Health Report - Full program podcast

The debate continues on whether the TGA acted too soon on the rescheduling of psilocybin and MDMA for the treatment of some mental illnesses.  Calls for Australia's cardiovascular disease guidelines to recommend coronary calcium scoring for patients at intermediate risk.  And did you know ovarian cancer often originates in the fallopian tubes? A simple surgical procedure could drive down cases.

How much screen time is too much for young kids? Taking a looking at what digital playtime is doing to children's brains.  Calls for better models of care for people living with lymphoedema, to avoid deterioration and costly hospital stays.  And organ donation is yet to fully recover from a pandemic-driven dip. Why aren't more people consenting?

Mind Medicine Australia share their thoughts on the recent approval of psychedelic compounds for treatment-resistant depression and PTSD.  A study in Sweden has looked at a possible association of maternal and paternal primary antibody immunodeficiencies — and if this provides a natural test of a hypothesis about parental immune activation. An intriguing story about people who can't burp, and turn to the internet for answers. Turns out there's a surprising treatment to unlock their gas.

The Therapeutic Goods Administration recently approved the psychedelic compound psilocybin for treatment-resistant depression; and MDMA–or ecstasy–for treatment-resistant post-traumatic stress disorder. A group of researchers think this is premature. More people are tackling the bracing discomfort of ice bath sessions—for the touted health benefits ... but there are some serious risks, so pay attention to the instructions before hopping in. Chronic, non-cancer-related pain is hard to treat and so alternate medications—like antidepressants—are used because of their action on the brain. A group of researchers has compiled the available evidence on their efficacy.

Australians will pay a lot to relieve the pain of arthritis—sometimes opting for unproven therapies using stem cells. Why does this happen? Women are twice as likely as men to be diagnosed with Alzheimer's disease. Researchers have long looked for the reason why— it may be related to the amount of 'cognitive reserve' some groups have been able to accumulate. Researchers have found that a protein in the K'gari (Fraser Island) funnel web spider venom has the ability to stop heart cells dying. It could also help preserve organs prior to transplant. A genetic form of diabetes can occur later in life, and doesn't require insulin. A pilot project has looked at the benefits of early genetic testing for it.

The Strengthening Medicare Report was released recently, and the key recommendations include changes to the digital health environment; working to scope of practice; and modernising My Health Record. Psilocybin and MDMA are now approved as treatments for depression and MDMA—with caveats. And still need co-ordination between clinicians and manufacturers (the TGA has not approved or registered specific psilocybin or MDMA medications). A financial reward for obese people to achieve sustainable weight loss has proved successful—but the general health environment must also be considered. How to make healthy weight work for a whole population and working on how food is presented and for which particular age groups—so a healthy choice can be made

The prescription rate for medications to treat Attention Deficit Hyperactivity Disorder rose in recent years but was still below what's thought to be the extent of the condition. Organ donation is one of the great miracles of our time, but that's not to say it's easy. To be viable, a heart needs to be transplanted within four or five hours, and this is a huge logistical challenge for a country the size of Australia. The Garvan Institute has studied the combination of genetic profile alongside family history of people with cancers called sarcomas, and found genes to aid early diagnosis.

Sun Pharmaceuticals is a supplier of generic medications and they're in hot water about possible violations of the manufacturing process at their facility in Gujarat, India. Fasting diets like the 5:2 or the 16/8 have become very popular. While there's lots of evidence for the benefits of the 5:2 diet in animals, there's hasn't been much in humans. The results are not out from a trial of intermittent fasting in overweight men and women. One of the biggest puzzles for humans is the brain, or more precisely, the minds. It's a bit of a mystery but still possible to learn something about how to keep it in good order. Hosts: Dr Norman Swan and Tegan Taylor

Royals have a tendency to change the course of history — in life and in death.  From King George III's apparent madness, to Queen Victoria's genetic legacy, the Health Report takes a look back at the illnesses (and deaths) that have shaped the world. Note that the change of broadcast time mentioned at the end of the program refers to our live program on Mondays.

Mild Cognitive Impairment (MCI) affects 7 or 8 per cent of people in their 60s, and one in four people in their 80s. In an ageing population the number of those with mild cognitive impairment will increase. There's a new perspective on the cause and progress of Alzheimer's disease. Are we doing the right thing by removing accumulated amyloid protein from the brains of people with it? Some people experience a tingly feeling when they hear certain noises and this feeling might be a useful intervention for people with anxiety. Atrial fibrillation is a type of arrhythmia characterised by a rapid and irregular heartbeat. There is increasing evidence that relaxation methods like yoga and meditation can help manage the condition. Hosts: Dr Norman Swan Tegan Taylor

More than two decades ago a major milestone in cancer research was reached with the discovery of the BRCA1 and BRCA2 genes. Inherited mutations to these genes can dramatically increase the risk of developing breast and ovarian cancers. The discovery opened up new ways of knowing who is at risk of cancer, how to treat the cancer, and even how to prevent it happening in the first place. This moving feature describes what this genetic information means for families who have seen loved ones endure sometimes multiple cancers—and it explains the emerging frontier in medicine trying to change that. Guests: Michelle Brady Anna Murphy Dr Mark Pinese, Team Leader Personalised Medicine, Children’s Cancer Institute A/Prof Paul James, Clinical Geneticist and Director, Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital Dr Laura Forrest, Senior Research Fellow and Genetic Counsellor, Peter MacCallum Cancer Centre Host: Dr Norman Swan Interviewer and Producer: Sarah Sedghi

With COVID we've focused on vaccines and masks but there is more we can do, and the situation parallels a public health revolution from the mid-1800s. If you're a modern human you likely carry a bit of tech on you to track how physically active you are. But how can we be sure it's really promoting activity? Telomeres are small 'caps' on the ends of your chromosomes—the length of telomeres is seen as an indicator of how fast we age. How accurate could they be? Hosts: Tegan Taylor and Dr Norman Swan

It's expected now that on the whole we will live longer, but individuals want to know how to spend a longer life in good health—and to set a good foundation. This program was first heard on 25 April, 2022 Dr Norman Swan's book was published in July 2022. Guest: Prof Luigi Fontana Leonard P Ullman Chair in Translational Metabolic Health Director, Healthy Longevity Research and Clinical Program Charles Perkins Centre | Sydney Medical School (Central Clinical School) Faculty of Medicine and Health,  University of Sydney Host: Dr Norman Swan

A new study has found a genetic link between macular degeneration and Alzheimer's disease—with implications for drug development. The wellness space often refers to nicotinamide adenine dinucleotide—or NAD. It's found in products promoting longevity—so may give you pause for thought—but shows promising results for human eyesight. High blood pressure is one of the most toxic risk factors for heart attack, stroke, kidney damage, dementia, and probably premature ageing—so it's incredibly important to get blood pressure under control. Hosts: Dr Norman Swan and Tegan Taylor

Fish oil supplements—aka omega 3 fatty acids—are taken by some women during pregnancy. What are the benefits, and who gets them? Research into ageing has revealed a number of processes controlling its rate. Autophagy helps cells do a clean up. Researchers are wondering if it could be manipulated. Is it possible to say whether a pandemic is a natural spillover from an animal, or an accidental release from a lab? In her new book, Dark Winter, Professor Raina MacIntyre warns that scientists may not be the people to identify the source of pandemics—rather that Intelligence and law enforcement services could have a better toolkit.

The ABC’s Birth Project call out is discovering the good and bad of pregnancy and birth in Australia—one of the safest places in the world to give birth, but which sometimes fails women, their families, and clinicians. Parents-to-be now have access to simple blood tests that can indicate whether their baby might have a chromosome issue. But parents who want peace of mind or want to know the sex of their baby can feel blindsided when the result predicts high risk—or for something they didn't know they were being screened for. The Birth Project has shown us that the kind of care you might get if you're pregnant varies wildly across Australia. A national strategy around improving maternity care was launched in 2019.

With humans set to spend more time in spacer, one of the physical things to overcome will be gravity, and it's very important for how our bodies work. We hear frequent stories of mental health issues, but there is more investment in services, so are services effective or overwhelmed? An estimated 34,000 people in Australia have cerebral palsy. The cause can be a mystery but looking at a child's genes may supply information for parents and treatment teams.  Hosts: Dr Norman Swan Tegan Taylor

There's been talk of changing the packet size of paracetamol tablets, to reduce the self-harm of overdose—but it would be better to investigate and remedy why this harm occurs. The idea that society—as well as an individual—is responsible for this 'health literacy' is central to a new World Health Organisation report. Results of a randomised trial in people with low back pain who used a spinal cord stimulator were published recently, and the researchers are surprised by what they found. Hosts: Dr Norman Swan and Tegan Taylor

How analysts are making health data safer | Linked health data can see the bigger picture of healthcare use  | Clinical trials need more clarity on the kind of harms incurred | Donating mitochondria may mitigate the risk of some genetic disorders—but it's not a given.

The ABC series Magda's Big National Health Check us an immersive and personal journey about health in Australia today. It''s hosted by Magda Szubanski, who wants to know why Australia has a high level of chronic illness—and what to do about it. The latest statistics on causes of deaths in Australia show that deaths caused by alcohol rose by 6% last year—it's avoidable and advocates for greater alcohol control measures have been warning for years that there are not enough of them. Hosts: Dr Norman Swan and Tegan Taylor

Severe chronic traumatic encephalopathy (CTE) can be defined in pathology, yet only be diagnosed after someone has died and their brain examined. The Victorian state election is on 26th November and hospitals feature in political healthcare promises. Labor anticipates spending more than $6 billion on new hospitals and upgrading existing ones. Guest: Assoc Prof Michael Buckland Head of Dept of Neuropathology Royal Prince Alfred Hospital and Director, Australian Sports Brain Bank

There's a new perspective on how we think about the cause and progress of Alzheimer's disease. Are we actually doing the right thing by removing accumulated amyloid protein from the brain of people with it? Health practitioners are often still operating under the assumption that obesity is an individual's responsibility, even though science now tells us otherwise. It makes intuitive sense that if you screen people for disease the outcome will be good - because you get on top of the problem. But how far should you go.

The debate may be over about robotic surgery for men with prostate cancer—but can hospitals afford the robots? How do you know if memory lapses are a part of slowing down—or an early sign of dementia? The psychology of moving more—and eating better. An Australian researcher in women and cancer has died .

Bringing clarity to health and medical issues from social, scientific and political points of view.

Bringing clarity to health and medical issues from social, scientific and political points of view.

From King George III's apparent madness, to Queen Victoria's genetic legacy, the Health Report takes a look back at the illnesses (and deaths) that have shaped the world.

Vital health and medical news.

Vital health and medical news.

Vital health and medical news.

Exploring how changing your diet—or even your eating schedule—can improve your long-term health outcomes.

Vital health and medical news.

An option for cervical cancer screening could be a game-changer and miscarriages or stillbirths may bring an increased risk of stroke

With COVID there are more protective measures to take—and there's a historical parallel | The results of a trial of vitamin D supplementation find no evidence to support vitamin D supplements | Shingles can be a painful disease and those over 70 can have a free vaccination, but not the costly and most effective one.

The amount of money to spend on health care in the last year of someone's life is debatable. | The vital eligibility criterion for voluntary assisted dying in Australia is a problematic issue for doctors. | For a heart attack you want the best care possible—but where you live can affect limit that. Climate change is becoming more obvious—it now includes a noticeable mental health aspect.

Some immunologists are concerned that COVID-19 is not travelling as expected. An internationally respected immunologist had four doses of COVID vaccine but now recovering from heart failure after getting the virus. There are still community questions about the value of getting a fourth vaccine dose—we asked a vaccine development expert to explain why you should. Fitness and living longer are more than just how much you eat and how much you exercise?

In 2009 Australia launched a National Preventive Health Strategy with the aim of being the healthiest country in the world by 2020—where we're at with it now. The Australian Commission on Safety and Quality in Healthcare has created a national clinical care standard for diagnosis and treatment. Many people are told to take a vitamin D supplement, especially in winter when there's less sunshine, but you can have too much of it.

Australia has many stories from people who say they have long COVID but who are unable to access help | Updated versions of coronavirus vaccines targeting the Omicron variant have been announced, yet the virus still mutates | People with Type 1 diabetes need to monitor their blood glucose but automatic systems are being trialled to assist them | A study on the behaviour of teens undertaken during the pandemic identified some of the particular health risks for this group.

What an Australian Centre for Disease Control might aim to be; An Indigenous perspective and research to engage culture for protection against cardiovascular disease and stroke; Research on links between mental health and mortality concludes that both mental and physical health can be adversely impacted.

There may be a link between what you eat and your mental health—also, avoiding overtreatment for breast cancer; predicting your risk of osteoarthritis; and whether mammogram results should inform women about breast density.

The cancer risks that run through generations of families—and the growing frontier in medicine trying to change that.

The term 'time toxicity' expresses the idea that if treatment to extend a patient's life means lengthy periods in medical facilities, it may be time wasted; In Australia smoking has decreased generally, but tobacco use is higher than average in young people with mental health issues; The bad form of cholesterol is LDL — low-density lipoprotein, and high-density lipoprotein is the good form. An new study suggests there's a limit on how high HDL should be.

Those at greatest risk from unplanned pregnancy are often least able to access it; Study on 800 different lipids to check your metabolic risk and health profile; It's important to ask if someone's life will be improved by taking cancer drugs; Heart defects in kids may need surgery but new research considers exercise as a key to improving their life expectancy.

Combating monkeypox with increased vaccination—and monitoring polio cases in Ukraine; Treating the increasing number of melanoma cases; A faster and more mobile way to diagnose stroke; Comparing data on some mental health conditions against immune disorders.

Ahead of the election, The Health Report hosts a discussion between experts about the pressing health issues. What are the most pronounced problems, and what health questions have not been raised at all?

The risk of premature mortality has been mapped on to federal electorates and Australia's lack of response to the disparity contrasts with that of the UK. The effects of prostate surgery affect the man and his partner—and sometimes it means a change to sexual function. Doctors can struggle to communicate with Aboriginal patients—a podcast featuring Aboriginal elders offers advice on delivering culturally safe healthcare.

Global warming will probably mean that wildlife travels more and mixes with other species—and an effect will be to spread unfamiliar viruses; There is new guidance to help hospital doctors and clinicians prescribing opioids for pain; A disorder of the oesophagus creates symptoms similar to reflux or allergies, but the cause of the disorder is not known; The non-availability of a treatment for age-related macular degeneration has eye surgeons arguing for change.

It's expected now that we will generally live longer, but what really interests people is how to spend their longer life in good health—what to do now in order to set a good foundation.

Oncologists don't always know which chemotherapy drug will work best, and even then, one treatment won't suit everyone. So there's growing research on potential therapies using animal 'avatars'. And later ... an estimated one in six Australians lives with tinnitus but told nothing can be done to help it.

Many people are waiting for an organ donation and some of them may die before a suitable organ is found. Some researchers think that in the near future we will be able to grow organs in animals to be safely transplanted into humans. The first of two features about medicine's use of animals for organ and tissue transplantation. This program was originally broadcast in October 2021.

A review of multiple studies on common painkillers found that they have a marked effect on our resistance to infection—which is sometimes bad and sometimes good. Some of these medications could also reduce our response to a vaccination—especially if taken straight before one. Doctors, nurses and other health professionals keep you healthy. But despite Australia's relative good health it has major problems with general practice. By international standards we are probably overproducing medical graduates, but not enough go into general practice. New variants of the COVID-19 virus continue to appear, especially as there are low income countries with low levels of immunisation. The 2022-23 Australian Budget allocated A$85 million to COVAX, the international program for delivering COVID-19 vaccines particularly to low income countries. Is it enough?

Assessing the continuing ability to treat COVID-19 with antibody infusions. | A 'temporary stroke' means people get the signs of a stroke but the symptoms go away it's a called a Transient Ischaemic Attack - but that could be a misnomer. | If you have high blood pressure and lifestyle controls are not helping - by how much should pressure be reduced? | Primary aldosteronism (PA) is a hormonal cause of high blood pressure; it's treatable and there's a simple test.

What we know about the diversity of blood group types in Australia has just been updated—it reflects patterns in immigration. And we discuss the potential benefits of modifying diet to treat multiple sclerosis. And whether mental health issues may raise the risk of cognitive decline.

Japanese Encephalitis (JEV) is common in Asia but now causing concern in Australia. The rise of JEV in Australia happened when the Intergovernmental Panel on Climate Change (the IPCC) were reporting on climate change—a key aspect of which was the effect of climate on health. There's unique archival audio from the 1980s of the surgeon who performed a heart transplant operation on Baby Fae - using a baboon heart. And the records of 80 million people have been assessed to see why there are now less deaths from heart attack.

Australia is lucky to have free healthcare services—but there can be big gaps in who receives it; reports on two people with bipolar disorder finding benefit from a faecal microbiota transplant; and how stomas help the intestine heal.

Two recent scientific publications show that the pandemic originated in the Huanan Wholesale Seafood Market, in Wuhan, China. The publications are not yet peer reviewed but seem to put paid to the theory that the virus escaped from a Wuhan virology lab.

An Achilles tendon rupture is sometimes heard as a loud 'snap'—so then what? And how the cardiologists are developing new devices for heart transplants; And the complexity of treating cardiomyopathy in methamphetamine users.

Brendan Crabb on how we best understand and get to a COVID-normal life. Also, there's reason to consider screening kids at primary school age for hearing loss problems. Inflammation and how it may affect your risk of depression; And, congenital heart disease and genes not necessarily specific to the heart.

From the early days of the coronavirus pandemic, one expert came to the fore as a trusted voice, not just in his home country of the United States, but around the globe: Dr Anthony S Fauci, the director of the US National Institute of Allergy and Infectious Diseases.

An omnibus episode about protecting kids from drug and alcohol misuse.

What you need to know about ICE-crystal meth, and a first-hand account of how difficult it is to quit an ICE addiction. Both items in this programs were originally broadcast in June 2021.

Borderline Personality Disorder is one of the most stigmatised and misunderstood mental health conditions. It affects a significant number of people in the community, a large proportion of them having suffered trauma early in life. The emotional instability, fear of abandonment and patterns of self-harm can alter someone’s life and that of their loved ones in profound ways. But the enduring stigma around BPD means it often goes unrecognised or not properly treated and many fall through the cracks. This program was originally broadcast in September 2021

If you mention Transient Global Amnesia – TGA – the chances are that nobody has heard of it. When Dasha Ross lost her memory for a day she was diagnosed as having experienced this mysterious ‘neurological enigma'. This enigma affects over a thousand Australians a year, and Dasha was determined to find out why, and what causes it. This program was originally broadcast in April 2021

Rapid antigen tests can now be purchased by the general public, and what you need to know. There's Part 2 of our Chimeras in medicine—the use of animal avatars. And further responses to questions about snakebite treatment from the expert toxinologist.

Many people are currently waiting for an organ donation, and some of those waiting may die before a suitable organ is found. However some researchers think that we will be able to grow organs in animals to be then safely transplanted into humans. This is the first of two features about medicine's use of animals for human tissue and organ transplantation.

As the world opens up after COVID-19, what should we know about further vaccination; cholesterol studies in different age groups; digital health and how it helps health care.

Malaria and the implications of a vaccine for it; a new book about what happens to the Hippocratic Oath when it's in the real world; and, if you are bitten by a snake - what next?

The gender bias in healthcare is pervasive and causes harm when women receive worse treatment during a heart attack, are denied proper pain relief when in pain or when less likely to receive timely access to critical health interventions.

What may happen if the hospital systems in NSW and Victoria are overwhelmed when we open up at 70 and 80% and the expected surge in cases occurs? New research sheds light on colorectal cancer risks. And are the potential benefits of placebos overblown?

Borderline Personality Disorder is one of the most stigmatised and misunderstood mental health conditions. It affects a significant number of people in the community, a large proportion of them having suffered trauma early in life. The emotional instability, fear of abandonment and patterns of self-harm can alter someone’s life and that of their loved ones in profound ways. But the enduring stigma around BPD means it often goes unrecognised or not properly treated and many fall through the cracks.

How did Australia fare in the first year of the pandemic? What are the 'molecular messages' our body sends during exercise and how can they be used to help treat disease? Are the most common elective orthopaedic surgeries prescribed always the most effective option? And can a pill that combines four low-dose medications transform how high blood pressure is treated?

The COVID outbreak in regional New South Wales is highlighting the comparatively low vaccination rates in Indigenous communities. New research uncovers more on the origins of The Black Death. Researchers try to understand more about the experience of chronic illness after tick bites. And in the US, the trial of the founder of biotech company Theranos begins.

What new research shows about the effect of substituting salt and health - can it save lives?

Australia is pinning its hopes on modelling that says restrictions can start to ease once we hit vaccination targets, but will the high case numbers in NSW disrupt that plan? New research finds that people who are fully vaccinated but contract COVID can still carry high viral loads. Why are some countries seeing high numbers of children in ICUs, while others are not? And why are some teenagers more at risk of regular substance use? The answer - partly at least - may lie within the brain.

How can ventilation be improved to help reduce the spread of COVID? The surprising discovery that patients who isolate prior to surgery are more likely to develop post-operative lung complications. What's it like living with tinnitus and can anything be done about it? And calls to do more to prevent chronic disease.

We now have modelling to guide our way out of the pandemic, but some researchers say we will need to vaccinate even younger age groups to reach sufficient immunity. Why are so many women having critical medical care delayed when experiencing a heart attack? And research shows people living with anxiety are more likely to use alcohol. But what happens when drinking becomes a problem and where can you get help?

What are people experiencing in intensive care as a result of the delta COVID outbreak and how are hospitals coping?

Right now overseas, several covid vaccines are being trialled in children as young as babies 6 months of age. So how long will it be until younger kids can get vaccinated? How pandemic prevention measures have been particularly tough on the mental health of Aboriginal and Torres Strait Islander people. Cataract surgery can and is sometimes done in both eyes on the same day. But what does a review of the data tell us about whether this is best? And a puzzling link between two things that can cause disability as we age: cognitive decline, and fractures.

What's the best way to manage finite resources in the middle of a pandemic and what can Australia learn from other countries; what a review of COVID research exposes about waste and missed opportunities; low value care has little or any benefit and a new study finds patients agree; and what does research tell us about preventing alcohol and drug misuse in kids?

What does modelling tell us about what it will take to bring the NSW COVID cluster under control; scientists try to settle the debate about the origins of Covid-19; how can people with blood cancers stay safe in the pandemic; and can exercise help counter the toll poor sleeps takes on our health?

While NSW is still trying to contain COVID cases, the Prime Minister last week outlined a four stage pathway out of the pandemic. Singapore is already underway with its plan that uses a layered public health response including high vaccinations rates. Is this the path out of the pandemic? Just how dangerous is even small amounts of alcohol in pregnancy? Research shows it can set children up for unusual behaviours with alcohol while still very young. What help is out there for women with substance use disorders and their babies, and why are some falling through the cracks? And could a high-carbohydrate, low-protein diet be linked to a healthier life? Well, it depends on what kind of carbs you're talking about.

Around the country, the threat of COVID has emerged again. What does the modelling show about where this is heading? The World Health Organisation finds it's the biggest workplace hazard - long working hours. And it says long hours can be deadly. UK research finds type 2 diabetes might be reversible without drugs for some people, as well as the other conditions that often come with it. Also on diabetes, could a new class of drug slash the number of people who go on to need dialysis or kidney transplants?

This week, the first of a new series on substance use and what you need to know about ICE - crystal meth. Does early diagnosis of ovarian cancer through screening make a difference to survival rates? And the search for an Alzheimer's disease treatment is as controversial as ever. The US Food and Drug Administration has approved the first drug for Alzheimer's disease in nearly two decades, but not everyone is welcoming the decision.

From the early days of the coronavirus pandemic, one expert came to the fore as a trusted voice, not just in his home country of the United States, but around the globe: Dr Anthony S Fauci, the director of the US National Institute of Allergy and Infectious Diseases.

Are grommets over prescribed for children with recurring ear infections?

Australian atlas of healthcare variation; dangerous sunburn; targetted radiation therapy; antibody testing for vaccine efficacy

Taking a look at how long we spend sitting, and what to do about it; assessing the cumulative affect of yearly weight gain; the oral microbiome and our ancestors; aiming for a brain biobank; and Q&A

Modelling COVID vaccination targets to achieve pandemic prevention and control in Australia; the developmental outcomes of preterm babies is becoming clear; a study on who has followed over 4000 of these kids to the age of 5; and treatment in hospital of a common respiratory condition of babies.

An Australian research group has undertaken a wide study on paracetamol to see what evidence exists for its use in different types of pain. We also ask whether medicinal cannabis is we would like it to be as a pain reliever; and if antidepressants are effective be in your elderly relatives with dementia.

Gun policy and regulation; new approaches in treatment for multiple sclerosis; Italian findings about recovery for people with schizophrenia; the continued health of cancer survivors.