Macmillan Cancer Support says one in two people will get a cancer diagnosis. Yet our treatment still focuses on the disease, not the persons specific needs, says Dr Ranjana Srivastava, oncologist and author

I need you to see this patient now, a nurse whispers, her quiet tone masking a mountain of concern.

I am an oncologist, I introduce myself to the stricken stranger. We havent met before, but you dont look so well so I am going to help.

He nods.

For weeks, he has been in the grip of nausea, pain and insomnia. His six-hour wait in A&E culminated in being sent home. He has been bed-bound since, too weak to move, eat or drink.

I am so sorry, I offer, wondering for the umpteenth time how patients deteriorate like this before our very eyes.

Tears form and he shrugs.

Dad just wants to feel better, he knows things are bad.

My heart melts at the plea of his daughter, barely out of her teens.

Weve got this, I reassure her. Hell feel better soon.

The nurse, ever attentive, flicks the chair to recliner mode and catches his wrist. You are safe, she says simply.

At this, he dissolves into sobs that rack his whole body.

As I take in the heartrending sight of a grown, burly man reduced to the helplessness of a child, I try to imagine the affronts that have led him here. The patients differ but the underlying themes dont months of chemotherapy, failed drugs, countless appointments, perpetual uncertainty, endless waiting, lost income, tired relatives, disappearing friends and on top, the existential questions, Why me? Why my family? Why anybody?

I chart fluids and drugs and arrange for a hospital bed, feeling discomfited that the family is so dramatically relieved at such a basic intervention.

Later, in clinic, I see patients ranging from a stoical university student to a devastated father to the frail octogenarian who cant remember the day, let alone that he has cancer each patient an illustration of a recent Macmillan Cancer Support UK finding that it is more common for an individual to be diagnosed with cancer than to get married or have a first child. One in two people will encounter a cancer diagnosis in their lifetime, which is why the report says that, alongside marriage, parenthood, retirement and the death of a parent, cancer is now a common life milestone.

I bear witness to this milestone every day, yet I confess the report is a wake-up call because it has prompted reflection on the chasm between what medicine delivers and what patients desire.

Even a cursory search will reveal the leaps of imagination and discovery that have made cancer medicine fascinating, and indeed life-changing, for so many patients. In the short time that I have been an oncologist, I have gone from ruing that no effective therapy exists, to deciding how best to sequence an array of choices. Sure, not all therapies have delivered stunning results, unacceptable toxicity looms large, costs are prohibitive and our successes are largely confined to the rich world. These are problems to ponder but they dont diminish the genuine, incremental gains in cancer care. Every day, I see the human face of these gains and whisper thanks to the researchers who empower clinicians like me.

But as nearly every cancer patient observes, what cancer medicine has failed to keep up with is the needs of the person behind the patient. Though there are many diseases with no good treatments and far worse outcomes, the very mention of cancer invites terror like no other. A common rejoinder to the statement, You have cancer is, Am I going to die? to which a common, and unhelpful, response is: We cant say. For what patients are really asking is not for oncologists to be fortune tellers but for reassurance that we will be there to see them through the whole cancer experience, of which chemotherapy is just a part. They want doctors who are not only proficient but also humane, as capable of consoling as treating. Most oncologists aspire to this, but two things get in our way.

The first is medical training, which has an outsized focus on defeating disease at any cost and struggles to take into account patient choice. For all the rhetoric around patient-centred care, it has not been easy to put into practice. Cancer is a heterogeneous disease and the people who get cancer are a diverse lot too. A champion athlete, a vulnerable refugee, a youthful retiree and a frail elderly person all need care but each merits special consideration. The athlete wants to avoid nerve damage and the executive begs to keep her hair so her colleagues wont know.

The refugee doesnt own a car and cant travel to have intravenous infusions and the elderly man trembles at the thought of his inability to care for his disabled wife. He values quality of life over extent; he values staying together over being forced into care, but finds this a nearly impossible conversation to interest anyone in. Faced with an ageing population for whom a cancer diagnosis is but one of several serious challenges, this particular problem will test us all. Studies show that the frail elderly are willing to forego aggressive treatments in favour of preserving their quality of life, provided they are offered the choice. We will need to be realistic about what defines successful cancer treatment. It will mean looking beyond the tumour at the whole person.

Now let me be the first to admit how difficult it can be to do this, even for the most well-intentioned oncologist. Given patients myriad needs from rehabilitation and nutrition to financial, social and emotional welfare it is obvious that one doctor cannot come close to fulfilling them all. Cancer patients need team support but on any given day, it is far easier to prescribe a 50,000 drug with dubious benefit than find a physiotherapist or social worker. It takes months to access aged-care services in the community until the same patient falls and fractures a hip, after which services swing into place. There is no reason to bunch together cognitively impaired, mentally ill and non-English speaking patients except that they consistently receive inadequate care across all parts of the healthcare system.

Palliative care has value for patients and oncologists, yet the nexus between oncology and palliative care remains weak in many places due to a lack of education, collaboration and resources. If the emphasis, and hence funding, stays determinedly on finding a cure for cancer (which, as we are now realising, is not one disease) the manifold supportive care needs of patients will continue to go unaddressed. We will keep identifying the gaps without filling them. Oncologists need to appreciate the broader needs of their patients but they also need access to help. When people reach this sobering milestone, the science and art of medicine must coexist.

My next patient is late because there is no parking and the scarce wheelchairs are all in use. While waiting, I duck out to see my patient in the chemotherapy chair but stop at a distance. Saline courses through his veins and a crisp white blanket protects his stretched body. His nausea is gone, his pain has settled, and finally he is asleep, his agitated tears replaced by rare calm. Amid the low-level hum, he is fast asleep, his son dozes, and my heart cant help but skip a beat at how far a measure of kindness goes.

The nurse comes over to join me and we look on, feeling like proud parents who have averted a crisis.

What did you give him? I ask quietly, although I know the drugs that I charted.

Nothing more. He just needed to know he was safe.

Dr Ranjana Srivastava is an oncologist and an award-winning author

Read more: https://www.theguardian.com/commentisfree/2017/sep/12/cancer-common-marriage-wake-up-call-macmillan

An artist's illustration of Cassini at Saturn.
Image: nasa

Who knew that teaching actors about space science was part of NASA’s mandate?

Milo Ventimiglia who plays Jack in This is Us and Jess on Gilmore Girls begged NASA via Twitter on Monday to keep the Cassini spacecraft “alive” in orbit around Saturn. And, because Twitter is the great equalizer, of course the space agency replied.

NASA’s official Cassini account explained that the agency has no way to keep Cassini functioning after September, when the spacecraft is scheduled to make a planned death dive into the huge world’s atmosphere, burning up in the process.

It’s not that NASA doesn’t want to keep Cassini alive at the ringed planet, you see. I promise you, Milo, no one will be sadder to see that spacecraft go than the scientists who have devoted their careers to it. It’s just that Cassini is running out of fuel.

Plus, Cassini is plunging into Saturn’s atmosphere in September for a very specific and not to mention altruistic reason.

If scientists were to just allow Cassini to totally run out of fuel and free-fall somewhere in the Saturnian system of moons, it could actually contaminate a world that might harbor alien life.

It’s possible that Enceladus and Titan two moons circling Saturn both have subsurface oceans that may actually be habitable. Who knows what microbes lurk there?

If Cassini were to slam into one of those moons, it could bring Earthly organisms to the surface of the world, possibly harming native life. By burning up in Saturn’s atmosphere, Cassini avoids that possible issue.

The spacecraft has been studying Saturn and its dozens of moons since it arrived in 2004 after launching in 1997. In other words, this is a long mission.

Saturn as seen by Cassini.

Image: nasa/jpl-caltech

It’s actually rare for spacecraft to live as long as Cassini has. In fact, it was never expected to survive so long in the first place. Cassini’s initial mission was only set for four years, but NASA extended it twice.

Cassini’s long life has transformed the way we understand Saturn and its place in the solar system, revealing new information about the planet’s moons and rings.

So, Milo, please, let’s just thank Cassini for its service and send it on its way to the great space robot heaven in the sky.

Cassini has done enough.

Read more: http://mashable.com/2017/05/08/nasa-schools-milo-ventimiglia-on-cassini/

Artist's illustration of two neutron stars merging.
Image: nasa

Billions of years ago, two black holes merged in a violent explosion that rippled the fabric of our universe.

Those cosmic ripples known as gravitational waves produced by this collision spread far and wide in all directions, carrying with them information about the black holes that brought them into being.

In September 2015, that information made it to Earth. While these weren’t the first gravitational waves to reach our planet, they were the first we could observe.

Two powerful tools known as theLaser Interferometer Gravitational-Wave Observatories (LIGO) were able to directly observe the gravitational waves sent out by the two black holes, opening up a new way for scientists to study the inner-workings of some of the most extreme objects in the universe.

Until now, scientists studying the cosmos were limited to just staring at our universe using different wavelengths of light.

Artist’s illustration of colliding black holes.

Image: LIGO

While this type of investigation has completely transformed our understanding of how stars, galaxies, planets and other objects work, it also has left us in the dark when trying to understand the inner lives of black holes and other exotic objects.

All of that is changing now, however.

In the not too distant future, scientists should be able to peer into the hearts of exploding stars, figure out how matter is changed within the hot, high-pressure center of a neutron star, and better characterize what a black hole really is all thanks to barely-detectable waves sent out to the far ends of the observable universe.

Being an astronomer right now, as gravitational wave science begins in earnest is “kind of the equivalent of being there when Galileo put together his first telescope,” scientist Edo Berger, who is involved in LIGO-related research, said in an interview.

A light turning on

The entire history of astronomy has hinged on studying the universe with light, but now, we have an entirely different way to peer out into the cosmos. It’s as if astronomy as we know it has gained a new sense.

Instead of trying to look directly at something like a black hole that doesn’t give off light, astronomers can now piece apart the “chirps” of gravitational waves to learn more about the masses, sizes and lives of the objects that created them.

“… Using gravitational waves we can probe environments that are enshrouded with a lot of matter which blocks our view,” Harvard University astronomer Avi Loeb said via email.

“For example, when a massive star collapses or when a neutron star gets swallowed by a stellar-mass black hole, or when two massive black holes coalesce while being surrounded by gas duringthe merger of two galaxies, we cannot easily probe the center of the action because it is hidden behind a veil of matter,” Loeb added.

“But gravitational waves can penetrate easily through matter and reveal the inner working of such engines. “

Image: Bob Al-greene/mashable

You can’t feel or see gravitational waves move through Earth’s part of space, but they do affect us nonetheless.

In fact, the signal discovered in September warped all of the matter on Earth including all of the matter in our bodies by just a fraction of a proton.

And that’s what LIGO had to measure. Both observatories one located in Louisiana, another in Washington recorded the moment the gravitational waves passed through Earth’s part of space at the same time.

The twin “L”-shaped observatories both have a laser that runs down each arm of the L to mirrors located at the end of the arms. If no gravitational waves pass through Earth, the lasers should each bounce back to the middle at precisely the same time, but if a wave were to pass through, that timing would be off.

This is because the matter around the laser stretches ever so slightly as the wave passes through, changing the length of the arms but not affecting the light itself.

“What LIGO had to do to detect the waves was to measure the motion of mirrors (due to the passing gravitational wave) that was smaller than a single proton,” LIGO researcher Nergis Mavalvala said.

“Imagine that, put mirrors 4km (2.5 miles) apart and watch them get closer or farther to each other by a distance one-one-thousandth the size of a proton.”

Discoveries already pouring in

Scientists have already analyzed data brought to Earth by the gravitational waves discovered in September, characterizing the black holes that created those ripples like never before.

A study published in June 2016 found that the two black holes which gave rise to the gravitational waves actually began their lives as massive stars orbiting one another.

Eventually, after millions of years in orbit around one another, the stars collapsed, forming two black holes about 30 times the mass of our sun. And one day, those black holes merged, rippling the fabric of space and time like a bowling ball spinning around on a bed sheet.

The authors of the study used data gathered by LIGO to create a computer model of the universe that would have given rise to the gravitational waves detected here on Earth billions of years after the black hole merger.

“The black holes were monsters, and the results show that their progenitor stars would have been some of the brightest and most massive in the universe,” physicist J.J. Eldridge wrote in a piece accompanying the study at the time.

Neutron stars and a new state of matter

LIGO should eventually do even more than reveal the secret lives of black holes as well.

In the future, astrophysicists are hoping to use gravitational wave tools to figure out what’s going on in the intensely hot, high pressure middle of a very mysterious class of stars known as neutron stars.

“You build an instrument for things you want to measure, and then you see things that you didn’t expect to see”

Neutron stars are more massive than the sun but packed down into an area the size of the city of Boston. These types of stars form when stars about four to eight times the size of our sun die.

The hearts of these stars might actually be so dense and high pressure, that they warp molecules into a totally different state of matter than what can be observed in labs on Earth.

“In this case, of course, it [the matter in a neutron star] exists in a state that we’re not familiar with from our own personal experience because we’ve never witnessed those kinds of pressures,” Berger said.

At the moment, LIGO isn’t able to easily detect neutron star mergers as they are somewhat less energetic than black hole collisions, but in the future it should be able to as its sensitivity advances, revealing the hearts of those dense objects.

Simulation of gravitational waves.

Image: NASA/C. HENZE

Gravitational wave science also has the ability to add to the already rich tapestry of science done by looking at light in the universe.

Some astronomers are already attempting to pinpoint the optical sources of gravitational waves to see if there’s any kind of light signal that goes along with mergers of black holes.

At the moment, LIGO isn’t very good at pinpointing exactly where a signal is coming from in the sky, so other technologies could be further developed to meet that challenge in the future, allowing scientists to gather precise data on the sources of gravitational waves, LIGO’s Mavalvala said.

And one day, LIGO and the host of new technology that will be produced around it may even hear a new signal that scientists can’t even imagine now.

“You build an instrument for things you want to measure, and then you see things that you didn’t expect to see,” Mavalvala said.

“I think that’s the true promise of these instruments.”

Watch black holes collide in VR

Take a VR journey through space and time in the latest episode of The Possible.Click here to download the Within app to watch The Possible.

BONUS: These scientists are proving Einstein wrong

Read more: http://mashable.com/2017/02/27/gravitational-waves-future-of-astronomy/

The full moon during a penumbral lunar eclipse in 2013.
Image: Hildenbrand/Epa/REX/Shutterstock

This weekend is set to start off with a cosmic bang.

On Friday night, the full moon will be eclipsed by the shadow of the Earth, and in the darkness of Saturday morning, just hours after the eclipse, a green-tinted comet will make its closest flyby of Earth.

This skywatching coincidence should make for an interesting start to the weekend for people around the world who are able to see both the comet and the eclipse.

First, an eclipse

The shadow of the Earth should start encroaching on the face of the moon’s surface starting at around 5:30 p.m. ET and lasting for 4.5 hours as the moon dips deep into Earth’s outer shadow known as the penumbra and comes back out again.

A diagram of how lunar eclipses work.

Image: Sky & Telescope illustration

If you have a view of the moon during that period of time, you should be able to see at least part of the penumbral eclipse.

The Friday eclipse won’t be like a dramatic total lunar eclipse, which can turn the moon a deep shade of red, but a penumbral eclipse is still beautiful in its subtlety.

“The outer part of Earths penumbra is so pale that you wont notice anything until the Moons edge has slid at least halfway in,” Alan MacRobert, a senior editor at Sky & Telescope magazine, said in a statement. “So start looking about 90 minutes before mid-eclipse.”

The shadow should start encroaching on the moon’s left side, slowing moving inward and then slowing moving in reverse as the moon comes out of its dip into Earth’s shadow.

A view of a penumbral eclipse in 2012.

Image: Hong Kong Space Museum/Sky & Telescope

“With time, the dusky shading will become more prominent, and as mid-eclipse approaches, the lopsidedness of the moons illumination will be totally obvious,” Sky & Telescope added in the statement.

The northern bit of the moon’s face should look slightly darker than the rest of the lunar surface, the magazine added, because it will be the bit closest to the deep shadow of the Earth, known as the umbra.

Then, a comet

Once the eclipse ends, the next bit of our cosmic weekend can start in earnest.

In the wee hours of Saturday morning, Comet 45P will make its closest approach with Earth, bringing it nearer to our planet than any other comet has been in about 30 years.

The comet won’t be visible with the naked eye, but if you have a pair of binoculars or even better a backyard telescope they should at least give you some sense of what this icy wanderer looks like.

During this close approach, Comet 45P will fly about 7.4 million miles from Earth.

“It’ll be visible in the morning sky in the constellation Hercules,” NASA said in a skywatching video. “The comet then passes through the constellations Corona Borealis (the Northern Crown), Botes (the Herdsman), Canes Venatici (Botes’ hunting dogs) and Ursa Major. Then on to Leo by the end of February.”

If you don’t catch the comet this time, don’t worry, you’ll have another chance to see it when it comes back around in 2022, according to NASA.

If you aren’t in a part of the world that affords you the ability to see the comet and lunar eclipse or if it’s cloudy in your area then the skywatching organization Slooh has you covered.

Slooh will air two live broadcasts to share live views of the comet and the lunar eclipse with expert commentary. The live eclipse broadcast will begin at 5:30 p.m. ET, with the comet show set for 10:30 p.m. ET on Slooh’s website.

Read more: http://mashable.com/2017/02/10/comet-lunar-eclipse-skywatching-weekend/