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One such nurse is Lorrie Graaf, RN, a public health
adviser who works for the CDC. She was assigned to Iowa's
Department of Public Health in Des Moines to establish
and manage its comprehensive cancer control program.
Having no funds for skin cancer prevention activities,
Graaf has come up with innovative ways to educate the
public. One example is the partnership created with
Pioneer Hi-Bred International Inc., a seed company in
Des Moines, to spread the word about sun exposure.
In order to raise seed corn, seasonal field workers
are employed to detach the tassels from corn. Most of
them are teenagers earning money during the summer.
This year, Pioneer expected to have more than 27,000
employees in 10 states involved in de-tasseling efforts.
"That's a fairly significant population that's
at risk for sun exposure," Graaf said, "so
we offered to partner with Pioneer and offer them material
developed by the CDC called 'Choose Your Cover.' "
Pioneer printed it and distributed it to its worksites.
Graaf hopes these efforts will increase awareness about
the dangers of sun exposure.
Under a legislative mandate, the Iowa Department of
Public Health completed a study of comprehensive cancer
control. Based on the findings, Graaf learned that while
the new case rates for skin melanoma are relatively
low in Iowa compared with other cancers, the new case
rates have increased in the past five years. Although
the rate of new cases is still low, the death rate for
melanoma is relatively high.
Graaf believes melanoma may be emerging as a more aggressive
form of cancer with a significant health burden on the
state.
"One of the more challenging things about melanoma
[and skin cancer in general] is that it's thought of
as being a disease of elderly individuals," said
Peggy Esper, MSN, CS, RN, an advanced oncology certified
nurse and a nurse practitioner in the Department of
Medical Oncology at the University of Michigan Comprehensive
Cancer Center in Ann Arbor.
Melanoma, however, is a disease or type of malignancy
that has no preference for age. A majority of patients
are men aged 25 to 55.
"In looking at the statistics for cancer,"
Esper said, "you see most of the malignancies have
leveled off and we're not seeing the increases in incidence
rates that we had seen in previous years except for
melanoma and non-Hodgkin's disease lymphoma.
In addition to clinical trials research looking at
different therapies under investigation for patients
with stage III and IV melanoma, Esper is conducting
her own study. She has seen an inordinate number of
melanoma patients with a previous history of hypothyroidism
and questions whether the disease may be related to
thyroid function or medication.
By carrying out a retrospective chart review, Esper
is trying to find a commonality that will provide insight
into factors that cause or contribute to the development
of melanoma.
"When it comes to research, the reality is that
you can see the potential for a drug to help people,"
Hill said, "and I've seen it."
She recalls a female patient with advanced T-cell lymphoma
who had large, visible tumors. As a result of research
protocols and drugs, the tumors subsided. "She's
now a functioning member of society," Hill said.
"She goes out to eat. She's not a recluse."
At M.D. Anderson, Hill is the study coordinator for
research protocols concerning cutaneous diseases, including
T-cell lymphoma and basal cell carcinoma. That research
is aimed at discovering what will put the disease in
remission or at least give patients with end-stage disease
a better quality of life.
Skin cancer research doesn't receive the publicity
that other types of cancers do, some specialists say.
"We are not a glamorous specialty," Hill
said. "I tell people dermatologic diseases or skin
diseases are not acceptable diseases in our society."
But the fact remains that skin cancer can be difficult
to detect.
"Melanoma can be a little black or discolored
mole that is ignored and by the time it's noticed,"
Hill said, "the patient has disseminated disease."
As for Barbara, four years have passed. She has an
excellent prognosis, most likely the result of early
diagnosis and treatment. "Occasionally, we reflect
on what might have been," Tawa said, " but
we remind ourselves that listening to the patient changed
the course of events."
Contact Joan Sosin at joansosin@aol.com
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