled by Primary Care team

•Only use one pharmacy

•No weekend or after hours requests for narcotics

For more information regarding chronic pain, please visit these websites:

The ACPA
Oregon Pain Guidance
Paintracker

Questions? Contact us.