Cancer Awareness Calendar 2023

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January

Cervical Cancer Awareness Month

Blood Donor Month

February

National Cancer Prevention Month

Gallbladder and Bile Duct Cancer Awareness Month

World Cancer Day (February 4, 2023)

National Donor Day (February 14, 2023)

Rare Disease Day (February 28, 2023)

March

Colorectal Cancer Awareness Month

Kidney Cancer Awareness Month

Multiple Myeloma Awareness Month

Triple-Negative Breast Cancer Day (March 3, 2023)

International Women’s Day (March 8, 2023)

Anal Cancer Awareness Day (March 21, 2023)

April

National Cancer Control Month

Esophageal Cancer Awareness Month

Minority Cancer Awareness Month

Minority Health Month

Testicular Cancer Awareness Month

World Health Day (April 7, 2023)

National Oral, Head, and Neck Cancer Awareness Week (April 11-17, 2023)

AML Awareness Day (April 21, 2023)

May

Bladder Cancer Awareness Month

Brain Tumor Awareness Month

Cancer Research Month

Clinical Trial Awareness Week

Melanoma and Skin Cancer Awareness Month

Skin Cancer Detection and Prevention Month

Melanoma Monday (May 1, 2023)

Women’s Check-up Day (May 8, 2023)

Women’s Health Week (May 14-20, 2023)

June

Cancer Survivors Month

Cancer Survivors Day (June 4, 2023)

Men’s Health Week (June 12-18, 2023)

July

UV Safety Awareness Month

Sarcoma and Bone Cancer Awareness Month

 August

Summer Sun Safety Month

World Lung Cancer Day (August 1, 2023)

September

Childhood Cancer Awareness Month

Uterine Cancer Awareness Month

Gynecologic Cancer Awareness Month

Blood Cancer Awareness Month

Thyroid Cancer Awareness Month

Ovarian Cancer Awareness Month

Prostate Cancer Awareness Month

MPN Awareness Day (September 14, 2023)

World Lymphoma Day (September 15, 2023)

Take a Loved One to the Doctor Day (September 19, 2023)

October

Breast Cancer Awareness Month

Liver Cancer Awareness Month

National Mammography Day (October 20, 2023)

November

Lung Cancer Awareness Month

National Family Caregiver Month

Carcinoid Cancer Awareness Month

Pancreatic Cancer Awareness Month

Stomach Cancer Awareness Month

Psychosocial and Emotional Impact of Cancer: Change on Career Plans

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As young cancer patients, we have to endure more than our disease, but the life changes that come with it. One of the changes may be a change in career plans, and this can have a varying psychosocial and emotional impact.

For me, personally, having a cancer diagnosis at the age of 27 vastly changed the direction of where my career was headed. I was working in healthcare already and also attending graduate school, but I didn’t know what kind of role I wanted to have in healthcare when I graduated. Getting cancer during this time and going through a very personal, yet somewhat traumatic experience helped me to realize that my purpose in life is to help other cancer patients. However, it’s not always as clear why we got cancer at the age we did, and how that will continually affect us. There are also no clear-cut rules on whether we should continue working even if we’re going through treatment, whom to tell about our diagnosis, and how, or how best to describe a gap in our resume. Luckily, the Cancer and Careers website has all the answers to some of our biggest questions:

  1. Should I tell my employer?
    • Consider the side effects of treatment, the general law about disclosing, and your environment
      • If you think you’ll need to request a reasonable accommodation or medical leave, you may have to disclose a medical condition but not necessarily the diagnosis
      • Is your company big or small? Do people have close-knit relationships?
      • What are your side effects like and will they affect your daily productivity?
  2. If I need to tell my employer, when do I tell them and whom do I go to?
    • It is best to let the people below know when you and your healthcare team have developed a plan for treatment
      • Your boss – generally you are protected by the ADA if you’ve made your employer aware of a medical condition
      • Human resources department
      • Co-workers, if you feel comfortable
  3. What do I tell them?
    • Tell only as much as you want and prepare ahead of time what information you want to share
    • Tell them what to expect, for example, future absences or even changes in appearance
    • Reassure that you’re still a part of the team!
  4. How do I explain a gap in my resume?
    • Remember that you’re not required to disclose your diagnosis during an application process or interview
    • Know that it is prohibited by law for any recruiter to ask about “health issues” should you choose to use that phrase to explain the gap
    • If your resume, list your skills first, and highlight community or volunteer work, as well as part-time and freelance work

More Resources:

How to Comprehensively Explain a Medical Bill to a Patient

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Talking about difficult medical situations and finances can be challenging for anyone. When a patient is suffering or attempting to process a potentially traumatic medical condition, it’s understandable they might get more easily upset or frustrated and have a harder time listening. Still, this is the territory that comes with working as a healthcare professional, and it’s important to be mindful of a patient’s situation when discussing certain topics.

Going over a medical bill, for example, can be incredibly confusing and stressful for a patient. In fact, studies have shown that 72% of patients in the U.S. are confused by their medical bills, which can undoubtedly cause them to be further upset on top of everything else they are dealing with.  Understandably, as a healthcare professional, your day is also exhausting and stressful, but reacting negatively to a patient who is potentially struggling never helps.

While the best scenario would be healthy communication where both the patient and the medical professional speak calmly, understanding that you are both under immense amounts of stress—this is not always the case. And as a healthcare professional, it is ultimately your job to help the patient.

Patients put their trust in you, so it can be upsetting for them when the person they trust is handing them an expensive bill they can’t afford or when their claim gets denied by their insurance. These things can easily damage the trust you’ve built, which can make it hard for the patient to remain calm and understanding.

This article will offer tips and considerations for healthcare professionals to help their patients better understand the medical billing process and how to make the conversation go as smoothly as possible.

Tips for Explaining Medical Bills

The medical billing process is extensive and complex, which is often why it is so confusing for patients. For them, they see things from a very removed perspective—understandably. They are not healthcare professionals, nor do they likely have experience in complex billing processes. So when a bill is much more expensive than they were expecting, it makes sense that they might get upset.

As a medical professional, you understand more thoroughly how the process works and why costs are so high, but the patient does not. So getting defensive is never helpful. It’s important to stay calm and remember that they are not experts in billing, and they are dealing with this stressful financial situation in addition to their medical condition.

Avoid talking down to them as if they are ignorant, but do try to help them understand. It would likely not be helpful to fully explain the medical billing process and how insurance costs work, but you can try to calmly walk them through the basics to help them better understand.

This can involve talking about front-end versus back-end costs, for example. Most patients likely understand where front-end costs come from, but as back-end costs are out of sight, out of mind, those are harder for them to understand.

For a quick refresher on the two, front-end costs are costs associated with patient registration, scheduling, initial patient collections, and administration of the patient’s care and files. Back-end costs are those related to medical billing and claims management and final patient collections.

You can also briefly go over how drug costs work, as this is another factor that can make a patient’s medical bill higher than they were expecting, even if they have insurance.

Additional tips for having conversations with patients about their medical bills include:

  • Be mindful of your body language. Your words are not the only thing that can trigger a patient and make the conversation more difficult. How you use your hands, your facial expressions, and your posture can all communicate to your patient how you are feeling or even what you are thinking. So be careful and try to use friendly and open body language.
  • Don’t dismiss their feelings. It’s easy to get defensive and treat a patient like they are overreacting, but this will just make the situation worse. Even if you don’t understand things from their perspective, acknowledge that their feelings are valid. Use phrases like “I understand why you’re upset or why this is upsetting” instead of saying things like “calm down” or using negative words such as don’t, can’t, or won’t.
  • Be a better listener. Healthcare professionals often have a habit of always explaining things to their patients, and while this is necessary for some situations, it’s also important to let them speak as well. Even if you don’t agree with them or if they don’t fully understand why their medical bill is so expensive, it’s still crucial for you to hear them out and be a good listener. This can show them that you respect them and aren’t just trying to speak down to them.
  • Offer them additional help. In some cases, you might need to seek out another coworker for help. If a patient has already decided that you are against them, it can be hard to change their mind. So offer to get someone else that you know might be able to more calmly talk to them. Having another person say the same things you did might also help the patient better understand that you were being honest with them and telling the truth. If available, you can also direct them towards financial programs that can help them handle their medical bills if they are low income and need financial assistance.
  • Be kind and compassionate. Overall, the most important thing to remember is to be as kind and compassionate as possible. Kindness really does go a long way. If a patient is upset and being difficult, matching their attitude won’t help. It’s always better to rise above than to sink to someone else’s level, especially when that person is a patient dealing with a potentially traumatic condition. So always try to be as kind and understanding as possible.

Final Thoughts

Just because you are a medical professional doesn’t mean you should be an emotional punching bag for your patients. So it’s understandable that it may be challenging at times to remain calm when dealing with a difficult patient. Still, the calmer, happier, and more positive you are, the more likely your patient will reflect those things in return. Generally, happy staff equals happy patients.

Using health records software (EHR) can also help in situations where in-person communication is going nowhere. With an EHR, patients can return home and more calmly review their records on their own, which can allow them more time to process and potentially come up with more helpful questions that you can then better answer for them later. Just be mindful not to always rely on EHR to do the work for you. It’s important to still maintain a good relationship with your patients, as this can help establish that trust that is so important.

Five Things You Need to Know As a Newly Diagnosed Follicular Lymphoma Patient

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What’s important for newly diagnosed follicular lymphoma patients to know? In the “Follicular Lymphoma Treatment Decisions: What’s Right for You?” program, expert Dr. Tycel Jovelle Phillips from the University of Michigan Rogel Cancer Center shares five things newly diagnosed follicular lymphoma patients should know about your care and treatment.

 1. Understand How Follicular Lymphoma Progresses

Follicular lymphoma progresses from stage I through stage IV, though you may be diagnosed after it has progressed past early stages. Stage I is when the cancer is localized to one area, stage II is on one side of the diaphragm, stage III is on both sides of the diaphragm, and stage IV could involve progression into an organ. The grade of follicular lymphoma indicates how large the cancer cells look under a microscope, starting with grade 1 and then grade 2, grade 3A, and grade 3B. 

 2. Learn About Factors in Treatment Decisions

Several factors can play into follicular lymphoma treatment decisions. A patient’s age, overall health, comorbidities, treatment side effects, and treatment goals must be considered in treatment options. Patients in early stages may have a more aggressive treatment approach, while later stage patients may have a treatment approach that prioritizes quality of life. But the age and physical condition must also be considered in the treatment approach. Make sure to talk to your doctor about any concerns you have about factors under consideration for your treatment options. 

3. Know What to Expect for Treatment

Starting treatment for follicular lymphoma immediately is not always a given. Your doctor or care team may sometimes advise a period of watch and wait to monitor your progression instead. Reasons for waiting may include things like avoiding treatment side effects when there would be little benefit to fighting the cancer at its current stage.

4. Understand Your Role As a Patient

Follicular lymphoma patients now have more options to learn about treatment options. You can talk to patients and experts on social media or support groups to build foundational knowledge  about available treatments. Also, getting second opinions is no longer the taboo that it used to be. In fact, many follicular lymphoma specialists also encourage their patients to get second opinions, since there is not currently a standard of care. Patients should not feel like you’re doing something wrong by seeking a second opinion.

5. Discover Why It’s Important to Speak Up

Though doctors can observe some patient information in blood tests and other lab work, they  also must hear from their patients. Patients are the ones who know how you’re feeling, and this is why it’s vital for you to communicate with your doctor about any symptoms and side effects that you experience. Treatment can often be adjusted to minimize symptoms and side effects to provide patients with optimal quality of life while fighting your cancer.

By taking time to learn more about their care and treatment, follicular lymphoma patients can gain confidence to work toward the best care for your unique situation.

See More from The Pro-Active Follicular Lymphoma Patient Toolkit

MPN Patient and Care Partner Breakdown Terminology

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MPN Patient and Care Partner Breakdown Terminology from Patient Empowerment Network on Vimeo.

MPN Empowerment Leads Jeff and Summer share how overwhelming medical terminology can be. Jeff encourages everyone to ask your healthcare team questions whenever you need to. He shares that asking the right questions is part of becoming an empowered patient.

Other Videos Featuring Jeff and Summer:

Roles Reversed: Taking Care of Your Care Partner

 Patient and Care Partner Address the Mental Aspects of an MPN

 How Can Care Partners Combat Burnout

Transcript:

Jeff:

Hi, I’m Jeff.

Summer:

I’m Summer and this little darlin’ is Zelda.

Jeff:

And we’re your MPN Network Managers (Editor’s Note: Network Managers are now referred to as Empowerment Leads) for the Patient Empowerment Network. Here to talk to you today about medical terminology, which often is very confusing. Isn’t it, Summer?

Summer:

Yes, I would say very confusing. And Dr. Tanaka told me oh, you need to take a bone marrow test to determine what kind of myelo, I’m writing this down, myeloproliferative neoplasm. Anyway, Jeff can explain all that to you. To determine all that and I thought, oh my god this is so confusing. She said – she kind of set me straight and made me realize that this is really important.

Jeff:

And, so, we didn’t know, neither of us, what these things meant originally. Dr. Tanaka explained some of it to us pretty well, but then I went home and I’m interested in this, so I became, I’m Summer’s caregiver. And I started doing research, and that’s what I’m going to give you some pointers that I found.

First of all, specific words you can probably Google and find on the web and they’ll tell you want it means. There are a number of organizations that specialize, in our case myeloproliferative neoplasms and blood diseases. The LLS, Leukemia and Lymphoma Society is one of them, and the MPN Research Foundation is another. And there is plenty of information here on Patient Empowerment Network about these diseases.

So, you need to find out the answers to the questions that you have. And you will probably do some of this on your own because you’ll have, when you have your appointments with your doctor you need to ask the questions. There’s no question that should not be asked, and your doctor will be able to tell you. If  you are blessed with a good care team, they’re going to have the ability to explain to you what’s going on with your disease in simple terms and terms that mean something to you. And we are truly blessed to have Dr. Tanaka who is able to do this wonderfully.

So, ask those questions, do your own research, you need to become an empowered patient. That’s what we had to be here at Patient Empowerment Network. So the more you know about this unusual disease, in our case – in Summer’s case, myelofibrosis, or other myeloproliferative neoplasms, which by the way that means cancers of the blood produced by the bone marrow, and we found that out. So, you need to become an expert on this kind of stuff yourself because you need to become an empowered patient. That’s our advice to you.

Until next time, I’m Jeff.

Summer:

Summer and I have another bit of advice. Being married or involved with someone who, like Jeff, had all this interest, if you’re not into medical things, helps a lot because I never really think about it very much. I depend on Jeff who does a great job.

Jeff:

Thank you very much, dear.

It’s part of our concept that we’ve told you about before. You’re really apart of a team. You have the caregiver, the patient, and your healthcare provider. So, become a strong team and you’ll be an empowered team.

Until next time, I’m Jeff.

Summer:

I’m Summer and this is Zelda.

What Healthcare Trends Are Observed in MPNs?

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What Healthcare Trends Are Observed in MPNs? from Patient Empowerment Network on Vimeo.

MPN Empowerment Leads Jeff and Summer share trends they’ve observed since Summer’s initial diagnosis of myelofibrosis a few years ago. They share recent studies they’ve viewed and are following. Jeff gives a charge to viewers to be your own empowered patient and keep up with research when you can. “Be your own advocate.”

Videos Featuring Jeff and Summer:

Roles Reversed: Taking Care of Your Care Partner

 Patient and Care Partner Address the Mental Aspects of an MPN

 How Can Care Partners Combat Burnout

Transcript:

Jeff:

Hi, I’m Jeff.

Summer:

And I’m Summer.

Jeff:

And we’re your Network Managers (Editor’s Note: Now referred to as Empowerment Leads) for Myeloproliferative Neoplasms for the Patient Empowerment Network. And, we’re here today to talk to you about healthcare trends in MPN medicine, basically.

Summer:

I was diagnosed with myelofibrosis over three years ago. And at the time, they could only offer me one medication, Jakafi (ruxolitinib), which for me work but doesn’t work for everybody. So, I’ve had good luck with it and I haven’t really had any other symptoms.

Jeff:

But this is an exciting time in the MPN medicine because since that time, there have been two more medications released to control myelofibrosis. One called fedratinib. And just last month, pacritinib was released and approved by the FDA. So now there are three medications that can be used to treat the symptoms of myelofibrosis.

There are currently no medications that can cure a person of myelofibrosis. The only cure, currently, is a stem-cell transplant. But some exciting developments are happening that may even be able to cure it.

I just read an article that some scientists have found that the medication used in breast care – breast cancer treatment causes remission in bone marrow fibrosis in mice. So they’re working along the way to see if that will be effective in humans, eventually. And that might be, potentially, a cure for myelofibrosis. Those are exciting trends in the MPN research and medicine world.

Summer has other information that’s useful though.

Summer:

Yeah, that’s really exciting about the new medication. I was looking up what the Mayo Clinical has to say and being happy and having a good attitude really enhances the immune system. There is a chemical that you get that comes from being happy that really, really keeps the disease from being more serious.

So anyway, that’s what I believe in because I’m an actor and so I don’t get into the medical thing, but I know Jeff is brilliant for it. So, that’s exciting all along having a good attitude and the new developments in medication.

Jeff:

So, keep those in mind, consult with your healthcare provider, and you need to be your own empowered patient and keep up with the research by yourself. It’s all available online, no problems at all, just Google it and you’ll be able to keep up yourself. You have to be your own advocate.

Until next time, I’m Jeff.

Summer:

I’m Summer and, wait a minute, this is our little baby, Zelda.

Patient Advocacy: How To Optimize Your LinkedIn Profile

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When was the last time you updated your LinkedIn profile? People tend to think of LinkedIn as simply a place to post their resume, but there is so much more to it.  The platform is flourishing right now and has released some new features to make it an even more engaging place for users. 

With 810 million global users (185 million in the United States), LinkedIn is an excellent way to network with healthcare professionals and disease experts. It can also provide the perfect platform to showcase your advocacy activities. In this post,  I’m going to share with you some tips on how to take full advantage of LinkedIn’s potential. I’ll show you how to improve your LinkedIn profile and turn it into the cornerstone of your professional online presence. Whether you’ve been using LinkedIn for a while or are just starting out, optimizing your profile for maximum visibility and engagement is worth the effort. 

Before you begin, gather together the following: 

  • A current version of your bio 
  • Your CV with your employment history 
  • A high-quality headshot 

1. Make A Positive First Impression

Let’s start with the basics. LinkedIn reports that profiles with photos receive 14 times more views than profiles without. Your profile photo is the first thing that people see when they navigate to your account, so make sure that it portrays you in a professional manner. You can upload a jpeg or png image sized between 400 (wide) x 400 (height) pixels (maximum file size is 8MB).   

LinkedIn photos are usually cropped just below the shoulders, so choose a photo that won’t require much cropping.  On mobile devices, only the center portion of the photo appears, so avoid putting anything important on the outside edges. You can adjust the photo after it has been uploaded by cropping, changing its position and size, and even adding photo filters.

2. Add A Banner Image

If you have noticed, there is space behind your profile image where you can upload a banner or header image.  Consider this your professional billboard. This is an opportunity to increase your LinkedIn visibility and make your profile stand out. 

On the desktop version, your profile photo is located about 50 pixels from the left, so move any important information (such as a logo or contact information) out of this area so it won’t be obscured. 1584 pixels wide by 396 pixels high is the recommended image size. Your background image will look blurry or pixelated if it is not high-resolution. Whenever possible, choose an image with a file size as close to the maximum (8 MB) as possible, as larger files tend to look better. Choose photos over images with logos. You can crop, filter, and adjust your photo after you upload it to LinkedIn.   

3. Customize Your Profile URL

It It is very likely that someone will find your LinkedIn profile first when they google your name. Claim your LinkedIn url (i.e., your LinkedIn address) for the best Google ranking. Your address is unique to you, and if you haven’t customized it, it will likely consist of your first and last name followed by numbers, letters, and dashes; this doesn’t look very professional.  

This feature can be found under your profile picture. If it’s not customized, you can do so by clicking on Edit your public profile. If your first and last names are already taken by someone else on LinkedIn, you can add an affiliation or middle initial.  After creating your custom URL, you can use it on your business cards, add it to your email signature, and anywhere online you wish to build your personal brand. 

4. Create Your Professional Headline

The first thing people see on your LinkedIn account is your profile picture, but the first thing they read is your professional headline. Because your headline follows you everywhere on LinkedIn, it is important to make it as compelling as possible. An individual’s profile, for example, will show both their picture and headline. 

In addition to being highly visible, your professional headline is also searchable by Google. LinkedIn is like a secret search engine. Google crawls pages and URLs for keywords, and LinkedIn profiles allow users to embed keywords. If you want people to find you on LinkedIn, you’ll want to emphasize the keywords that people search for on the site and that will show up on search results.  

5. Add Your Location and Industry

Location is one of the top five fields that LinkedIn prioritizes when doing a keyword search. To add your location and industry, open up the Edit Intro window and fill in your location details as prompted.  

6. Enter Your Education Details

To add details about your education to your LinkedIn profile, click the + sign in the upper right of the Education section. In the box that appears, enter details about your school, degree, studies, etc. 

7. Complete Current and Previous Job Experience Section

Provide a list of all the jobs and positions you’ve held and their descriptions. Most of this information can be found in your CV. Emphasize the keywords you want to be known for. One of the most common LinkedIn mistakes is an outdated Experience section. Archive previous experience and make sure all of your current experience is correct. 

One of the newest features added by LinkedIn is the ability to add a career break to this section. I really like how LinkedIn frames a career break as a way to add something unique to your skillset. As many of us have breaks in employment due to illness, this is a welcome feature on the platform.  

8. Add A Compelling Profile Summary

Immediately below your picture, name, location, company and education sections, you have the opportunity to write a summary about yourself. In my experience, many people skip over this section or give it very little attention. This is a big mistake. This section tells the story of what you are passionate about. It makes your profile less about being a resume and more about you. It’s an opportunity to establish your credibility and show some personality. It’s also a great place to include keywords that will help make you more visible in search results. Think of this space as your elevator pitch. Use it to describe the story of what you do and the unique qualities you bring to your work.  

Tip: When completing this section, break it up into short paragraphs and make it easy to scan for the reader. It’s important to note that only two lines of text from the Summary show up on your profile before the “see more” link to click. Those two lines need to be compelling enough to get people to click. 

9. Showcase Your Skills

Adding skills and expertise to your profile also helps you show up in relevant searches. You can list up to 50 skills with LinkedIn showcasing your top 10 skills based on endorsements so people know where you excel.  To add a skill, click the Me icon and select View Profile. Scroll to the Skills & Endorsements section of your profile and click Add a New Skill.  

Remember, it’s the top three skills that are immediately visible when people scroll through your profile, so make sure you order your skills the way you want them to appear.  

10. Obtain Recommendations

A LinkedIn recommendation is a brief paragraph that someone has written describing their experience of working with you.  Get into the habit of asking people if they would be willing to recommend you on LinkedIn after they have thanked you in person or complimented you for work you have done. 

11. Add Projects, Honors and Awards

Scroll all the way down your profile, and you’ll discover there are sections to add your current and past projects, as well as any honors and awards you’ve received.  Be sure to populate these sections to showcase your advocacy activities.  

Conclusion

Taking time and care with each of these steps will pay dividends and reward you with increased visibility and enhanced professionalism. Your LinkedIn profile should never be done once and then forgotten. Review it regularly. Remove outdated information, include fresh keywords, add new images, and keep your profile looking current and relevant. 

From Network Managers to Empowerment Leads

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 At Patient Empowerment Network (PEN), we believe it is our duty as advocates to reach as many patients as possible by creating and curating relevant content. This includes our PEN-Powered Activity Guides, #PatientChats, blog posts, and educational media written by cancer patients and care partners for cancer patients and care partners.

 As Empowerment Leads (previously Network Managers), each one of us strives to create content that is relatable and easy to understand, all while promoting PEN’s mission “to fortify cancer patients and care partners with the knowledge and tools to boost their confidence, put them in control of their healthcare journey, and assist them in receiving the best, most personalized care available to ensure they have the best possible outcome.”

As Empowerment Leads, we look to guide patients in the right direction when it comes to quality, comprehensive cancer care. While each one of us comes from a background that is unique, as members of a community of people who have been touched by cancer in one way or another, we have found that we’re more alike than we initially understood. As volunteers, we aim to empower PEN’s community by using our various talents, including writing, conducting interviews with physicians, and producing comedy shows, amongst others. We do this because we’ve been there, and we know what it’s like to have to go through trying times when it comes to a devastating diagnosis, such as cancer.

Furthermore, Empowerment Leads recognize the importance of having someone to speak to. We can have all the education, but sometimes you want to speak to another person who can relate to what you’re going through. Each one of the Leads has their own email you can send a message to at any time with any questions you may have. There’s also a text line PEN recently created, all for the purpose of getting information to the right person at the right time. Please note, though, that any information passed on does not constitute as medical advice, and information should also be discussed with your healthcare team.

Finally, although there has been a name change, the power of our program has not changed. We are here for the patient community and always will be. That is our mission, and we’re sticking to it!

Self-Education Is the Basis of Better Health Outcomes, Physically, Mentally, and Financially

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We have all heard the phrase, “Hindsight is 20/20”. Yes, it can be, if we know to look and be retrospective and heed the lessons learned. However, too many of us don’t take the time to take advantage of hindsight and find ourselves caught over and over in the same tidal pool.

When my husband was diagnosed in 2002 with MGUS, the driving force for me to use as a guide to be proactive in his health as his advocate was the illness and subsequent death of my 5-year-old brother David, who was very rarely spoken of in my family. I always wondered why it was sort of secretive. I remember finding his death certificate in a chest and wondered about him for years until as a teen I asked my mother about him and his illness. You see, I was only 1-year-old when he died, I have no memory of him. What I know was told to me by my mother, many years after his death. He had leukemia, diagnosed when he was 4. At that time, it was a death sentence. He was in “treatment” but it was all experimental at the time. I asked my mother what kind of leukemia he had. She wasn’t sure. She knew she had to give him over 50 pills a day. I asked what they were, but she didn’t know. I couldn’t believe how little she knew about his illness or what was being done to him. I always felt that when hearing her tell me about David that she was guarding herself somehow. He was eventually sent home to die. Hearing the bits and pieces always struck a weird chord with me.

It was only as an adult accompanying my husband on his cancer journey with Myeloma that I began to understand the horrible cost to David and subsequently my parents and older siblings. I was always trying to investigate his illness from afar. So, now the seeds of questions that always remained with me and the illness and death of my husband has led me to where I am now. Those two experiences, especially the journey with my husband made me acutely aware on a daily basis of the urgent need for all patients to be educated in their illness, so they can openly and actively participate in their treatment not only of cancer but their overall health, mentally, physically and financially.

Overcoming barriers of bias both conscious and unconscious are still huge barriers that many patients face. Educating oneself seems to be a huge equalizer. Knowledge gives you the confidence to question, make better decisions, and to benefit from those decisions. It gives you relative peace of mind that the decisions you make are in your best interest and your family.

You may be asking how all of this comes together when in treatment for Myeloma, AML, or quite honestly, any illness. Simply, the more you know about your treatment the better equipped you are to ask the right questions about the cost of treatment, its side effects if you are going to have to take time off from work if there are other anticipated upcoming treatments that you need to prepare for. And, If your treatment is available in town or if you need to find treatment elsewhere. You can ask if there are other treatments available with perhaps less associated costs. You can prepare your personal finances and make sure your insurance coverage is the best it can be. Knowing your full treatment plan can help you gather the financial assistance you will need to help you get and stay on treatment.

There are many resources that you can easily access to educate you on your illness as well as give you information about financial resources for which you may qualify. They include help with travel for medical treatment, co-pay, deductible and premium help, utilities, lodging, and urgent financial help.

Many of the resources available today were not around to help my husband or I had no knowledge they existed and no one to inform us during his cancer journey and certainly not available to my parents with the cancer journey of my young brother in the early ’60s. Education can even be the playing field for many patients.

Becoming knowledgeable about available resources can help you control your stress levels which can benefit your overall health outcomes. And knowing that there are financial resources available to you can help alleviate some of the financial stress that comes with having a very expensive illness.

In one of the few conversations, I had with my mother, I asked how they found out about my brother’s cancer. She said they were told over the phone. The doctor said,” Your son has cancer and is dying”. I can’t imagine living that experience. My mother said she felt hurt and angry for it being so impersonal. She said this was a hurt for which she never forgave herself. This was a time in 1961 when the disparity in healthcare was even more glaring than it is today. My parents didn’t know how or were even encouraged to ask questions to participate in David’s care. David and our family suffered as a result.

I encourage everyone to take advantage of the learning opportunities available to them. Doing so will provide you with the peace of mind that you are getting the best care while managing the cost of your treatment and reducing overall stress to allow you to live your best life.

The Basics and “Why They Aren’t The Basics” of Clinical Trials

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We’ve all heard about clinical trials, especially with the recent pandemic (for which there are still ongoing trials available!). But it’s not always intuitive on how to find trials, how to enroll in them, what goes into them, and how there still is (and how we can fix!) the lack of diversity in trials despite efforts. Therefore, this blog is specifically dedicated to just that! If you have additional insights, feel free to reach out in the comments or email me at carly@powerfulpatients.org so that this can be updated! 

First, let’s break down what a clinical trial is not. A clinical trial is not a method of care that the healthcare community tries to take discriminatory advantage of. Although it has been that way in the past, especially amongst the African American community, I believe trials are trying to do a better job when it comes to equity and inclusion of multiple races and ethnicities, as well as clear consent. Clinical trials are a way to advance medical sciences and treatment initiatives for patients around the world experiencing the same diseases and conditions that make us vulnerable. Clinical trials aren’t always looking for treatment opportunities, however, some trials are focused on prevention, the feasibility and/or safety of a medical device, or on quality of life. No matter the type of trial, though, there is always something to be learned to enhance healthcare in a number of ways, even if it’s not easily recognizable. 

Doctors sometimes do not mention clinical trials as a treatment option because they feel like they are “giving their patients away.” After all, healthcare is a business, and if a doctor “loses” their patient to a trial, it’s not the most economical option for them. This is another reason why we have to be advocates of our own health and do research.  

Clinical trials can be found doing a quick Google search, on www.clinicaltrials.gov, or by going to a local or national hospital’s website and searching for available trials. Most hospital systems will direct to clinicaltrials.gov if there’s a record for the trial because it contains the most information, including the purpose of the trial, the outcome(s) the investigators are looking for, eligibility criteria, and what will be happening during the trial and for how long. A patient can bring this information to their doctor and ask if it’s appropriate for them. If so, the trial generally lists who and how to contact at the bottom of the record on clinicaltrials.gov or on the hospital’s website. What it doesn’t tell you is if you’ll be compensated for your time, which may hinder trial enrollment. 

Compensation information for a trial, if applicable, can be found in the informed consent document, which is an official document that includes what will happen in a trial and for how long, what the objectives of the study are, compensation information, and the risks/benefits of participation. Compensation in clinical trials is considered a “recruitment incentive,” not necessarily to obscure the risks and/or benefits of a trial. According to the NIH, the FDA doesn’t consider reimbursement for travel, lodging, airfare, and/or parking, but for “their time, inconvenience, discomfort, or some other consideration.” Usually, it’s in the form of a gift card, and “any credit for payment should accrue as the study progresses and not be contingent upon the subject completing the entire study.”   

Given that patients would be paid to participate, does this help break down barriers for vulnerable populations? It may not be enough. Patients are not responsible for routine care costs during a trial if they’re covered under private insurance or Medicare. However, as stated above, patients are not reimbursed for travel, lodging, airfare, and/or parking. Depending on how far the patient has to travel and where, the gas money, much less airfare, and hotel costs could drive up the costs exponentially. This is especially true in major metropolitan areas as opposed to more rural or suburban areas, as there may be more local trial locations such as hospitals and clinics. 

How do we increase diversity in such important potential medical discoveries? The FDA suggests that study sponsors are “encouraged to think about reducing visit frequency, when appropriate, in addition to considering whether flexibility in visit windows is possible and whether electronic communications, such as phone, email, social media platforms, or other digital health technology tools can replace site visits and provide investigators with real-time data.” Tying this advice back to patient compensation, electronic communications replacing in-person could be a game-changer for patients. If Covid hadn’t forced some medical offices to close and offer virtual visits, it couldn’t have come any sooner. Additionally, continue to have clinical trials that are for specific patient populations, as applicable to specific diseases (for example, breast cancer trials for African American men and women). Finally, establish networks in the local community, and go where the patients are. Learn about them. Clinical trial enrollment can only get better if we step out of the board room and into the classroom. 

Five Tips to Participate in MPN Care and Treatment Decisions

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How can myeloproliferative neoplasm (MPN) patients become more active in their care? In the “How Should You Participate in MPN Care and Treatment Decisions?” program, expert Dr. Abdulraheem Yacoub of the University of Kansas Cancer Center shares five key tips MPN patients can take for a more active role for optimal health outcomes.

1. Become a Patient Self-Advocate

It’s vital to have the ability to advocate on your own behalf no matter your age at diagnosis. And some MPN patients will be diagnosed at a relatively young age and will have different MPN care providers over the course of their disease. These patients need to get accustomed with the idea of care approaches changing over time.

2. Get Involved and Build Your Village

Being involved in your well-being as a patient is of utmost importance, and thinking about your support network is recommended as one of your early steps as a patient. Think about who among your friends, family, co-workers, and spiritual community might be able to help support you – and ask your MPN care provider about support resources if you need some additional help.

3. Bring a Friend or Loved One to Appointments

It’s important to have someone else at your appointments with you to help understand the information you receive and to also take notes and to ask questions if it’s helpful for you. Having a second set of ears is especially important with your early visits about treatment options, and the use of telemedicine makes it easier for loved ones to help support your appointments.

4. Get a Second Opinion

Second opinions are no longer the taboo that they were once perceived as. Listen to medical facts given to you from your MPN specialist and from your primary treating physician. And if you want a second opinion from another MPN specialist, this practice is easier to carry out now through telemedicine.

5. Seek Out Credible Resources and Research News

Keep yourself informed about the latest MPN research and treatment news by visiting credible online resources. In addition to PEN, check The Leukemia & Lymphoma Society (LLS) and MPN Research Foundation. The annual meetings of expert conferences like the American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO) bring research updates for MPN online resources to cover.

By taking a more active role in their care, MPN patients can help determine the best care and treatment plan for optimal health outcomes.

PEN Featured On Advarra’s In Conversations With Podcast

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Patient Empowerment Network (PEN) recently had the opportunity to participate in a podcast with its partner Advarra through their In Conversations With podcast. In this episode, Becoming Your Own Best Advocate Through Patient Empowerment, Advarra’s Chief Commercial Officer Robann Cunningham and PEN’s Director of Development Robin Barnes discuss how patients can become their own best advocate through resources like those provided by PEN. 

Advarra’s Mission

Advarra helps advance how clinical research is conducted: gathering life sciences companies, CROs, research sites, investigators, and academia together at the intersection of safety, technology, and collaboration. With its trusted review solutions, innovative technologies, and consultants and worldwide connections, Advarra provides solutions that help safeguard trial participants, empower clinical sites, ensure compliance, and optimize research performance. Advarra is working on clinical trials to help make them safer, smarter, and faster for all patients. You can learn more about them at advarra.com.

Breast Cancer Survivor’s Lessons About Patient Engagement

Robann Cunningham of Advarra has a personal connection to Patient Empowerment Network’s mission through to her own experience as a breast cancer survivor. After her diagnosis with triple-negative breast cancer with a BRCA mutation, Robann was scared but also felt fortunate to have knowledge of how to take control of her cancer journey as an engaged patient. She knew about the importance of exploring treatment options and multiple opinions to decide on the best path forward for her. Robann feels that one of her goals in her mission as a breast cancer survivor is to increase patient engagement in clinical trials, and the podcast with Robin is one way she has worked toward fulfilling her goal. 

Robann collected some key takeaways from her cancer journey including:

  • Finding the right path for you is key—and knowing how to find it is even more important.
  • Education and awareness are everything.
  • We can increase the number of success stories.

You can learn more about her breast cancer experience in her article “What Being a Breast Cancer Survivor Taught Me About Patient Engagement.”

Empowering Patients 

The Advarra In Conversations With podcast provides a rich conversation about patient empowerment. Robann shares some things about her cancer journey, while Robin shares about her experience as a care partner for her husband. Robann shared her views about empowerment, “The humbling experience that that was being in this industry, but I think what I really took away and what’s important here is that I would define empowerment as both awareness and advocacy and I think that if we can raise awareness, advocate, and then I would also say education is critical.”

Robin also shared PEN’s views, “Empowerment will mean something different to each and every one of us, but at the Patient Empowerment Network the core of what we believe empowerment means is having the knowledge and also the confidence to become a co-decision maker with your healthcare team, and what that often looks like is insisting on personalized treatment options it means asking questions, it means having the knowledge and education though resources…to be able to come with confidence to that conversation and make sure that what you are receiving is the right treatment for you…”

Clinical Trials Process

Clinical trials, of course, are discussed in the podcast. Robin shared, “Encouraging patients and care partners to not think of the clinical trial, as a last resort option if other treatments have failed but to consider it at the very first step of a diagnosis, and that, of course, ties into when appropriate biomarker testing and all of these wonderful tools that we  have today.”

Regarding clinical trial informed consent documents, Robann shared, “I recommend if anyone out there is considering getting involved is to really take your time through that process, make sure that you are afforded that opportunity to have a conversation with the investigator and staff you ultimately you need to have a level of confidence and a good relationship with your investigator and their team…” Patients must be given time to take the document home to review the terms and to discuss them with their care partner and family members to ensure the patient is comfortable with the proposed research. I know Robann also shared, “…there is a popular saying, which is ‘Nothing about me without me,’ and so much of what you’ve shared today, I think, really speaks to that.”

In the podcast, Robann and Robin also discuss timely topics including health literacy, health equity, actionable resources, community-based organizations, and goals for the future. PEN is excited to be partnering with Advarra to help advance patient empowerment and clinical trial efforts. We hope you can take some time to listen to the podcast or to read the podcast transcript – and to read Robann’s article about her breast cancer experience and what she learned about patient engagement. Stay tuned as we report more about our ongoing partnership efforts with Advarra in our dedicated efforts on the behalf of cancer patients and care partners.

Listen Now

Six Ways the digital sherpa® Train-the-Trainer Program Can Empower Your Members

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The Patient Empowerment Network digital sherpa® program empowers mostly older cancer patients to improve treatment outcomes through digital technology. Program participants learn skills including identifying credible online resources, using telemedicine and their patient portals, and how to use mobile devices to improve health.

Benefits program participants have learned include how to:

1. Use Patient Portals

Using patient portals can be helpful to save time for common tasks. Participants learn about booking health provider appointments, requesting prescription refills, and getting lab test results.

2. Perform Google Searches

Doing Google searches can be helpful when carried out with a watchful eye. Participants learn about performing Google searches, finding reliable sources, adding bookmarks for favorite websites, and copying and sharing links with others.

3. Utilize Social Media

Twitter and Facebook social media tools can be useful for those seeking more information and support. Participants learn the nuts and bolts of both tools including how to set up an account, checking and maintaining privacy settings, how to post or tweet, finding experts, connecting to online support communities, using hashtags and tweetchats, and posting photos.

4. Benefit From Telemedicine

Learning about telemedicine and best practices can be helpful for optimal visits. Program participants learn how to install video conferencing tools, how to be prepared for a telehealth visit, and who to contact if they run into issues.

5. Improve Health Travel

Using mobile apps can assist patients and care partners in health-related travel. Participants learn about the apps Uber and Lyft and are shown how to set up accounts.

6. Engage With Patient Communities

Engaging with patient communities can be reassuring for patients and care partners alike. Program participants learn about patient communities such as Inspire, PatientsLikeMe, MyLifeline, StupidCancer, HealthUnlocked, Cancer Support Community and how to join support groups in them.

By taking part in the digital sherpa® train-the-trainer program, participants can learn valuable skills to gain confidence and to improve treatment outcomes through digital technology.

How Medical Financial Hardship Can Affect Your Health

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How Does Your Finances Affect Your Health?

In 2002, my husband was diagnosed with MGUS, a precursor to Multiple Myeloma. As many of you have also experienced, your life changes. At diagnosis, you probably felt you couldn’t breathe or process. All you could think of for days was cancer, cancer. And if you have been unfortunate enough to witness someone else in your family or close circle of friends with cancer you could only relate to their experience or what you thought their experience was. Good or bad..

I’ve witnessed too many people in my family battle cancer. My brother with leukemia, my father with lung cancer, my great grandfather with prostate cancer and my husband with multiple myeloma. I watched my parents struggle with the cost of his care. My mother was the caregiver to my father and stopped working to care for him. That was difficult for her because her sustainable income became almost non-existent. Fortunately, it came at a time when all but one of my seven siblings were independent and on our own. This at least was less responsibility for my mom and dad to worry about. However, because he was in the hospital a lot, and she no longer had income coming in, we all covered her daily expenses, food, mortgage, gas, water, purchased her a more reliable car, home repairs etc. We became her failsafe. Many people are not so fortunate.

My mother never spoke of the emotional or financial stress of everything to any of us, but we knew it had to be difficult. We saw the strain on her health. Her weight changed. She had trouble sleeping. Her blood pressure soared and her arthritis was always troubling her. More so than usual. My siblings who lived near would spend time helping her care for dad, and within a week of his death she had to take care of her mother who was an amputee and had Alzheimer’s.

So, it’s really not at all surprising to learn that medical financial toxicity or stress could be linked to worst cancer survival. The effects are many. Unfortunately for those who live in rural areas, have low incomes, those who are minorities, the underinsured or uninsured you already have financial stress. An expensive illness like cancer makes it all the more difficult.

My husband had great insurance from his employer. I thought at first we wouldn’t have to worry about medical bills. That is until he was at first approved for coverage for a stem cell harvesting and transplant in another hospital out of network, because there wasn’t a specialist in KY. Right after the transplant we were told treatment wasn’t going to be covered by his insurance.. After 5 weeks in the hospital!!! He became very despondent and depressed could not eat or sleep. He began to suffer with other emotional and physical issues unrelated to the illness itself. Additionally healing from the transplant was difficult. Lesson learned, having good insurance does not shield you from financial stress.

An analysis of 25,000 cancer survivors showed that financial hardship had a significant association with premature death among cancer survivors, no matter their insurance coverage. And according to K. Robin Yabroff, PhD, MBA, of the American Cancer Society in Kennesaw, GA and colleagues, almost 30% of patients ages 18-64 reported financial toxicity, which is associated with a 17% excess mortality risk compared with same-aged patients who did not report medical hardship.

In older patients, they found that financial hardship was less common with a 14% excess mortality risk. Having insurance did reduce the risk but not by much and certainly didn’t eliminate it.

An earlier study in the Journal of the National Cancer Institute found an increased mortality risk in cancer survivors who filed for bankruptcy. Though the number filing was low, medical financial hardship covers a range of economic stressors.

Some of the financial hardships associated with financial stress included; patients not adhering to or even forgoing treatment. Having problems paying for expensive prescriptions could lead to not taking medicine as prescribed to make it last longer or not getting it filled at all, In addition mental health counseling and other health issues are neglected.

How to mitigate a lot of the financial stressors that can lead to higher mortality?

Understand your illness and all aspects of your treatment. Ask your doctor to refer you to someone in the facility who can help you find financial assistance to help you manage the costs of your care and help you manage your everyday expenses. A quick google search can help you locate local, state and federal resources that may be available to you. Seek out help from organizations such as American Cancer Society, Leukemia and Lymphoma Society. There are many others. Get help with finances and budgeting CoPatient is a great organization that can determine of medical bills over $500 are accurate and fight that battle for you. Triage Cancer is a great resource to help you understand legal, and insurance information based on your state of residence.

The main takeaway is, you need to focus on healing and staying healthy. Seek out help regarding your finances so that you won’t find yourself in a financial crisis. Support groups are great sources of information.

Don’t be afraid to ask. Your health depends on it!

Low Testosterone in Cancer or Transplant Survivors

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I was one of the authors (out of more than 50) of a review article on male specific late effects in stem cell transplant patients [1]. The article looked at many late effects in male transplant survivor. This post is a summary on one late effect, hypogonadism (that is low testosterone) as well as my opinion about the recommendations on screening for low testosterone.

We do not know much about low testosterone in cancer survivors or transplant survivors. There is a significant increase in the incidence of low testosterone but the size of the increase in transplant survivors is not well understood. Symptoms related to low testosterone include: “loss of body hair, small testes, and ED (Erectile Dysfunction)”. Other symptoms that may be signs of low testosterone but may be signs of other problems include: “loss of libido, anemia, fatigue, lack of motivation, reduced muscle mass, and increased fat mass” (I don’t really know what “lack of motivation” means). The article recommends: “testing and consideration of hormone replacement therapy based on symptoms”. This is similar to what has been recommended in the past [2].

In 2016, some 23 years after my bone marrow transplant (BMT) I was diagnosed with low testosterone. I had finally asked one of my doctors to get tested and my testosterone level was 192 (my free testosterone was also low, and this is useful for the doctors, but I won’t mention it anymore). The normal level of testosterone is between 300 and 1000 nanograms per deciliter (ng/dL). [3] While I had symptoms, low libido, loss of muscle mass and fatigue primarily, no doctor had asked about those symptoms, and I had not thought about them as more than getting old.

I started on testosterone replacement, and it has made a huge difference. The biggest difference in my mind is less fatigue. One of the more common side effects of testosterone replacement is it can raise your red blood count (I like to call this an “effect”). Since a year or two after my transplant, my hemoglobin was on the low side (typically 12-13, normal for men is 13.2-16.6) and my hematocrit was generally between 37 and 40% (normal for men is 38.3-48.6%) [4]. A few years ago, at my annual exam my hematocrit was close to 35%. I went to see an oncologist (the oncologist who treated me is no longer seeing patients in the office). A whole bunch of tests were run, but not a testosterone test and nothing abnormal other than my red blood values was found. After starting testosterone replacement, my hematocrit is 43-45% and my hemoglobin is 14-15. The biggest change for me is that I have far less fatigue presumably because I have more red blood cells.

Testosterone levels naturally decrease with age. The folklore is that the testosterone level decreases about 1% per year from age 30 or so. [5] Other sources say from age 20. I believe this means that if you level is 800 at age 30 (there seems to be little data for a “normal” level at different ages), it will go down about 8 units per year (1% of 800). So, at age 80, the level would be around 400 (if this actually means a decrease of 1% of the current level every year, it will go down to about 480 at age 80). If the level was 600 at age 30, then it would be about 300 at age 80 (or around the low end of the normal range, which I imagine is about the average level for 80-year-old men). What if a 30-year-old had a testosterone level of 800 and then was diagnosed with AML and had chemotherapy and a transplant? Perhaps 2 years post-transplant is now 500, which is normal. There seems to be no data on testosterone levels in long term transplant survivors. However, if this goes down 8 units a year (this seems to be as good a guess as any), then after 25 years the level would be 320 and after 30 years it would 280, which is less than the 80-year-old man without cancer. It is important to state that there appears is no data to support or refute this scenario. Still my belief is that this is essentially what happened to me. My guess is that quite a few male transplant survivors have a testosterone level in the normal range 1 or 2 years post-transplant (although most will not have it tested) but will eventually have hypogonadism and likely not realize it.

While there is a lot we do not know about testosterone levels in transplant survivors (or for that matter healthy men), there is one thing we do know. “The majority of health care professionals do not address [sexual dysfunction]” [1]. In my mind this calls into question the recommendation to test testosterone levels “based on symptoms”. Most doctors do not seem to ask about symptoms specific to low testosterone and the other symptoms are non-specific. It seems to me that not testing testosterone levels at say 1 or 2 years post-transplant is likely causing harm to some male long term survivors. A better guideline would be to routinely test 1 or 2 years post-transplant and then again if symptoms warrant.

The BMT Infonet as part of their Celebrating a Second Chance at Life Symposium had a really good workshop on Sexual Concerns in Men after Transplantation by John Mulhall MD, from Memorial Sloan Kettering Cancer Center. You will have to register before viewing the replay of this workshop. While it covered other topics, there was a lot of information about low testosterone 

Contact Art Flatau, flataua@acm.org

Bibliography

[1] Phelan, R et. al., “Male-Specific Late Effects in Adult Hematopoietic Cell Transplantation Recipients: A Systematic Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Transplant Complica,” Transplantation and Cellular Therapy, 2021.

[2] Navneet, Majhail S.; et. al., “Recommended Screening and Preventive Practices for Long-Term Survivors after Hematopoietic Cell Transplantation,” Biology of Blood and Marrow Transplantation, vol. 18, no. 3, pp. 348 – 371, 2012.

[3] Icahn School of Medicine at Mount Sinai, “Testosterone,” [Online]. Available: https://www.mountsinai.org/health-library/tests/testosterone

[4] Mayo Clinic, “Complete Blood Count,” [Online]. Available: https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919

[5] Mayo Clinic, “Testosterone therapy: Potential benefits and risks as you age,” [Online]. Available: https://www.mayoclinic.org/healthy-lifestyle/sexual-health/in-depth/testosterone-therapy/art-20045728

[6] WebMd, “Is Testosterone Replacement Therapy Right for You?,” [Online]. Available: https://www.webmd.com/men/guide/testosterone-replacement-therapy-is-it-right-for-you