Cell 2 Soul: The Humane Health Care Blog

Henriette Thompson: Nonagenarian Pianist and Marathoner

Harriette Thompson, a classical pianist and cancer survivor who started to run marathons when she was 76 and ran the fastest time in a marathon for a woman over 90, died on Monday, October 16 in Charlotte, N.C. She was 94. NY Times Obituary.

[In the past few years, she ran] while wearing white tights to cover the open wounds on her legs from radiation treatments for cutaneous squamous cell carcinoma. Over the last seven years she had also dealt with a recurrence of oral cancer, which first struck her in 1986. The short and instructive New York Times obituary has many teaching points and is inspirational.

1. This 94-year-old musician and athlete died from a fall at the facility she was living in, not from her cancers.
2. Although she had squamous cell carcinoma of her legs and was being treated with radiotherapy the skin cancers were not proximate causes of her demise. This corroborates the work of E. Linos on “Nonmelanoma Skin Cancer in the Elderly.” In my opinion, we pay far too much attention to skin cancers which are billable to Medicaid and Medicare than to having patients use canes or having 94-year-old people being extremely cautious about stairs.
3.  This remarkable woman was a pianist until her death, she was an athlete. She had great meaning of her life.

For me, as a dermatologist, this reinforces the fact that treatment of non-melanoma skin cancer in the elderly, especially people over age 85, is not likely to improve their quality of life. Before recommending therapy, we may need to step back and not scare our elderly patients into having unnecessary surgery but, as experts, we should have honest discussions with them. Lesions in certain areas are best treated (around the eyes, nose, ears); but lesions on the torso and extremities can often be followed by active surveillance.These short You Tube videos will interest some of you.

 

 

Poor Lives Matter

The Rich Live Longer Everywhere.
For the Poor, Geography Matters.

By Neil Irwin and and Quoctrung Bui
NY Times April 11, 2016

Here are some excerpts from the Times article:

For poor Americans, the place they call home can be a matter of life or death. New research, has an optimistic message: The right mix of steps to improve habits and public health could help people live longer, regardless of how much money they make.

The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich Americans have gained three years of longevity just in this century. They live longer almost without regard to where they live. Poor Americans had very little gain as a whole, with big differences among different places.

It has long recognized that health care interventions have a much smaller effect on life span than behavioral factors like smoking and exercise. “There remains this misconception in our society that health is determined by health care,” A common thread among many of the places with a smaller longevity gap was population density, with wealthy cities like New York leading the way.

It may be good to know that poor Americans are living a lot longer in some places than in others, but it would be better to know — in terms of specific policy prescriptions — how the places with better results are doing it.

The Times article is based on a report in JAMA (April 10, 2016):

The Association Between Income and Life Expectancy in the United States, 2001-2014 FREE ONLINE FIRST

Raj Chetty, PhD et.al.