Cancer treatment has come a long way from where it was in 1975 when I entered medical school. But success is still mainly dependent upon early detection. With early detection, the cure rate for many cancers is exceedingly high. Therefore, who wouldn’t want to improve our ability to detect cancers early?

Allysia Finley, writing for The Wall Street Journal, tells us of the dramatic case of Roger Royse, who was diagnosed with pancreatic cancer in July, 2022. But unlike most people, Royse was diagnosed in Stage II, with limited disease, instead of Stage IV. The five-year relative survival rate for late-stage metastatic pancreatic cancer is 3% – which means that patients are 3% as likely to live five years after their diagnosis as other cancer-free individuals. But if pancreatic cancer is caught before it has spread to other organs, the survival rate is 44%.

The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.

Early diagnosis is the best defense against most cancers, as President Biden noted when he announced his Cancer Moonshot initiative two years ago. But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force, an independent panel that evaluates medical screenings.

Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.

Naturally, it’s expensive. The test costs $949 and isn’t covered by Medicare or most private insurance. Mr. Royse, a lawyer who works with Silicon Valley startups, paid out of pocket for the test and follow-up imaging to confirm his cancer. Most Americans can’t afford to do so, and some public-health experts think that’s just as well. They fret that widespread use of multicancer early-detection tests would cause healthcare spending to explode. Those fears have snarled Galleri and similar tests in a web of red tape.

Mr. Royse learned about Grail’s test in April 2022 and asked his physician about it. “He said it was unnecessary, and you don’t have symptoms,” Mr. Royse says. A second doctor also refused to prescribe it. So Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.

An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans.

Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal. Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer. That may sound low, but the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer. Yet all women over 40 are advised to get regular mammograms.

What is hampering the widespread use of this new form of cancer screening?

More on that next post.

This blog is about healthcare; all forms of healthcare. I guess that even includes empty nest coaching. Wait, I know right about now you’re wondering, “What’s an empty nest coach?” I’m glad you asked because this post is all about them.

Tara Weiss, writing in The Wall Street Journal, says there’s a new occupation out there now for those looking to help parents adjust to the emptiness of their house when their children leave home. Weiss says, “Helicopter parents get accustomed to tracking their children’s every move via smartphone, keeping activities tightly scheduled, scrutinizing homework and grades, exchanging miles of texts. For a certain cohort of hands-on parents, getting their teens into college marks the finish line. Then comes the coup de grâce. ‘Bye, Mom! Bye, Dad! See you at Thanksgiving!’”

She says the kids are fine, but the parents are now the ones who need help. The exit of high-school seniors leaves many feeling like “they’re being fired from a job they’ve had for 18 years,” says Jason Ramsden, who has made a name for himself on TikTok as “The Empty Nest Coach.”

It seems this new occupation is a growing livelihood – with training certification, support groups and $250-an-hour private-counseling sessions. Demand is driven by parents who feel an emotional and logistical vacuum after years of shepherding children from one moment to the next.

Kenny Hayslett recalled bittersweet feelings when his oldest child left for college. But he didn’t expect the profound sadness when his middle child said goodbye last year. “They all sting, but this one hurt,” the 56-year-old said. “Even though you know it’s coming to an end, it is such a shock,” said Ramsden, who ushered his last child out the door a little more than two years ago. TikTok’s algorithm, sensing Hayslett’s pain when his second child left for college last year, served one of Ramsden’s empty-nester videos. Hayslett, of Clearwater, Fla., said he felt like “this dude is talking right to me. I can’t believe this is a thing.” He paid Ramsden $2,000 for weekly videoconferences over about three months before Camden left for college.

Weiss tells us, like other things no longer taboo—from getting fired to not wearing pants—empty-nesters want to talk about their struggle. Ramsden has drawn more than 50,000 subscribers to his TikTok account since becoming a certified coach in 2022. Elsewhere on the internet, the Facebook group Empty Nest Moms has more than 12,000 members seeking guidance and assurance from others in the same emptied boat. The Inspired Empty Nest, an online community started by empty-nester Bobbi Chegwyn, offers to connect local parents seeking to commiserate about the sudden silence at home.

Executive and life coaching were popular specialties when Valorie Burton, CEO of the Coaching and Positive Psychology Institute in Atlanta, began in 2002. In past years, she said, coaching services have widened to people going through a divorce or career change. Training can last a weekend or as long as six months, teaching coaches to help clients set goals and carry them out.

Empty-nesters get plenty of unsolicited advice from friends and family: Get a job. Get a hobby. Get a life. Empty-nest coaches say such suggestions aren’t helpful first steps. “They need to grieve,” said empty-nest coach Natalie Caine. She became a $250-an-hour certified coach in Los Angeles following her own entry into empty-nesthood 15 years ago. “I get asked all the time,” Caine said, “‘Do other parents feel like this?’”

Camden Hayslett said he wasn’t surprised his father was sad about him leaving for college. The only time he ever saw him cry was when the family said goodbye to his older brother after they dropped him at school. What he didn’t see coming was his dad hiring an empty-nest coach. Camden thinks it has helped. It doesn’t hurt that he talks with dad every day. “That’s something that makes him feel more in the loop,” he said.

I’m probably the least qualified person to comment on this subject since my wife and I are not parents. I’m sure my parents weren’t looking for an “empty nest coach” when I went off to college 2000 miles away – they were probably celebrating! But this sounds like another indicator that some people just have too much money and too much time on their hands.

What kind of driver will your teenager be?

That has to be among the most important questions on the minds of young parents. Perhaps you believe if you’re a good driver, your teenager will be the same. That may be wishful thinking. How do you know? There are apps to track teen driving, but that information only tells you how well they did after the fact. What you really want to know is how well they’re going to do before they get out there on the road!

Relax! Someone who feels your pain is doing something about it. Julie Jargon, writing for The Wall Street Journal, says researchers at Children’s Hospital of Philadelphia built a virtual driving assessment—essentially a realistic car simulator—and found that it can accurately predict crash risk in newly licensed drivers. Why did a hospital do this? Because driving is one of the most important healthcare issues for teenagers.

Here are some statistics to make you nervous. Drivers between the ages of 15 and 20 made up just 5% of all licensed U.S. drivers in 2021, but accounted for 8.4% of fatal traffic crashes, according to the National Highway Traffic Safety Administration. The Centers for Disease Control and Prevention identified vehicle crashes as the leading cause of deathfor U.S. teens.

The researchers aren’t keeping the test to themselves. They have brought the tests to doctor’s offices in Pennsylvania and parts of New Jersey and Connecticut, as well as to traffic courts in Ohio. They are also seeking funding to offer them to teens in other states as part of their routine medical checkups.

How does it work?

To take the test, a teen sits at a desk with a driving wheel, brake pedal and gas pedal, all attached to a laptop running assessment software. “Grand Theft Auto” it isn’t, but it does have a realistic feel.

The 15-minute test is a simulated drive through a city where teens encounter pedestrian-filled crosswalks, railroad crossings and other potentially dangerous scenarios. Exposing them to possible crashes is a good way to see how they respond to real-life road crises, say researchers. Eye-tracking software analyzes where teens are looking while they drive down the virtual streets.

Peyton Leverich, a 15-year-old in Lansdowne, Pa., took the virtual driving assessment at her church in November. Turns out, she drives too fast on straightaways. She also needs to pay more attention to the speed and distance of oncoming cars when she’s making left turns. “It felt very realistic. Lots of people were crossing the street and there were school zones where you had to drive slower,” says Peyton, who plans to take driving lessons before trying to get her license. (Pennsylvania requires driving experience but not professional driving lessons to obtain a license. Personally, I took the Pennsylvania driving test at the Pennsylvania Highway Patrol driving course 56 years ago in a stick-shift car – and passed the first time!)

In an early study, nearly 17,000 young drivers in Ohio took this virtual assessment between July 2017 and December 2019. During the study, the tests were administered at motor-vehicle branches just before the young drivers took their license exams, though it wasn’t part of the exam. Once the drivers got their licenses, the researchers monitored state police crash-report records for the subsequent year, and compared how well the test-takers did. The kids who drove best ended up having a 10% lower-than-average crash risk. The ones who experienced major issues had an 11% higher-than-average chance of getting into a wreck.

The study, conducted by the Children’s Hospital of Philadelphia researchers along with colleagues from the University of Pennsylvania and the University of Michigan—with funding from the state of Ohio and other donors was published in the journal Pediatrics in October this year.

This spring, the researchers plan to study which interventions, such as behind-the-wheel training or online driver education, are most effective in helping teens improve driving skills. They hope to offer the virtual assessments in doctor’s offices around the country, where teens approaching driving age could take them as part of their annual checkups, just as they take vision exams.

“My dream is to start treating car crashes as the health risk they are for teens,” says Flaura Winston, a co-author of the study and one of the developers of the virtual-assessment software. “We want it to be part of routine preventative adolescent healthcare.”

Sounds like a great idea for young drivers – and for parents, too!