Newswise Irvine, CA June 12, 2020 A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

The study, published today in Nature Communications, titled, Quantification of ongoing APOBEC3A activity in tumor cells by monitoring RNA editing at hotspots, reveals how the genomic instability induced by the protein APOBEC3A offers a previously unknown vulnerability in cancer cells.

Each day, in human cells, tens of thousands of DNA damage events occur. In cancer cells, the expression of the protein APOBEC3A is one of the most common sources of DNA damage and mutations. While the mutations caused by these particular proteins in cancer cells contribute to tumor evolution, they also cause breaks in the DNA, which offer a vulnerability.

Targeting cancer cells with high levels of APOBEC3A protein activities and disrupting, at the same time, the DNA damage response necessary to repair damages caused by APOBEC3A, could be key to more effective cancer therapies, said Remi Buisson, PhD, senior investigator and an assistant professor in the Department of Biological Chemistry at the UCI School of Medicine. However, to exploit the vulnerability of the cancer cells, it is critical to first quantitatively measure the proteins activity in tumors.

To understand the role of APOBEC3A in tumor evolution and to target the APOBEC3A -induced vulnerabilities, the researchers developed an assay to measure the RNA-editing activity of APOBEC3A in cancer cells. Because APOBEC3A is difficult to quantify in tumors, developing a highly sensitive assay for measuring activity was critical. Using hotspot RNA mutations, identified from APOBEC3A-positive tumors, the team developed an assay using droplet digital PCR and demonstrated its applicability to clinical samples from cancer patients.

Our study presents a new strategy to follow the dysregulation of APOBEC3A in tumors, providing opportunities to investigate the role of APOBEC3A in tumor evolution and to target the APOBEC3A-induced vulnerability in therapy, said Buisson. We anticipate that the RNA mutation-based APOBEC3A assay will significantly advance our understanding of the function of the protein in tumorigenesis and allow us to more effectively exploit the vulnerabilities it creates in cancer therapy.

This study was funded in part by the National Institutes of Health, a California Breast Cancer Research Program grant and an MPN Research Foundation Challenge grant.

About the UCI School of Medicine

Each year, the UCI School of Medicine educates more than 400 medical students, and nearly 150 doctoral and masters students. More than 700 residents and fellows are trained at UCI Medical Center and affiliated institutions. The School of Medicine offers an MD; a dual MD/PhD medical scientist training program; and PhDs and masters degrees in anatomy and neurobiology, biomedical sciences, genetic counseling, epidemiology, environmental health sciences, pathology, pharmacology, physiology and biophysics, and translational sciences. Medical students also may pursue an MD/MBA, an MD/masters in public health, or an MD/masters degree through one of three mission-based programs: the Health Education to Advance Leaders in Integrative Medicine (HEAL-IM), the Leadership Education to Advance Diversity-African, Black and Caribbean (LEAD-ABC), and the Program in Medical Education for the Latino Community (PRIME-LC). The UCI School of Medicine is accredited by the Liaison Committee on Medical Accreditation and ranks among the top 50 nationwide for research. For more information, visit som.uci.edu.

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UCI Researchers Uncover Cancer Cell Vulnerabilities; May Lead to Better Cancer Therapies - Newswise

STEAMBOAT SPRINGS Residents of Steamboat Springs are not the type to let a global pandemic stop them from enjoying the great outdoors.

For proof, ask Pete Van De Carr, owner of Backdoor Sports and a well-known face around the city, who just got off a river trip through the Desolation and Gray canyons in Utah. He is preparing for another voyage on the Middle Fork of the Salmon River in Idaho.

With business slow and extensive restrictions imposed by COVID-19, Van De Carr has found a silver lining amid the crisis in that he has more time to get on the water. He admits his profits likely will take a hit, and he sympathizes with those who have suffered much worse consequences due to the virus.

He also knows the situation is out of his control, so it is better to ride the rapids with a smile.

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Its really been a pretty glorious time for me, Van De Carr said of his free time to spend with family doing what he loves.

Amid the intense limitations Coloradans have been living under since March, recreation has been one of the few activities they can still enjoy and the state encourages. At the start of June, when Gov. Jared Polis announced a new phase of recovery, he called it Safer at Home and in the Vast, Great Outdoors, highlighting the millions of acres of federal land, city and state parks and other open spaces that allow for recommended distancing.

But as Van De Carr acknowledged, recreation is not what it was. The pandemic has wrought new challenges and frothed unprecedented concerns over his well-being that he never gave much thought to before the virus. On river trips, he keeps his distance from other families and wears a mask when necessary, something he has never had to do before.

As he said, Thats the reality of owning a small business there are no sick days.

Before COVID-19, exercising was a remedy to lifes struggles, a way to release stress from a long day at work and have fun with friends.

While it continues to serve that purpose for many, it is hard to escape the ever-pervading anxieties of getting sick or getting someone else sick.

Dr. Justin Ross, a psychologist withUCHealth Integrative Medicine Center in Stapleton, has studied anxieties caused by COVID-19. When it comes to exercise, he has heard patients list a variety of reasons for their apprehension, from passing people on trails who are not wearing face masks to exposing themselves to the virus at indoor workout facilities where sweat and spit are the currency of fitness.

Asrecent research from Belgium showed, the social distancing requirement of 6 feet might be inadequate for preventing disease transmission during higher-intensity activities that can spew saliva as much as 65 feet. That helps to explain why the state was reluctant to allow gyms and fitness centers to reopen until this month, and those that have opened must implement strict mitigation protocols.

To make matters worse, parts of the country have seen a resurgence of the virus.On June 5, Utah reported its largest growth in COVID-19 cases in a single day after 439 peopletested positivefor the virus. Fortunately for Colorado, new case counts haveremained low, as Polisannounced Thursday, but he raised concerns about a second wave of infections, particularly with thousands of people gathering in police protests.

With these and other concerns on peoples minds, it is no wonder some residents, particularly those more vulnerable to the virus, are wary of recreating. The consequences have been far-reaching.

Organized team sports effectively ended with the stay-at-home order imposed in March. More than just a way to stay fit, these activities provide a sense of community for participants. They are as much a time to socialize as to exercise.

Sean Pummill works at the Tennis Center of Steamboat Springs, but he is no tennis expert. His game of choice is pickleball, and he has helped to amass a loyal group of players. Last summer, more than 80 people participated in a single day, Pummill said. The players range in skill level and age, from a 12-year-old to those well into their 70s.

The social aspect of the sport is what propelled it into the popular imagination about a decade ago, according to Pummill. Players chat between matches, exchanging gossip as well as beta.

I have a lot of friends I met solely through pickleball, Pummill said.

When the Tennis Center closed in March, he found himself yearning not just for the game itself but for the people he saw on almost a daily basis.

It was very jarring, Pummill said. I dont even know how to describe it.

He is not alone in feeling that way. A group of pickleballers put a lighthearted spin on their quarantine with a YouTube parody titled I wanna dink with somebody. (A dink is pickleball lingo for a type of soft volley.)Set to Whitney Houstons hit song, it features players reminiscing about days on the court and knocking over lamps trying to host a match in a cramped living room.

Even individual exercise has a communal aspect. When Old Town Hot Springsreopened on June 5 with a strict mitigation protocol in place Marketing Director Vanessa Cory noticed a cultural change within the facility. With more than 8,000 members, the fitness center and pools usually are places where people catch up with other locals alongside their workouts.

A lot of that connection has been lost with how we have to run the facility right now, Cory said.

Before the pandemic, chairs surrounded a fireplace in the lobby. It was a space for people to sit around, have a snack and chat with passersby. Due to mitigation protocols, staff had to remove the chairs. Now, members are more deliberate with their visits to the hot springs, the environment more regulated and clinical.

As numerous stories from around the world show, exercise is important. It improves not just ones physical health, honing the lungs and heart and muscles into fine-tuned powerhouses, but also ones emotional and mental well-being.

Those worried about getting sick might take note that exercise can buttress whatever regimen of expensive supplements and quasi-medicinal elixirs they might have adopted. Regular, moderate exercise has been shown to give the body more robust immune responses to vaccines and reduce ones risk of illness, according to areport from the American College of Cardiology.

Dr. David Wilkinson,an emergency medicine physician at UCHealth Yampa Valley Medical Center, said outdoor recreation might provide special defenses against COVID-19. As he explained, the virus itself is unstable outside of the body, and UV light kills it quickly.

All of those elements are outdoors and serve to protect you to some degree, Wilkinson said.

People who had or have the virus should listen to their body when it comes to exercising. Those without symptoms who feel up to it should start gradually and build from there.

What you dont want to do is exercise when you are still having symptoms, Wilkinson said, explaining how it hampers the bodys immune response and could get others sick.

For reasons scientists are still studying, even a brief walk through a forest provides health benefits. Such strolls have been a long-held tradition in Japan, calledshinrin-yoku, or forest bathing.

Participants of the practice tend to be less anxious, sleep better and sleep longer after spending as few as 20 minutes outside. Sojourns through forests also have been shown to strengthen the immune system, reduce blood pressure, increase energy and boost overall well-being. It has proved so beneficial, Japan launched anational campaign in 1982 to encourage forest bathing.

Wherever there are trees, we are healthier and happier, Dr. Qing Li, a Japanese physician who has spent years studying the practice, writes in his aptly named book,Forest Bathing: How Trees Can Help You Find Health and Happiness.

Fortunately for those in Steamboat, forested areas abound, with ample public trails to allow people myriad of options to walk and unwind. Wilkinson hopes people can see theses places as benefactors for their health, not threats.

I want people to get out there and get exercise but to remember the virus is still there and take steps to protect themselves, he said.

Leaders in other realms of exercise are making similar attempts to encourage a return to recreation and assuage peoples fears.

The Tennis Center has guidelines in place to operate at reduced capacity and require people to wear protective equipment in certain areas. Initially, only a trickle of players showed up for pickleball matches, Pummill said, but more return each week.

It is just great to see them again, he said.

Old Town Hot Springs went so far as to hire an expert epidemiologist to draft a 50-page reopening plan, which has protocols ranging from frequent disinfecting of rooms and equipment to requiring people to wear masks indoors, even while working out. The hot springs originally had a reservation system to limit the number of people. It since has switched to a first-come, first-served basis with reduced capacity, accepting only people who had memberships before the pandemic.

Our number one goal is to stay compliant so we can stay open, said Cory, the marketing director.

She hopes the fitness center can welcome more people and offer classes as the recovery plan progresses. Until then, Cory wants all members to feel safe when they come to work out or soak. It has not been easy to navigate the ever-changing rules and guidelines, but such is the reality of an unprecedented crisis.

As Cory put it, At the end of the day, we just feel grateful that we can be open.

To reach Derek Maiolo, call 970-871-4247, emaildmaiolo@SteamboatPilot.comor follow him on Twitter@derek_maiolo.

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Exercise anxiety: How COVID-19 changed the way we recreate - Steamboat Pilot and Today

publication date: Jun. 12, 2020

By Alexandria Carolan

This story is part of The Cancer Letters ongoing coverage of COVID-19s impact on oncology. A full list of our coverage, as well as the latest meeting cancellations, is availablehere.

A movement that began with a fatal chokehold on a Minneapolis street grew into demands for police reform, but outrage didnt stop there. Amplifying, reverberating, it became a call for racial justice in medicine, in oncology.

The COVID-19 pandemic focused Americas attention on health disparities. The murder of George Floyd led them into the streets, and they kept going, people from all walks of life, including thousands of doctors young and old, out there, taking aim at racism in medicine.

White Coats for Black Lives extends much further than the knowledge of the violence, a knowledge of the killing of young men and women by police, a knowledge of the police brutality against blacks. Consequently, all of this affects health care, Edith P. Mitchell, a member of the Presidents Cancer Panel, clinical professor of medicine and medical oncology in the Department of Medical Oncology, director of the Center to Eliminate Cancer Disparities, and associate director of Diversity Affairs at Sidney Kimmel Cancer Center at Jefferson, said to The Cancer Letter.

Some say this is the turning point, that clear changes will be made to increase diversity in leadership positions, that work will get done to narrow health disparities, that black patients will get the same care as white patients.

I am more than cautiously optimistic that this is our first step to healing, that this is our first step to really getting real change, Robert Winn, director of Virginia Commonwealth University Massey Cancer Center, said to The Cancer Letter. Ive never been more hopeful in my entire life. I think people are waking up from their slumber, and as a country, we are embracing and becoming our best selves.

There are no shortcuts.

Im thrilled that doctors are concerned about health disparities, but we need to get at the social root of the cause. And we need to tackle all aspects of the health disparities problemincluding, why is it that American society has created this thing? Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, said to The Cancer Letter.

Perhaps the reason this movement feels so different, is the words Black Lives Matter have permeated the mainstream.

I would say, even as recently as a few months ago, to talk about police brutalityto even say the words Black Lives Matter was something that was felt to be political or controversial, Malika Siker, associate dean of student inclusion and diversity in the Office of Academic Affairs, associate professor in the Department of Radiation Oncology, student pillar faculty member, at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education, said to The Cancer Letter.

I feel like that conversation has changed now, and people are no longer afraid to say those words, and not just say the words, but understand what they meanand show a commitment to social justice and anti-racism, said Siker, who is also academic vice chair of the Community Advisory Board at MCW Cancer Center, Medical College of Wisconsin.

In oncology, these doctors say staying silent about racism is no longer an option. If a physicians goal is to alleviate human suffering, how can the quest for racial justice be overlooked?

If you dont step out, there is no middle ground. Weve got to be anti-racist, and every person in their position, in the medical field, needs to speak out, step out and do what we need to do so that we are removing the knee from the neck in all areas, Mitchell, a former president the National Medical Association, said. We can therefore face a world of equity, health care equity, for all. Its not only ethically the right thing to do, but for this countryfor health care, for all, its the best instance.

At the start of Mitchells career, in the year 1972, she recalls being fitted for her white coat as a sophomore. The seamstress asked: Are you going to like working in the kitchen at the hospital?

Physicians have a responsibility to address racism, Christina Chapman, assistant professor in the Department of Radiation Oncology, University of Michigan School of Medicine, and Center for Clinical Management Research, VA Ann Arbor Healthcare System, said to The Cancer Letter.

Its also the recognition that the physician does take a white coat off at the end of the day, but still has that responsibility, even in other sectors of their lives, to take a stand on racism, as one of the very critical roles in the healthcare system, Chapman said. Its to unite, and to not give physicians a pass on their responsibility in addressing racism.

Until recent events, doctors whose work isnt focused on disparities could simply not think about injustice. If they didnt live it, or actively engage with it, they didnt have to talk about it.

On the end of health disparities and our day-to-day lives as oncologists, its easy to just sort of ignore, or be very casual about the health disparities that we see and we encounter, Curtiland Deville, associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins University School of Medicine, said to The Cancer Letter.

I hope that this time it helps people take it to the next levelreally trying to solve the cancer disparities that they see in the communities they serve, or even just at the individual level of the patient, or the immediate patient that they have, Deville, who is also clinical director of JH Sibley Radiation Oncology, and co-director, of JH Sibley Prostate Cancer Multidisciplinary Clinic at The Kimmel Cancer Center Sibley Memorial Hospital, said.

The decision to come out into the public square is never trivial.

Police have tear gas, a chemical weapon, no less. They have rubber bullets, which hurt like hell and can put your eye out. They have pepper spray, which adds injury to humiliation. They slug you with their truncheons, knock you to the ground, bind your hands with a zip tie behind your back, cart you off, and maybe tell your employer, whose views on racial justice might differ from yours.

The risk of COVID-19 makes the threat bigger.

If you need to protest, there is something that is a threat to your safety and your security and your livelihoodand you have deemed that that threat is greater than the immediate threat of the coronavirus, Deville said.

If youve been schooled in public health issues, you might find it hard to argue that racism is anything other than a public health issue. You would also see the overlap of COVID-19 and police brutality. George Floyd survived the former, but was killed by the latter.

There are two pandemics, there are two infectious diseases. Theres COVID-19, and theres racism. Racism hasnt gone anywhere, and racism is of paramount importance, Chapman said.

The impact of racism extends beyond just the risk of police brutality and murderpeople arent simply out there protesting because of what happened to George Floyd. Theyre protesting because they know that the system that allowed that police officer to do what he did is the same system that creates residential segregation, and poverty, and health inequities that black people die from, she said.

On June 1, in Washington, D.C., in Lafayette Square, a park across Pennsylvania Avenue from the White House, police used tear gas, rubber bullets, flash bangs, horses, and a helicopter on peaceful protesters to make it possible for President Donald Trump to hold up a Bible, using St. Johns Episcopal Church as a backdrop.

Deville marched down the same street less than one week later, on June 6. The temperature was in the 90s that day, as tens of thousands of demonstrators took to the streets to let it be known that Black Lives Matter. Protesters marched peacefully to the White House from all directionsthe Lincoln Memorial, the U.S. Capitol, the National Mall. Chances are that if you were anywhere near downtown D.C. that day and you werent already in a protest, you would have become a part of one.

By then, D.C. Mayor Muriel Bowser had ordered that two blocks of 16th Street NW leading to Lafayette Park be renamed Black Lives Matter Plaza.

The words BLACK LIVES MATTER are emblazoned in yellow on the asphaltimpossible to miss.

It was a shift in what was becoming a very negative and hostile kind of situation, into a more positive direction forward, Deville said. Being able to be there for an hour or two was a very positive feeling.

The chants were unforgettable:

Say her name: Breonna Taylor. Say his name: George Floyd.

Its a call and response.

Its not just black people, marching, its all kinds of backgrounds who are, equally as enthusiastically shouting, Deville said. You really do feel it that they are just upset, and agitated, and not holding back. And theyre shoutingthese black people that were killedtheyre shouting their names out. It was very powerful.

The marches by the White Coats for Black Lives movement were held in multiple cities. Students, faculty, and staff showed up on June 5 at Johns Hopkins University campuses. Deville was there, taking a knee alongside other protesters.

Institutions participated, too. On the same day, Memorial Sloan Kettering Cancer Center, like other hospitals across the U.S., held a moment of solidarity. Hundreds of MSK employees joined in. At Chapmans University of Michigan School of Medicine, more than 1,000 students, staff, and faculty called in to a virtual protest organized by the University of Michigan Black Medical Association. Chapman was one of the virtual attendees.

The decision to protest is complicated for oncologists, who took the risk of being exposed to SARS-CoV-2.

The risk was worth it for Allison Betof Warner, assistant attending physician in the Melanoma Service and Early Drug Development Service at MSK. She stood with nearly 3,000 other health care workers in the East Meadow of Central Park.

Living in New York City and having worked on the front lines of COVID, I am very wary of any groups of people. That being said, I think its critical to have the voices of healthcare workers heard. Both COVID and cancer disproportionately affect people of color, Betof Warner said to The Cancer Letter. Racial disparities in access to health care profoundly affect our patients.

Betof Warner wore an N95 mask. She maintained her distance from other participants, who were primarily healthcare workers in New York. Masks were distributed to anyone who didnt have one.

I firmly believe that racial disparities are a public health issue, and therefore, its critical that we hear from doctors, nurses, and other healthcare workers that the time for change is now, she said.

Protesting is a personal matter. Siker doesnt judge those who choose to, or who choose not to.

At the end of the day, it comes down to an individual choice. For me, as an advocate, as somebody whos committed to social justiceand an oncologist still actively treating cancer patientsthis has been a really tough decision, MCWs Siker said. Because I know that if one of my cancer patients were to see me at an event, they might be disappointed that I would be putting myself at risk of contracting the virus, and therefore putting them at risk when they come to the clinic.

Chapman agrees. I treat head and neck and lung cancer, and my patients tend to be not only immunocompromisedbecause most of my patients are receiving concurrent chemotherapyand given that I treat lung cancer and I work at the VA, a lot of my patients have bad lung function, Chapman said. So, for me, I decided, given the risks to my patients, I havent gone out there.

The role of the physician is to provide guidance, to educate protesters on how to protect themselves, Deville said.

As a physician, I think you can educate people. If youre going to go out there, maybe there is no 100% safe way, but certainly, there are things you can do to try to minimize your risk. I mean, we tell people that all the time, right? Deville said.

Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance released a guidance for employees protesting in the time of COVID-19:

Wear a mask or face covering that fully covers your nose and mouth.

Strongly consider wearing or having ready access to goggles or eye protection for added protection (avoid wearing contacts).

Bring hand sanitizer and use it frequently.

Avoid sharing drinks, carrying others signs or touching objects that others have touched.

Attempt to limit your group size and maintain six feet of physical distance whenever possible during the activity.

Try to avoid crowded activities that involve shouting or singing in close proximity to others, and avoid those who are not wearing masks or face coverings if possible.

Bring your own water, food, or other personal items.

The epidemiological principles of pandemic containment have not changedit has always been to limit exposure, wear a mask and practice other precautions, Ishwaria Subbiah, palliative care physician and medical oncologist in the Department of Palliative, Rehabilitation and Integrative Medicine, Division of Cancer Medicine, at MD Anderson Cancer Center, said to The Cancer Letter.

Assuming no legislative mandates on gatherings are in place, the decision to engage in a peaceful assembly is the individuals to make. Patients with health concerns can engage their medical team to assist through a discussion of the risks to self and others of person-to-person COVID-19 transmission, Subbiah said.

Risk-taking is subjective. A pandemic makes the downside steeper.

If you have the luxury of having the conversation around, Should I weigh this versus that, then, you know, thats a privilege in itself that you should be aware of, Deville said. I dont know that a protest occurs for convenience. If you look throughout history, when did people protest when it was convenient?

While Hopkinss Brawley is hopeful that this movement will spark real change, he is concerned that COVID-19 will spread as a result of these protestsand African Americans have already been the hardest hit population in the U.S. African Americans make up 13% of the U.S. population, but comprise greater than 33% of all COVID-19 deaths.

We keep talking about this as if its a tidal wave. I think theres going to be a series of big wavesnot one big tidal wave. I think were going to see it in the fall, August, September, Brawley said. I cannot say that people ought to protest and not worry about the coronavirus. Every protester needs to understand the risks that they are putting themselves in.

While the oncology workforce is growing increasingly diverse, the leadership still appears to be predominantly white and male.

There are a total of 71 NCI-designated cancer centers. VCU Masseys Winn is the only black director. No data exist on self-identification by other directors. There are nine women directors (The Cancer Letter, June 5, 2020).

Senior leaders at cancer centers are finally starting to really grapple with the issues around diversity within their own ranks, or the lack thereof, Winn said. In fact, I think that its probably been the first time in my life time that Ive seen CEOs and deans and people not just reflect, but look at their own institutions and say, How can I be wanting to aspire to actually have diversity and not have any in my own ranks?

Leaders of many institutions have used the words Black Lives Matter in their public statements.

People need to take a critical look at their lives, their circles of influence and power, and be intentional about wielding that power in a way that includes voices that may not be at the table, MCWs Siker said. How that looks for each individual may be different.

Mitchell agrees. How many deans do we see are African Americans? How many professors are at the highest ranks and are African American? How many hospital directors, and how many cancer center directors are African-Americans? Mitchell said.

And what about funding?

NIH is evaluating how many individuals of African American or other underrepresented minority descent receive top grant funding from NIH. NIH is therefore contributing resources to study this and to improve the number of individuals receiving grants, and who become grantees for NIH funding, Mitchell said. This goes farther than police brutality, its involved with equity, and diversity, and inclusion.

For Deville, workplace diversity is a prerequisite to addressing health disparities and health equity.

In the areaI went into prostate cancer, the reason I was drawn to it was because I was going through my rotations and saw a lot of black men with prostate cancer. The fact that their outcomes were worsethey have death rates twice as highI was feeling like, why arent people as wound up about this as Im feeling? Deville said.

It says to me that, what a shame that patients often do not have providers that look like them. They often dont have that option in a large proportion of healthcare settings throughout the U.S. Its just sad.

NCI requires that its designated cancer centers have Community Outreach and Engagement programs focused on addressing health disparities.

Doctors are realizing that they have a social obligation. I actually wish they would push it a little further, because even amongst doctorsthe thought is always the racism, getting rid of the racism when the patient has a diagnosis and is being treated, Brawley said. And that, certainly, is an important part of it. But the thing to realize is that the police issue, the health disparities issuethey are all part of one thing. Theyre held together by this gravity of racism.

This gravity of racism is entrenched in an almost endless array of health inequities that affects the black cancer population. There are multiple barriers to treatment: cost, travel, inferior quality and delivery of care, and distrust.

African Americans have higher incidence of hypertension, diabetes, lung disease, prostate cancer, and now, COVID-19. To pull patients out of peril requires concerted effort by leaders in health care.

Therefore, we really must increase insurance for individuals. Again, its been recognized that those individuals who live in states where there has been expansion of Medicaid have better oncological outcomes, Mitchell said (The Cancer Letter, June 5, 2020; June 21, 2019). So, we can say that African Americans and other underrepresented minorities, whether racial or ethnic, have access to the best health care and that we can, in a few years, show that there were no differences in individuals based on their ZIP code and where they live, and the color of their skin.

Often, African Americans cant afford and dont have access to the latest and greatest drugs and technologies.

You get a system where, by innovating in a way that doesnt account for racism and doesnt account for other forms of discrimination, you actually perpetuate and exacerbate disparities, Chapman said.

Its not surprising that when we come out with the next targeted agent, and that when those agents initially are only available in the context of clinical trials, we know that minoritiesand especially black peopleare less likely to go to hospitals that have expensive technologies, have these drugs available, have clinical trials available, Chapman said.

New treatments should be designed in a way that allows for access, Chapman saidin ways that can be disseminated to hospitals that are not academic, that have a payer mix that is primarily Medicaid or for the uninsured.

Disparities remainand growin part because people have learned to accept them.

In other words, we have not only come, as a society, to accept that disparities will occur (as a law), but we can always explain them away by the differential distribution of individual risk factors (as the theory), Winn wrote in an editorial about the very subject in COVID-19 (The Cancer Letter, May 11, 2019). Thus, the individual risk factor theory becomes a unifying, acceptable explanation and a refrain that is absolving from our collective, societal responsibility.

To put it even more simply, underserved communities, are underserved, because they are underserved (as stated by Dr. Otis Brawley), and this has been made abundantly clear during the recent COVID-19 crisis.

People are paying attention because of the gruesome murder of George Floyd.

I think weve gone through a radical transformation with the recent events. And I think that theres a better understanding from our university administration about what this movement means to our black community and our students, Siker said. Its been great to see our administration step up and acknowledge that black lives matter in a public way, as well as support the students during this time.

Brawley is hopeful, too.

You go to Missoula, Montanawhere there are no blacksbut theres a Black Lives Matter protest. There were 300 people out for a Black Lives protest in Missoula, Montana, and they were all white, Brawley said. The majority of people under the age of 50, who are white, actually are starting to get it, and not be threatened by it. Caring about other people, and not feeling threatened, can get us very far in this movement.

More:
#WhiteCoats4BlackLives aims to lead to real change in oncology The Cancer Letter - The Cancer Letter

As states gradually reopen even as the pandemic wears on, many of us are concerned about our health and well-being. Especially now, with some continuing to stay at home and social distance while others join the throngs at nationwide Black Lives Matter protests, it may even be a priority.

From state to state, the loosening of restrictions vary, and within our local communities, the reality is that not only do people have different ideas on what constitutes social distancing but for many others still, in the face of racial inequality, the desire to create social change far outweighs the potential risk of spreading or catching the virus.

It's all the more reason to make sure we're taking the best care of ourselves to fortify against the disease. But while living a healthy life may be a desired goal, how to achieve it is another story.

Now, more than ever, the world needs trustworthy reportingbut good journalism isnt free. Please support the nation's longest continuously published newspaper serving the African American community by making a contribution.

Even if you're someone whose healthful habits were perfected to a tee during pre-pandemic times, you may find yourself struggling to engage in even the most basic self-care in these increasingly unpredictable days.

That's where a wellness routine can come in handy.

I'm not talking about a spa escape every so often or even regular massages or chef-prepared meals (though all of that may sound really nice). I'm talking about creating your own personalized routine that will benefit you physically and emotionally, one that simply requires a regular commitment to yourself.

Creating a wellness routine allows you to shift from diet culture and adopt healthy habits that easily fit into your daily lifestyle. What's more, having a routine allows you to focus on health goals by creating structure and organization, which can be particularly beneficial when things seem out of your control, like life during an unprecedented pandemic and simultaneous upheaval as people fight against social injustice.

In fact, predictable routines, or ritualistic behavior "developed as a way to induce calm and manage stress caused by unpredictability and uncontrollability, heightening our belief that we are in control of a situation that is otherwise out of our hands," according to researchers at Tel Aviv University.

"We need an internal structure because our external lives have become totally unstructured and that triggers anxiety and stress," said Robin Foroutan, a New York City-based integrative medicine dietitian and spokesperson for the Academy of Nutrition and Dietetics.

"In the beginning, we thought this was going to be a little break; a couple of short weeks, and then we'd resume life as we knew it. Now we know that probably is not going to be the case. We don't know how long this will last, but we can find ways to stay steady and structured on the inside amidst the chaos outside."

And while social obligations, travel and other commitments typically make it challenging to start new habits, being stuck at home without these distractions provides an opportune time to start creating a wellness routine that is accessible, doesn't require a lot of money and is something that you can count on during this uncertain time and in the future, too.

How to create a wellness routine

Health experts say it's important to create a manageable routine that you can stick with as part of a lifestyle not something overly ambitious that you can't sustain. One way to do that is to start small and build upon it, as you feel comfortable.

Here are some tips to get started in creating your personal wellness routine.

Set regular times for sleeping, eating and exercise

For sleep: Everyone's sleep schedule is different, and that's OK, as long as you stick to your natural circadian rhythms, experts say. That means going to sleep when the sun is setting (or a bit later) and waking up when sun is rising (or a little later, according to your individual needs).

Aiming for seven to nine hours of sleep is key, as it helps to "reduce the stress hormone cortisol and your adrenal load," Cardwell said.

Getting adequate sleep also bodes well for engaging in other healthful behaviors by going to bed at a reasonable hour, you'll be less likely to engage in nighttime eating or mindless eating in front of the TV, and you're more likely to wake up early and start exercise, Cardwell explained.

For eating: Setting regular meal times, and taking a break to eat your food mindfully is key, Cardwell advised, but when you actually eat is up to you. "Some do well on three meals per day with an afternoon snack; others prefer three smaller meals and three snacks."

Regardless of the pattern you choose, aim to eat at least every four hours, which prevents blood sugar from crashing and can lead to overeating. For example, if you're eating three meals and one afternoon snack, you might choose to eat breakfast at 8 a.m., lunch at 12 p.m., a snack at 4 p.m. and dinner at 7 p.m.

Taking a few deep breaths, enjoying the wonderful smells of the food you are about to eat and chewing food really well can all help make mealtime a healthful ritual, Foroutan explained.

Additionally, dinnertime can become a daily social ritual by sharing the meal with family or friends, advised Jen Scheinman, a Denver-based registered dietitian nutritionist and owner of Jen Scheinman Nutrition, a virtual nutrition coaching practice. "Even a Zoom dinner with a friend if you're by yourself can help you feel connected."

For fitness: Pick a time that you're most likely to stick with. That might mean taking a morning walk before your day gets started, or scheduling your favorite fitness class on your calendar so you won't forget.

"I shut my day down with a run or yoga at around 5:30 p.m. That's my last thing for the day. The more you can make it a routine, the less you have to think about it," Scheinman said.

Plan for food, fitness and sleep

Planning what you will eat and how you will exercise means that you are more likely going to do what you intend to do, which will ultimately help you achieve your health goals. For example, planning meals in advance means you'll be less likely to reach for quick sugary snacks when you run out of energy. It also helps to limit shopping trips.

"Not only does planning your meals ahead of time help cut down on the number of times you're going to the grocery store, but it can also help reduce food waste and ensure you have meals that were intentionally picked to fit your nutritional goals," said Denver-based registered dietitian nutritionist Kelli McGrane.

For food: Eating a nutrient-rich breakfast sets the stage for making other healthful choices throughout the day.

Choose protein-rich breakfasts like egg whites, cottage cheese or smoked salmon on a bagel; Greek yogurt, smoothies with low-fat milk, high fiber cereals with milk or peanut butter on whole wheat toast.

Scheinman recommended preparing breakfast foods ahead of time, like making overnight oats with milk. "It makes the breakfast routine less daunting."

For lunch and dinner, Cardwell encouraged a fist-size portion of protein, such as fish, chicken or beans; a fistful of carbohydrates like whole wheat pasta or brown rice; and a half plate of veggies. This will help meet your micronutrient needs, as well as fiber. Use fats sparingly, as a condiment, to make your food taste better, but limit fried foods and saturated fat, Cardwell advised.

For snacks, choose protein and carb combos, like cheese with crackers, sliced fruit with peanut butter, nuts and seeds with dried fruit or Greek yogurt. Pairing protein with carbs "helps keep your blood sugar level stable, and helps you stay fuller longer," Cardwell said.

Scheinman recommended using the weekends for batch cooking, like making chili or soups, which you can freeze to enjoy later in the week. Washing and chopping veggies and fruit during the weekend can also save you time during the week.

For fitness: Pick a fitness activity that inspires you and is doable. There are a lot of fitness apps offering free trials and online Zoom fitness classes, so you can use this time as an opportunity to try something new. Cardwell recommended aiming for at least 30 minutes per day, if possible.

If you are looking for a simple at-home cardio workout, MaryAnn Browning, founder and CEO of Browningsfitness in New York, recommended jumping jacks, high knees, butt kicks, burpees and switch jumps during which you'll jump to turn 180 degrees and then back again for 15 seconds each. Then repeat the circuit five to 10 times, depending on what you can handle.

For at-home fitness essentials, Browning recommended getting a set of yellow, green and red resistance bands, which can be used for back, bicep, triceps, shoulders and leg work. She also recommended looped bands to go around the calves or thighs, which strengthen the glutes and can help prevent knee and back injuries.

If you want to weight train but don't have equipment, anything that will give you muscle tension will be beneficial, such as jugs of water, books or even your children. "I use my kids I'll do planks and have them sit on me ... or I'll do leg presses while letting them do airplane," Cardwell said.

And don't forget to keep moving throughout your day. Tracking apps like Lose It! are a good way to see how normal daily activities can all count toward our daily fitness goals.

"Dancing with your kids or partner, yard work, house projects, sex and cleaning are all trackable activities. Doing these activities with intention and extra vigor all count towards a healthy lifestyle," said Cardwell, who is also a contributing dietitian for Lose It!

For sleep: Engage in a bedtime routine where you can quiet down and prepare for sleep. "Turn off electronics, including the TV, iPad, and cell phones an hour before bedtime," Scheinman advised. This helps to reduce exposure to blue light, which "the brain perceives as daylight, so your brain is not quite getting the signal that it's nighttime and melatonin is not produced."

Unplugging also prevents you from checking one more email or scrolling through social media while in bed, which can be stimulating and interfere with sleep, Scheinman explained.

Other tips for a successful wellness routine: a morning ritual and self-care

Most experts recommended engaging in a morning ritual that brings you pleasure. "Starting your day with the same routine each morning can bring steadiness and calm to the rest of the day. You are starting from a more grounded and positive place, versus waking up; grabbing the phone and checking the news and getting stressed out," Foroutan said.

"The morning is a nice time to start integrating things you didn't have time for previously like taking the dog for a longer walk in the morning, making a nice cup of coffee you can sit and enjoy or engaging in a meditation practice," Scheinman added.

"It sets the day off with a healthy intention, with a sense of comfort. ... I know this is what I do," Scheinman said.

Foroutan enjoys waking up and writing down three things she is grateful for. "Starting the day with a thought about gratitude can be really centering. Writing it down does something extra it solidifies the thought and intention. Not every day is good but there's something good in every day. Even if it's one small thing that gives you a sense of gratitude that's really grounding and it can help shift your perspective."

Stretching your body after you wake up or doing a sun salutation can help to get your blood flowing and your body moving in the morning.

It's also important to prioritize self-care. "Make stress relievers like enjoyable activities a non-negotiable right now," Cardwell said. That may include knitting, taking an extra-long shower or bath, reading, taking a tea break, enjoying a glass of wine or calling family members. Even better, schedule these stress relievers into your day just like mealtimes and other obligations.

"We're taking stock of what's important ... and [our] health is important. Doing these things now can help you deal with the stress of right now," Cardwell said.

It can also keep you healthy and feeling good well into the future, too. That's a gift from quarantine life if there ever is one.

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