Amnesia Patient's Sister Found in Louisiana

A man who awoke in the emergency room at Desert Regional Medical Center in Palm Springs, Calif., last February speaking only Swedish and suffering from a case of global transient amnesia, has a sister living in Louisiana who is stunned by the fate of her long-lost brother.

The hospital has identified the patient as 61-year-old Michael Thomas Boatwright and says that he has been told he has a sister, Michelle Brewer, 59, of Kentwood, La.

"She hasn't talked to him in over 10 years," Brewer's step-daughter, Shannon Coleman, 36, told ABCNews.com. "She seemed like she was really surprised."

Boatwright, 61, was found unconscious in a Motel 6 and was taken by hospital ambulance to the medical center, according to medical center spokesman Rich Ramhoff.

The only things he had on him were a duffel bag of athletic clothes, a backpack, five tennis rackets, two cell phones, some cash, a set of old photos and four forms of identification, including a Florida license and a veteran's card.

But Boatwright had no memory of who he was or how he got there. He did not speak or understand English and didn't even recognize his own face, according to the Desert Sun, which first reported the story. He told hospital officials his name was Johan Elk.

Brewer said her brother had "just disappeared" and she had no way of getting in touch with him after their mother died last year.

"He's always been a wanderer," she told the Sun. "Then he'd come back when he needed some money or something from somebody. Then he'd take off again."

An investigation into his IDs found that Boatwright was likely a 3-D graphic designer who had worked in China and Japan as an English teacher for a decade. He had flown from Hong Kong to Palm Springs just four days before he was found unconscious. The U.S. Navy veteran, who was raised in Miami, first went to Sweden in 1981.

The Sun tracked down Brewer, but hospital spokesman Ramhoff said the hospital has not yet independently confirmed their relationship. But, he said, Boatwright has "shown an interest in trying to reach out to her."

"We did not find any major trauma on him," he said. "The assumption was the cause [of the amnesia] could have been psychological in nature, but nothing physical was found."

Ramhoff said psychiatrists concurred on the diagnosis of transient global amnesia, a sudden, temporary episode of memory loss that cannot be associated with epilepsy or a stroke, or a general "fugue" state, which can be longer in duration.

For the last five months, Boatwright has been staying at the Desert Regional Medical Center's skilled nursing facility, which reached out to the community and found people who spoke Swedish to help translate.

His social worker, Lisa Hunt-Vasquez, has been trying to locate family and friends by working with the media and making calls to the Veteran's Administration, Florida police and other leads.

"She has spent a lot of time calling China and Sweden to find information, but the language barriers and lack of information ran into dead ends," Ramhoff said.

Media around the world took an interest and stories appeared in the Swedish paper Aftonbladet and in the British press. As a result, the Sun received photos of people who looked like Boatwright.

Internet users in Sweden said they recognized him as an American who moved to Sweden in the 1980s.

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Brainwave Test for Patients or Profit?

A wiry weave of brainwave-reading electrodes designed to detect signs of attention deficit hyperactivity disorder is drawing skepticism from experts who say behavior trumps brain activity when diagnosing ADHD.

The device, dubbed NEBA for "Neuropsychiatric EEG-Based Assessment Aid," was approved by the U.S. Food and Drug Administration Monday to help confirm an ADHD diagnosis, a complex label borne by some 6.4 million U.S. kids. But critics say the gadget puts profits before patients.

"I don't know that this is going to help the situation at all," said Rachel Klein, a professor of child and adolescent psychiatry at NYU Langone Medical Center. "I think it's going to make people spend money needlessly."

During a 15-minute test, the NEBA system measures and compares two kinds of brainwaves through electrodes on the scalp. Studies have found that kids with ADHD tend to have different brainwave ratios than those without the disorder, but Klein said there's "nothing to suggest" the comparison works to diagnose individual children.

"When a child walks into the office, we already know there's a problem. The issue is whether it's ADHD or something else," she said, noting that learning disabilities and certain mood disorders can share symptoms with ADHD. "We have no idea whether [the makers of NEBA] have been able to discriminate ADHD from something else."

NEBA Health, the Augusta, Ga., company that makes the device, has yet to publicly release data from a trial of 275 children on which the FDA based its approval.

"The study results showed that the use of the NEBA System aided clinicians in making a more accurate diagnosis of ADHD when used in conjunction with a clinical assessment for ADHD, compared with doing the clinical assessment alone," the FDA said in a statement, providing no further details about the comparison or the significance of the results.

Multiple calls to NEBA Health were not immediately returned.

An ADHD diagnosis is typically based on interviews with parents and teachers, though Klein admits not all general practitioners have time to take such a thorough history.

"There's no way someone can do the child justice in a 10- or 20-minute visit," she said, stressing that the diagnosis should be reserved for child psychiatrists and psychologists with the proper training. "You need a lot of background information, and you just don't have the time to get it in a regular medical practice."

Klein fears that busy GPs might buy into the NEBA system, which generates a readout of brainwave activity similar to the squiggly lines of a lie detector test, as a way to simplify a complex diagnosis.

"They can charge for it and it gives you a pseudo-scientific basis for the diagnosis – a piece of paper with little wiggles and you can say they're not the wiggles you expect," she said, adding that she hopes parents "understand the limitations of the test" and "realize they don't have to rely on commercial promotions."

The cost of the NEBA system and the proposed charge for the test has not been made public.

ADHD diagnoses are on the rise among U.S. children and teens, climbing steadily by 5 percent a year, according to data from the U.S. Centers for Disease Control and Prevention. In 2007, roughly 2.7 million U.S. kids were receiving medication for the disorder, according to a CDC survey of parents.

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HIV Undetectable in Two Patients

Two HIV-positive patients have shown no sign of their infection after receiving bone marrow transplants.(Credit: Getty Images/Cultura RF)

Two HIV-positive patients who underwent bone marrow transplants have shown no sign of their HIV infection despite being off HIV drugs for months.

Harvard Medical School researcher Dr. Timothy Henrich announced Wednesday that he has been unable to detect HIV in two of his patients who purposefully went off antiretroviral therapy for 15 and seven weeks, respectively. Although it’s not clear whether their HIV will return, the findings may represent another step toward a cure.

“Both patients have been very involved in the research,” Henrich said at the International AIDS Society conference in Kuala Lampur. “They’ve been very interested in what we are doing. And they’ve been very excited to participate in the studies that are ongoing.”

Read about the HIV-positive Mississippi baby’s supposed “fundamental cure.”

The two patients had been on long-term antiretroviral therapy, which suppresses HIV and stops its progression into full-blown AIDS, but they both developed lymphoma several years ago. To treat the cancer, Henrich treated these men with chemotherapy and a bone marrow transplant, but they continued antiretroviral therapy during and after transplant.

This year, Henrich conducted a clinical study in which he instructed the patients to stop taking antiretrovirals to see what would happen. ?So far, the virus has not rebounded, as it normally would have without continued antiretroviral therapy.

“It’s possible the virus could come back next week. It’s possible the virus could come back months from now, and it’s even possible that it could take one or two years for this virus to return to these patients,” Henrich said. “”We still do not know the full impact of the findings that we have.”

Although more research is needed, Henrich said it’s possible the patients were able to suppress the HIV without drugs because of a bone marrow transplant complication called “graft-versus-host.” Although this complication usually has a negative connotation, it could mean that the donor stem cells in the bone marrow attacked the HIV patients’ remaining HIV-positive cells and replaced them with healthy ones.

Perhaps the most famous HIV-positive patient to receive a bone marrow transplant is known as “the Berlin patient,” a man who stopped taking antiretrovirals the day of his transplant in 2006 and says he hasn’t needed them since. This man, however, accepted a bone marrow transplant from a donor with a mutation called CCR5, which makes patients immune to HIV.

Henrich said his patients received bone marrow from donors who did not have this mutation, meaning their cells were susceptible to HIV infection.

Read about the “Berlin patient” and his announcement six years after transplant.

Earlier this year, doctors announced that they’d “fundamentally cured” a rural Mississippi baby by introducing high doses of antiretrovirals just hours after the little girl was born to an HIV-positive mother. Less than two weeks later, French researchers claimed they had 14 HIV-positive patients who’d experienced remission after stopping antiretroviral therapy because it was “fashionable at the time.”

Read about the 14 patients in HIV remission.

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Types of relaxation techniques, which can help cancer patients

Cancer detection and following treatments lead to emotional stress. Patients worry constantly about their current situation and how it lowers their quality of life. Some of them are not able to return to work and school, while some no longer can; take part in social activities Therefore they feel socially isolated. It is at this point that they need more help from friends and family. To combat stress more effectively, they require relaxation techniques but. They act directly as alternative cancer therapies, but they help reduce symptoms in reducing the burden of cancer patients, as well as cancer. Some of them are:

Deep breathing exercise

Shallow breathing, which is brought on by fear, leads to an accumulation of carbon dioxide in the body. Deep breathing exercise, you will make sure feel. Simply breathing deeply from your diaphragm. Keep it for as long as you can then gently exhale. Repeat the process several times until you feel calm.

Images by

As the term suggests, creates images images on your mind. You can first lying on the bed and close your eyes. Imagine a place synonymous with beauty and tranquility as directly on the beach. Imagine that you are resting on a hammock, experience and enjoy the waves as they dance and sing a quiet song. Visualize your family and have fun with the waves because they like to swim in the crystal clear water. Remember her laughter. Detect as open your eyes and bring you back to reality, you feel much better.

You can choose to perform the images in front of the hospital for your regular treatment sessions. This will somehow brighten mood, making you more positive about what you are doing. You will be surprised to notice that you don't feel so stressful as before. This may be no direct alternative cancer treatment, but it certainly improves your well-being, contributing much of the manner, as you are dealing with cancer treatments.

Progressive muscle relaxation

Includes specific muscle groups avoid this form of relaxation technique, and then enable to relax them. As you do this, lie down on the bed. Make sure that you are in a comfortable position and clothing. Close your eyes and feel the silent place. Think to yourself.

First, fold the forehead. Let your eyebrows to reach your hairline. Stay in this pose for five seconds, then relax. Focus on your eyes. Close properly (you will realize that your nose will be moved also). Scowl and you move the muscles in your lips, cheeks and jaw. Stretch your arms forward when pressing your fists. The relaxation you feel in your hands. Follow this up, because to build tension in the forearms, upper arms, shoulders, back, abdomen, hips and buttocks, thighs, feet and toes. If you keep some muscles feel tense feel, go back and do this again two-to three times.

It is but natural for cancer patients as you are looking to alternative cancer therapies, because you are hoping to improve your chances for survival. Relaxation one way to improve the condition, that really is on how you answer to cancer therapies help.

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As alternative treatments work for patients with lung cancer

There are alternative cancer therapies that really help cancer patients, or they only amounted are? Order to eliminate all misunderstandings, put together by the American College of Chest Physicians more than 100 researchers in 2007 several studies evaluated, offered through unconventional therapies in patients with lung cancer revealed great results. Consisting of oncologists and nutritionists, the evaluation reviewed the effectiveness which some replacement cures lung cancer symptoms manage. These include acupuncture, massage treatments, hypnosis, yoga and meditation.

Massage therapy

Massage therapy provides rapid removal of pain due to the release of certain chemicals in the body. It improves also the feelings of the affected, because they relax their minds. These positive results can not be long, but if cancer patients carried out, it can help to reduce stress. Therapeutic massage helps reduce the occurrence of swelling and inflammation. It improves blood circulation and relieves muscle spasms.

Acupuncture

Some scientific studies revealed how acupuncture can help patients with lung cancer. Because they occur with chemotherapy, it is only natural that they have problems with vomiting and nausea. The National Cancer Institute had seen evidence, in fact, acupuncture prevents, that suffer from these symptoms. Some oncologists advise avoiding this special kind of alternative cancer treatment like this pose may be more at risk for infections but patient session perform acupuncture before chemotherapy would.

Meditation

Patients find that peace that sit in a quiet place, huge make trying to delete their brains of fears and challenges and focus on her present life. How they meditation efficiently carried out, can note the reduction in symptoms of anxiety or depression and stress. As a result they can positively respond to cancer healing and thus their survival to influence. Meditation reduce people with cancer also their problems to sleep.

Hypnosis

In hypnosis cancer patients will be made into a trance-like situation can really relax. This is done by a therapist to train working how on some relaxation exercises and asking them to positive and happy thoughts thinking. As a result, you will feel restless people less anxious. Hypnosis reduces also pain and nausea.

Yoga

This type of alternative treatment combines gentle stretch routines with meditation and deep breathing. Lung cancer patients find yoga more advantageous as it allows them to no sleep difficulties. In principle, this is safe for them, when performed by an experienced instructor. In the event that people experience pain or discomfort, they must at once stop yoga. To do this, they can look at their teachers or friends who do yoga which exercises require softer.

Patients with lung cancer may be among the treatment plans of their doctors or oncologists, but it is still of course that they take into consideration or search for alternative cancer therapies. This is mainly because they try out other ways that help them survive, or would at least alleviate pain, anxiety and stress. They are also the choice of options at least eliminate or reduce the symptoms of conventional therapies, living through it.

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Study Examines Spiritual Support For Patients With Advanced Cancer

Main Category: Cancer / Oncology
Article Date: 08 May 2013 - 2:00 PDT Current ratings for:
Study Examines Spiritual Support For Patients With Advanced Cancer

JAMA Internal Medicine Study Highlights

A study by Tracy A. Balboni, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues suggests that spiritual care and end-of-life (EoL) discussions by the medical team may be associated with reduced aggressive treatment.

The study included 343 patients with advanced cancer. EoL care in the final week included hospice, aggressive EoL measures (care in an intensive care unit, resuscitation or ventilation), and ICU death.

Patients reporting high spiritual support from religious communities were less likely to receive hospice (adjusted odds ratio [AOR], 0.37), more likely to receive aggressive EoL measures (AOR, 2.62), and more likely to die in an ICU (AOR, 5.22), according to the results. The results also indicate that among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use (AOR, 2.37), fewer aggressive treatments ((AOR, 0.23), fewer ICU deaths (AOR, 0.19) and EoL discussions were associated with fewer aggressive interventions (AOR, 0.12).

"In conclusion, terminally ill patients receiving high spiritual support from religious communities receive more-intensive EoL medical care, including less hospice, more aggressive interventions, and more ICU deaths, particularly among racial/ethnic minority and high religious coping patients," the study concludes. "The provision of spiritual care and EoL discussions by medical teams to patients highly supported by religious communities is associated with reduced medical care intensity near death."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. JAMA Internal Med. Published online May 6, 2013. doi:10.1001/jamainternmed.2013.903. Please use one of the following formats to cite this article in your essay, paper or report:

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Avastin Can Lengthen The Lives Of Advanced Cervical Cancer Patients

Editor's Choice
Main Category: Cervical Cancer / HPV Vaccine
Also Included In: Cancer / Oncology
Article Date: 03 Jun 2013 - 10:00 PDT Current ratings for:
Avastin Can Lengthen The Lives Of Advanced Cervical Cancer Patients

The addition of targeted therapy Avastin (bevacizumab) with chemotherapy can significantly lengthen the lives of women with advanced cervical cancer by close to 30%, according to research presented at the 2013 American Society of Clinical Oncology Congress.

The finding is an important discovery in the fight against cervical cancer - the most common cancer in women under the age of 35.

More than 3,000 women in the UK are diagnosed with cervical cancer annually, while 1,000 will die from it. Cervical cancer is normally treated with surgery, radiotherapy, and chemotherapy. If the cancer is detected early and treated promptly, the prognosis is generally good.

Screening and vaccination against the human papilloma virus is crucial in preventing cervical cancer altogether, as well as keeping it from reaching an advanced stage if it does develop. For those patients who are diagnosed at an advanced stage, it becomes harder to treat the disease.

The research presented from this study is known as GOG 240. GOG 240 is an independent, National Cancer Institute (NCI) -sponsored phase III trail examining the effectiveness and safety of Avastin with chemotherapy (paclitaxel and topotecan or cisplatin) to treat women with recurrent, persistent, or advanced cervical cancer (stage IVb), that was not cured by standard treatment methods.

The study consisted of 452 women in the U.S. and Spain who were randomly assigned to one of four treatment schedules: paclitaxel and cisplatinpaclitaxel, cisplatin and Avastin (15 mg/kg every three weeks)paclitaxel and topocetan paclitaxel, topotecan and AvastinThe research revealed that the women who underwent combination treatment with chemotherapy and Avastin lived almost 30% longer, and when compared to those who were just treated with chemotherapy alone: the median overall survival was of 17 months compared to 13.3 months, respectively.

Also, the percentage of patients who responded positively to therapy increased by a third from 36% to 48%. The participants who received bevacizumab had more side effects than those who did not, however, these side effects were consistent with those previously known to be linked to bevacizumab.

Professor Stan Kaye, Head of Clinical Studies at The Institute of Cancer Research, London, and Consultant Medical Oncologist in the Gynaecology Unit at The Royal Marsden Hospital, said:

"The improvements in overall survival achieved for women with advanced cervical cancer treated with Avastin are extremely encouraging. Thousands of women are diagnosed with cervical cancer every year in the UK and for those with recurrent disease there is a desperate need for more treatment options."

Bevacizumab has a well-confirmed tolerability profile with the most frequently seen adverse effects in clinical trials listed as: hypertensionpainproteinuria (abnormal amount of protein in the bloodneutropeniaThese side effects are generally easy to take care of. The study did not find any new adverse effects. Bevacizumab was also associated with higher rates of grade 3 bleeding, thrombosis embolism, and gastrointestinal fistula.

Robert Music, Director of Jo's Cervical Cancer Trust, said:

"For women who receive a late stage diagnosis of cervical cancer the prognosis can often be poor. The results of this research look promising and if this work can go some way in improving outcomes and overall survival rates in women with advanced cervical cancer then that is a positive step."

Bevacizumab is not currently licensed for the treatment of advanced cervical cancer.

Avastin is approved for four different types of cancers in the United States: mCRC (metastatic Colorectal Cancer), NSCLC (Non-Small Cell Lung Cancer), rGBM (recurrent Glioblastoma Multiforme) and RCC (Renal Cell Cancer).

In 2011, the FDA removed the approval of Avastin for the treatment of breast cancer. The regulating body explained that Avastin is not effective or safe for that type of cancer.

Written by Kelly Fitzgerald

Copyright: Medical News Today
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'Avastin Can Lengthen The Lives Of Advanced Cervical Cancer Patients'

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Sorafenib Stops Tumor Growth And Provides The First Effective Treatment For Thyroid Cancer Patients Who Progress Following Standard Therapies

Main Category: Cancer / Oncology
Also Included In: Endocrinology;??Ear, Nose and Throat
Article Date: 04 Jun 2013 - 0:00 PDT Current ratings for:
Sorafenib Stops Tumor Growth And Provides The First Effective Treatment For Thyroid Cancer Patients Who Progress Following Standard Therapies

The kidney and liver cancer drug sorafenib holds metastatic thyroid cancer at bay for nearly twice as long as a placebo, according to results of a randomized phase III trial, which was presented by a researcher from the Abramson Cancer Center and the Perelman School of Medicine at the University of Pennsylvania in a plenary session during the American Society of Clinical Oncology's annual meeting (Abstract #4).

If approved for use in thyroid cancer patients by the Food and Drug Administration, sorafenib (Nexavar), a kinase inhibitor that mediates tumor cell division and growth of tumor blood vessels, would be the first effective agent for this patient population. Thyroid cancer is highly curable through surgery and radioactive iodine treatment, but about 10 percent of the 60,000 patients who are diagnosed with the disease each year fail to respond to standard therapies, with tumors eventually appearing in the lymph nodes, bones, lungs, and other sites. The only other drug for advanced thyroid cancer, doxorubicin, which was approved in 1974, is not used because it is highly toxic and is not effective.

"Until we began using sorafenib, we had no medical options for these patients who suffered due to progression of their disease," said Marcia S. Brose, MD, PhD, an assistant professor of Otolaryngology and Head and Neck Surgery and Hematology/Oncology, who led the study, which is known as DECISION. "Now, we can give patients hope - a breakthrough medication that can stop the progression of the disease for 5 months. This trial is the first step in a promising series of clinical trials to identify new drugs that are shifting the horizon for patients with advanced thyroid cancer."

Of the 417 metastatic thyroid cancer patients studied in the multicenter, international trial, 207 were randomized to take sorafenib, an oral drug, and 210 to a placebo arm. Twelve percent of patients experienced tumor shrinkage in the sorafenib arm, compared to 0.5 percent of patients taking a placebo. Importantly, the therapy also appeared to thwart disease progression even among many of those whose tumors did not regress: 42 patients who took sorafenib had stable disease after six months, compared to 33 percent of those in the placebo group.

Among patients taking sorafenib, median progression-free survival was 10.8 months, compared to 5.8 months among the placebo group. Patients taking the placebo were allowed to cross over into the sorafenib arm once their disease progressed; 70 percent of them did so. Overall survival data is not yet available.

The most common adverse events observed among patients taking sorafenib included hand-foot skin reaction, diarrhea, alopecia, rash, fatigue, weight loss and hypertension, all of which are consistent with findings from previous trials of the drug for its approved indications.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals provided funding for the trial. Editor's note: Dr. Brose has received consulting fees and honoraria from these companies.
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Identifying Glioblastoma Patients Most Likely To Benefit From Bevacizumab

Main Category: Cancer / Oncology
Also Included In: Neurology / Neuroscience
Article Date: 04 Jun 2013 - 0:00 PDT Current ratings for:
Identifying Glioblastoma Patients Most Likely To Benefit From Bevacizumab

A new test may help identify newly diagnosed glioblastoma patients more likely to benefit from bevacizumab (AvastinR), according to new research from The University of Texas MD Anderson Cancer Center.

The results of the study were presented at the annual meeting of the American Society of Clinical Oncology.

This study is associated with RTOG 0825, a large multi-center Phase III trial that evaluated the addition of bevacizumab to standard chemoradiation and maintenance temozolomide in treating newly diagnosed glioblastoma. Half of the participants received bevacizumab while the other half received a placebo.

Glioblastoma is the most frequent and aggressive type of brain tumor. Despite slight gains, tumors pose a high risk of recurrence and are commonly fatal.

"In general, glioblastomas are heterogeneous and no drug has been found that benefits every patient," said Erik Sulman, M.D., Ph.D., assistant professor in MD Anderson's Department of Radiation Oncology and lead author of the study. "We wanted to determine which patients are most likely to benefit from bevacizumab and use that information to develop a diagnostic tool that can predict which patients may be good candidates for the drug."

Does mesenchymal gene expression predict response to bevacizumab?

Bevacizumab is a monoclonal antibody that binds to the protein vascular endothelial growth factor. It is a type of anti-angiogenesis agent and prevents the growth of new blood vessels that tumors need to develop.

Previous studies found some patients with recurring glioblastoma have longer progression-free survival and receive some lessening of symptoms with the drug.

The goal of this study was to investigate the ability of a particular type of gene expression signature to predict response to bevacizumab.

Mesenchymal expression, poor outcomes correlated

As part of RTOG 0825, 637 randomized patients submitted specimens for molecular analysis. The umbrella study data also included molecular stratification that measured the degree of gene enrichment. These genes are known to function in cancer cell invasion and in establishing new blood supply, a function which bevacizumab is designed to prevent.

Researchers observed a significant association between a lower mesenchymal signature and better survival in patients taking bevacizamab.

Based on this association and following the examination of 43 genes in total, researchers modeled a novel gene expression predictor of outcome specific to those in the bevacizumab group.

"One of the key things about this predictor is that it's designed to be used on standard, archival tumors found in most clinical pathology labs," Sulman said. "It doesn't require fresh tissue."

Next steps

The group plans ongoing studies to determine the extent to which this gene signature represents a predictive marker for bevacizumab use in newly diagnosed glioblastoma.

"We will use data from the remaining patients on the trial to validate these findings," Sulman said. "We hope the test will be validated and used as a diagnostic tool to select patients for initial treatment with bevacizumab. Then, we plan to look beyond glioblastoma to see if it could benefit other tumor types currently treated or in clinical trials with bevacizumab."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. Support sources for the study include Radiation Therapy Oncology Group (RTOG) grants U10 CA21661, CCOP grant U10 CA37422, Brain SPORE P50 CA127001 from the National Cancer Institute and Genentech, Inc.

Disclosures: Sulman received an honorarium from Merck.

In addition to Sulman other MD Anderson authors on the study include: Mark Gilbert, M.D., Paul Brown, M.D., Ritsuko Komaki, M.D. and Kenneth Aldape, M.D. Other authors include: Minhee Won, MA and James Dignam, Ph.D., Radiation Therapy Oncology Group; Deborah Blumenthal, M.D., Tel Aviv Sourasky Medical Center; Michael Vogelbaum, M.D., Ph.D., Cleveland Clinic; Howard Colman, M.D., Ph.D., Huntsman Cancer Institute; Robert Jenkins, M.D., Ph.D. and Kurt Jaeckle, M.D., Mayo Clinic; Arnab Chakravarti M.D., Ohio State University; Robert Jeraj, Ph.D., University of Wisconsin Madison; David Schiff, M.D., University of Virginia; James Atkins, M.D., Southeast Cancer Control Consortium; David Brachman, M.D., Arizona Oncology Services; Maria Werner-Wasik, M.D, Thomas Jefferson University Hospital; and Minesh Mehta, M.D., University of Maryland Medical Center.

University of Texas M. D. Anderson Cancer Center

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Les décisions thérapeutiques : Médecin pour les Patients cancéreux

Main category: Cancer / Oncology
Also included in: primary care / General Practice
Article Date: June 5, 2013-0:00 PDT current ratings for:
The therapeutic decisions: doctor for Cancer Patients

Desire of patients for participation changes over the course of the disease

What are the treatments a doctor recommends for advanced cancer depends not only on the medical aspects. His relationship with the patient and his own vision of their life to their age situation play a role. It was discovered by a team of researchers led by Dr. Jan Schildmann of the Ruhr-Universitat Bochum (RUB) with colleagues at the University of Oxford. RUB researchers also studied how patients perceive and evaluate the information they receive for clarification and decision making. The report of medical ethicists in the journals the oncologist and Annals of Oncology.

One of the most difficult challenges in medicine

"The therapeutic decisions in advanced, life-threatening diseases are among the most difficult challenges in medicine", said Jan Schildmann, responsible for North Rhine-Westphalia junior research group "Medical Ethics at the end of life: Norm and empiricism. Scientific data often on the benefits and harms of therapy in such situations are rare. To RUB Institute, medical ethics and history of medicine led by the Prof. Dr. Dr. Jochen Vollmann, scientists have studied how cancer patients evaluated the explanation of potential therapies and what criteria physicians base their decisions on. To this end, the researchers interviewed doctors who work in medical oncology and patients with cancer and qualitatively evaluated discussions.

Personal values influence treatment recommendations of doctors

Making decisions for or against a therapy, in addition to medical factors, the age and the lives of the patients situation plays a role - for example, if they have a family. Thus, one of the doctors involved in the study of the interview said: "I think instinctively feel it as a young patient with a young family, it should make more effort to try to help them live a little longer. '' Doctors have also made comparisons to their age and their life situation. "I had recently a young woman... with teenage girls, the same age as my daughters, so there was a kind of sense of... it should not influence, but you can imagine the same as yourself person ', as an example of one of the interviews. The results of studies conducted in England are consistent with the already published results of the Germany.

The wishes of patients are changing during the illness

To explore the wishes of patients, the researchers interviewed people suffering from cancer of the pancreas. The result: at the beginning of the treatment, patients treatment hardly information received; their confidence in the physician was crucial. "I placed my life and my health in the hands of specialists and said you'll do this right", one of the participants said. During the illness, however, people have learned to treat the words of better doctors; While they wanted more information and be involved in the decision on possible therapies.

Reflecting the value judgments

"Unable to apply the results of this qualitative study to the entire cohort of oncologists, or all cancer patients", says Jan Schildmann. However, the results of other research groups also highlighted treatment that doctors recommendations are based not only on the medical aspects. "Doctors should reflect on the value judgements that play a role in the recommendations. They should also consider what information really allow patients to participate in the decision-making process according to their wishes at some point. ?

Article adapted by Medical News Today press release original. Click on "references" tab above for the source.
Visit our cancer / Oncology section for the latest news on this subject. Funding: The empirical study is part of a clinical and ethical research project directed by the North Rhine-Westphalia junior research group "Medical Ethics at the end of life: Norm and empiricism", funded by the Ministry of Innovation, Science, research and technology.

Bibliographic records: Schildmann J. j., P. Ritter, S. Salloch, W. Uhl, J Vollmann (2013): ?it takes a little confidence in the doctor...? ': a study qualitative interview with patients of cancer of the pancreas on their perceptions and their views on the information and treatment decision-making, Annals of Oncology, doi: 10.1093/annonc/mdt193

J. Schildmann, J. Tan, S. Salloch, J. Vollmann (2012): well, I think that there is great variation... ': a qualitative study of the experiences of oncologists and the views on the medical criteria and other factors relevant to the therapeutic decisions in advanced cancer, the oncologist, doi: 10.1634/theoncologist.2012-0206

The University of Bochum Ruhr

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Glioblastoma Patients Treated With Bevacizumab Experience Reduced Cognitive Function And Quality Of Life

Main Category: Neurology / Neuroscience
Also Included In: Cancer / Oncology
Article Date: 04 Jun 2013 - 0:00 PDT Current ratings for:
Glioblastoma Patients Treated With Bevacizumab Experience Reduced Cognitive Function And Quality Of Life

Many glioblastoma patients treated with bevacizumab (AvastinR) have significant deterioration in neurocognitive function, symptoms and quality of life. Not only that, the changes often predict treatment outcomes, according to new research from The University of Texas MD Anderson Cancer Center.

The findings from the large national multi-center Phase III trial, RTOG 0825, were presented at the annual meeting of the American Society of Clinical Oncology.

Glioblastoma is the most frequent and aggressive type of brain tumor. Despite slight gains, tumors pose a high risk of recurrence and are commonly fatal.

Previous studies found bevacizumab, a monoclonal antibody directed against the vascular endothelial growth factor, prolongs progression-free survival (PFS) in patients with recurrent glioblastoma.

RTOG 0825, one of the largest trials to study the clinical benefit of a brain tumor treatment, evaluated newly diagnosed patients treated with bevacizumab, in addition to standard chemoradiation and maintenance temozolomide, versus those who received a placebo and standard treatment.

Tests measured effects of treatment

Using objective tests of cognitive function and subjective measures of symptoms and quality of life, 507 patients were evaluated at diagnosis and at intervals throughout treatment as long as scans showed their tumors were not progressing.

"Most studies rely on traditional endpoints, including overall survival and radiographic outcomes, such as PFS, with little attention to the impact of the disease and therapies on the patient," said Jeffrey Wefel, Ph.D., associate professor in MD Anderson's Department of Neuro-Oncology and a senior author on the study. "This makes the potential clinical benefit difficult to ascertain."

Neurocognitive changes

At the beginning of the study, patients' neurocognitive function in both groups was below healthy population norms. Longitudinal analyses showed those treated with bevacizumab compared to ones treated with placebo demonstrated greater decline in global neurocognitive function, executive function (skills involved in tasks such as planning, organizing and multi-tasking) and processing speed.

Additionally, baseline performance and early change (through week 10) in global neurocognitive function, memory, executive function and processing speed were prognostic for survival.

"Relatively little attention has been directed toward investigating patient biomarkers associated with outcomes," Wefel said. "We sought to determine if patient cognitive function was a biomarker associated with progression-free and overall survival (OS) time. We found patients with worse cognitive function at baseline, and those who experienced cognitive decline after concurrent chemoradiation with or without bevacizumab, were at greater risk for shorter PFS and OS time."

Quality of life and side effects

Symptoms and quality of life were significantly worse for patients receiving bevacizumab, particularly at weeks 22 and 34. In particular, symptom burden, including treatments, and generalized and affective symptoms were greater, with persistent differences seen in treatment-associated symptoms. Additionally, overall symptom burden, tumor and treatment-related symptoms, as well symptoms that interfered with daily activities, were also worse for those on bevacizumab over the treatment course.

Baseline and early change rating of both symptoms and quality of life, like neurocognitive function, were also prognostic for survival.

"The idea of our research was to put together the total picture of this treatment, not only how it affects the tumor, but how it affects patients and how they go about their lives," said Terri Armstrong, Ph.D., adjunct professor in MD Anderson's Department of Neuro-Oncology. "It was our hope this treatment would improve life for them, but that just wasn't the case. For many, both tumor and treatment-related symptoms were worse and continued to get worse over time."

Next steps

"We're eager to continue investigating the data within this trial to identify subsets of patients for whom a particular therapeutic approach may have been associated with a favorable net clinical benefit for survival, cognition, symptoms and quality of life," Wefel said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our neurology / neuroscience section for the latest news on this subject. Support sources for the study include Radiation Therapy Oncology Group (RTOG) grants U10 CA21661 and U10 CA37422 and Genentech, Inc.

Disclosures: Wefel serves on Genentech's advisory board and is a consultant to Roche. Armstrong also serves on Genentech's advisory board.

In addition to Wefel and Armstrong other MD Anderson authors on the study include Mark Gilbert, M.D. and Ritsuko Komaki, M.D. Other authors include: Stephanie Pugh, Ph.D. and Minhee Won, MA Radiation Therapy Oncology Group; Merideth Wendland, M.D., Willamette Valley Cancer Institute; David Brachman, M.D., Arizona Oncology Services; Ian Crocker, M.D., Emory University; H. Ian Robins, M.D., Ph.D., University Wisconsin Madison; R. Jeffrey Lee, M.D., Intermountain Medical Center; and Minesh Mehta, M.D., University of Maryland Medical Center.

Abstract # 2004 and 2003

University of Texas M. D. Anderson Cancer Center

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Cancer Patients In The US Are Suffering From Drug Shortages

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Main Category: Cancer / Oncology
Also Included In: Pharma Industry / Biotech Industry;??Pharmacy / Pharmacist
Article Date: 04 Jun 2013 - 0:00 PDT Current ratings for:
Cancer Patients In The US Are Suffering From Drug Shortages

Eighty-three percent of cancer doctors have documented that they have experienced oncology drug shortages. Most of them also say their patients' treatments have been affected, according to a study presented at the 2013 American Society of Clinical Oncology.

The findings revealed that shortages - which have significantly affected medications to treat pediatric, blood, and gastrointestinal cancers - have left doctors surveyed without the supplies to treat patients with standard chemotherapies for a range of cancers.

The current study was the largest of its kind to survey chemotherapy shortages, with a random sample of 500 board-certified oncologists in the US in late 2012 and early 2013. The goal was to analyze the impact of drug shortages on their practices during the last six months.

The study's senior author Keerthi Gogineni, MD, MSHP, an instructor in the division of Hematology-Oncology in Penn's Abramson Cancer Center, said:

"Our results indicate that the vast majority of oncologists in the country are facing wrenching decisions about how to allocate lifesaving drugs when there aren't enough to go around. The potential impact of these drug shortages is vast: they're putting patients at risk and driving up costs of cancer care."

Additionally, the authors pinpointed several ways in which oncologists have modified their practices when recommended drugs are scarce: 78% report treating patients with a different drug or drug regimen77% substituted different drugs halfway through therapy43% had to postpone their patients' treatment37% had to pick certain patients who needed a specific drug29% eliminated doses and 20% decreased doses17% referred patients to another practiceThe authors suggest that the widespread treatment delays demonstrate the urgency of this problem. Risks arise when doctors substitute drugs partway through the patients' treatment schedule, because often there is no established dosage equivalence or known safety profile when the drug is used with other therapies.

Clinical trials can also be affected when drugs needed for them are scarce. Researchers found that 12% of the time, drug shortages prevented enrollment in these trials, postponed administration of a study drug, or suspended involvement of patients in human studies.

The results also detail the expensive burden caused by drug shortages. The prices of drugs and their substitutes have increased in recent years. Additionally, generic drugs have become harder to obtain.

Despite the incidence of the shortage problems, 70% of doctors said their cancer centers had no formal recommendations or guidelines for making assignment decisions. The lack of drug supplies force doctors to make difficult decisions and weigh the needs of different but equally vulnerable patients against one another.

Gogineni concluded:

"This is a dynamic problem, and when we learn about new shortages on the horizon, there is usually not a lot of time to plan for how to deal with them. Guidelines must be rapidly updated and disseminated, both to large academic medical centers and smaller community hospitals and practices -- where the majority of cancer care is delivered and which often lack the bulk-buying power to keep scarce drugs in necessary supply."

A small-scale survey on the same topic was conducted earlier this year by St. Jude Children's Hospital and had similar results, suggesting that drug shortages weaken the quality of and increase the cost of cancer care.

Written by Kelly Fitzgerald
Copyright: Medical News Today
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Additional Lymph Node Removal May Not Improve Survival in Breast Cancer Patients with Small Amounts of Cancer in Sentinel Node

Among women with early-stage breast cancer and small amounts of cancer (micrometastases) in the sentinel lymph node, removal of additional lymph nodes (completion axillary lymph node dissection) does not appear to improve overall survival. The results of this study were presented at the 2010 annual meeting of the American Society of Clinical Oncology.

For women with early breast cancer, determining whether the cancer has spread to the axillary (under the arm) lymph nodes is an important part of cancer staging. Evaluation of the axillary nodes may involve either an axillary lymph node dissection (ALND), in which many lymph nodes are surgically removed and evaluated or a less extensive procedure known as a sentinel lymph node biopsy.

The sentinel nodes are the first lymph nodes to which cancer is likely to spread. If the sentinel nodes are free of cancer, no further lymph node evaluation is performed. If the sentinel nodes contain cancer, however, most women then undergo ALND to remove additional nodes. This additional lymph node surgery has been shown to help control cancer locally, but the effect on survival has been controversial. Establishing the benefits of completion ALND is important because it can cause significant side effects such as pain, discomfort, and swelling (lymphedema).

To evaluate the effects of ALND in breast cancer patients with micrometastases in the sentinel node, researchers conducted a Phase III study among 991 women. Half the women underwent completion ALND, and half did not.

Five-year overall survival was 91.9% among women who underwent ALND and 92.5% among women who did not undergo ALND.Disease-free survival was 82.2% among women who underwent ALND and 83.8% among women who did not undergo ALND.The rate of local/regional recurrence (recurrence in or near the breast) was 4.3% among women who underwent ALND and 3.4% among women who did not undergo ALND.

In a prepared statement, the lead author of the study explained, “Our findings suggest that there may not be a benefit to removing more lymph nodes than the sentinel node only, and that women can avoid the risk of additional side effects that come with more extensive lymph node removal. Axillary lymph node dissection will still be needed in some cases, but these findings show it may be necessary for far fewer women.”

Reference: Giuliano AE, McCall LM, Beitsch PD et al. ACOSOG Z0011: A randomized trial of axillary node dissection in women with clinical T1-2 N0 M0 breast cancer who have a positive sentinel node. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract CRA 506.

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Acupuncture Reduces Hot Flashes in Breast Cancer Patients

Among women treated with hormonal therapy for breast cancer, acupuncture and EffexorR (venlafaxine) were similarly effective at reducing the frequency of hot flashes. These results were published in the Journal of Clinical Oncology.

The majority of breast cancers are hormone receptor-positive. These cancers are stimulated to grow by the circulating female hormones estrogen and/or progesterone. Treatment of hormone receptor-positive breast cancer often involves hormonal therapies that suppress or block the action of estrogen. These therapies include tamoxifen (NolvadexR) as well as agents known as aromatase inhibitors. Tamoxifen acts by blocking estrogen receptors, whereas aromatase inhibitors suppress the production of estrogen in postmenopausal women.

Common side effects of hormonal therapy include hot flashes and night sweats. Antidepressants such as Effexor have shown some effectiveness in managing these symptoms but can produce side effects and may not be acceptable to all women.

Acupuncture is a form of traditional Chinese medicine that aims to improve health by stimulating specific points of the body. [1] Because acupuncture has shown some promise in reducing hot flashes in breast cancer patients, researchers conducted a study to compare it to Effexor. [2] The study involved 50 women with Stage 0-III breast cancer who were experiencing hot flashes during hormonal therapy. Half the women received acupuncture for 12 weeks, and half the women were treated with Effexor for 12 weeks.

Both groups (acupuncture and Effexor) experienced significant decreases in hot flash frequency. Acupuncture appeared to be as effective at reducing hot flashes as Effexor.By two weeks after completing treatment with acupuncture or Effexor, hot flash frequency increased in the Effexor group but remained at low levels in the acupuncture group.Side effects among women treated with Effexor included nausea, dry mouth, dizziness, and anxiety. Acupuncture did not produce any negative side effects.

These results suggest that acupuncture may be as effective as Effexor at reducing the frequency of hot flashes in breast cancer patients treated with hormonal therapy.

References:

[1] National Center for Complementary and Alternative Medicine. Acupuncture: An Introduction. Available at: http://nccam.nih.gov/health/acupuncture/introduction.htm. Accessed January 4, 2010.

[2] Walker EM, Rodriguez AI, Kohn B et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. Journal of Clinical Oncology [early online publication]. December 28, 2009.

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Worse Outcomes for Breast Cancer Patients with Other Illnesses

Older breast cancer patients who have additional medical conditions have worse survival than patients without other illnesses.? These findings were recently published in the Journal of the National Cancer Institute.?

According to results from previous studies, illness in addition to breast cancer may shorten survival and increase death rates among older women with breast cancer. Studies to date have assessed the association between other illness as a whole and breast cancer death but have not evaluated specific illnesses independently.??

To better understand how medical conditions in addition to breast cancer may affect survival among older women, researches selected 13 medical conditions to evaluate; these included stroke, chronic obstructive pulmonary disease, chronic renal failure, congestive heart failure, dementia, diabetes, liver disease, heart attack, paralysis, peripheral vascular disease, previous cancer, rheumatoid arthritis, and ulcers. A total of 64,034 breast cancer patients were included in the study. Patients were 66 years old and older and had been diagnosed with breast cancer between 1992 and 2000.??

42% of patients had a history of one or more of the selected illness. ?Patients with selected illnesses experienced shorter overall survival times and increased overall deaths from breast cancer and other conditions compared with patients without another illness.?When patients between 66 and 74 years of age were further analyzed according to age and type of illness other than breast cancer, overall survival was worse or similar among patients with Stage I breast cancer and another illness compared with patients with Stage II breast cancer and no other illness.??

It appears that certain illnesses in addition to breast cancer may decrease overall survival and increase death among older women with breast cancer. These findings may help doctors more accurately predict survival among breast cancer patients. As well, they underscore the importance of balancing treatment for breast cancer with treatment for other conditions.?

Reference: Patnaik JL, Byers T, DiGuiseppi C, et al. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. Journal of the National Cancer Institute [online publication]. June 30, 2011.?

Posted July 21, 2011

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Genetic Differences May Influence the Severity of Joint Pain Among Breast Cancer Patients Taking Aromatase Inhibitors

Aromatase inhibitor-associated arthralgia (AIAA)? is a major side effect in breast cancer survivors, producing joint pain so severe that as many as ten percent of women discontinue their therapy prematurely while undergoing treatment with these lifesaving drugs. New research presented by investigators from the University of Pennsylvania’s Abramson Cancer Center at the 2010 meeting of the American Society of Clinical Oncology reveals a possible genetic basis for why these side effects occur and shows promise for treating these symptoms without interfering with the drugs’ efficacy. Additional research will also be presented shedding light on the physical and psychological factors that influence women’s decisions to stop taking the drugs.

Jun Mao, MD, MSCE, an assistant professor of Family Medicine and Community Health who heads the Abramson Cancer Center’s integrative oncology program, led a team that studied individual genetic variations that could potentially influence both the onset and the severity of AIAA.[1] His team studied 390 postmenopausal women with Stage 0 to III breast cancer receiving adjuvant therapy with aromatase inhibitors who reported joint pain related to their drug therapy.? They found that among this group, women carrying at least one copy of a “7-repeat” genetic variant in the aromatase enzyme (CYP19A1, the target of aromatase inhibitors) had a lower chance of developing AAIA than those with at least one “8-repeat” allele of the same gene. Having at least one copy of a specific IL-6 haplotype was also correlated with increased pain severity, while the presence of a different variant of that gene was associated with decreased pain.? Both these findings support previous research that indicates an important role for host estrogen metabolism and inflammation in causing AIAA.

“Due to genetic differences, women respond differently to aromatase inhibitors with regard to estrogen levels and inflammatory processes, and as a result, some women are more likely to have this pain or have more severe pain,” says Angela DeMichele, MD, MSCE, an associate professor of Hematology/Oncology and Epidemiology and Biostatistics, and a co-author on all three of the studies. “There are millions of women receiving AIs, as many as 50 percent of them experience some level of arthralgia, and up to 10 percent discontinue their treatment prematurely, so this is a significant issue.”

The investigators say that as more breast cancer patients become breast cancer survivors, clinicians must become more knowledgeable about the quality of life issues impacting women after they end active treatment for their cancers. The new findings are key to identifying which women may be at risk of problems like arthralgia—and then, Mao says, to developing more targeted interventions at both the physical and psychological levels.

The multidisciplinary team is also looking at issues related to clinician-patient communication, exercise, and co-factors such as arthritis or fibromyalgia that can increase pain and disability in order to keep more women on their treatment regimen. Mao, who is also a licensed physician acupuncturist, has begun a clinical trial examining the effectiveness of acupuncture for aromatase inhibitor associated arthralgia as part of conventional breast cancer survivorship care. These efforts are part of the Abramson Cancer Center’s comprehensive Wellness After Breast Cancer program.

“We believe that proactively informing women about the possibility that their breast cancer treatment may cause arthralgia and then intervening early is probably important to keeping them on these potentially life-saving cancer treatments,” Mao says. “When they are not prepared, or become frustrated because they didn’t know this could happen to them, they are far more likely to make the decision to stop treatment. Some studies have suggested that women with the most severe symptoms are those with the most complete blockage of aromatase. We want to do everything we can to assure that the women most likely to benefit from therapy don’t end it too soon because they are experiencing pain related to their treatment.”

In a related study, University of Pennsylvania researchers surveyed 300 breast cancer survivors to assess the impact of AIAA on upper and lower extremity functioning.[2] They found that women with AIAA had greater impairment of both upper and lower extremities than those who did not experience these symptoms. As many as 29 percent of participants reported that the pain limited their ability to perform their normal activities.

In a third study, Carrie Stricker, PhD, RN, clinical assistant professor of Nursing and an oncology nurse practitioner, led the team of researchers in surveying 490 postmenopausal, non-metastatic breast cancer patients to assess the factors that influenced their stopping AI therapy prematurely.[3]? This is one of only a few studies to analyze the rates at which women discontinue AI therapy and the variables that predict their decision to do so, and the only designed to evaluate patient-reported reasons for ending AI treatment. The study found that 7 percent of the patients studied had discontinued their AI treatment early, at a mean of 15.7 months from the beginning of treatment. The most significant predictors for stopping therapy were a previous history of taking tamoxifen, which can also cause arthralgia and other symptoms; having other inflammatory conditions such as arthritis; communication about difficulties with taking AIs, and being married. Patients who stopped AI treatment early cited side effects as the main reason, with arthralgia being the most common complaint. Effects on bone, hot flashes, and cognitive effects were also named as reasons for cessation of therapy.

“These data suggest that we can develop a profile of the women who are most likely to make the decision to terminate their AI therapy prematurely, and if we can do that, we can design better supportive interventions for these women and incorporate them into our clinical practice,” DeMichele says. “This information, derived directly from the patients themselves, reinforces our understanding that assessing and managing the side effects of cancer therapy, including joint pain, is critical to the overall success we can achieve in managing the disease itself.”

References:

[1] Mao J, Su I, Feng R et al. Genetic variation in CYP19A1 and interleukin-6 and aromatase inhibitor-associated arthralgia in breast cancer survivors. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract 526.

[2] Stricker CT, Palmer SC, DeMichele A, Mao J. Understanding premature discontinuation of aromatase inhibitor (AI) therapy in postmenopausal breast cancer survivors. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract 6073.

[3] Friedman CF, Bruner D, Xie S et al. Functional disability and aromatase inhibitor-associated arthralgia in breast cancer survivors. Presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract 9156.

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A Patient's Right To Control Genomic Health Information

Main Category: Genetics
Also Included In: Cancer / Oncology;??Alzheimer's / Dementia
Article Date: 13 May 2013 - 0:00 PDT Current ratings for:
A Patient's Right To Control Genomic Health Information

Doctors should not have the right or responsibility to force-feed their patients with genomic information about their future health risks, according to bioethicists writing in Trends in Biotechnology, a Cell Press publication. They write in response to controversial recommendations from the American College of Medical Genetics and Genomics (ACMG) on the reporting of incidental findings in clinical genome sequencing.

"A lot of people in this field would agree that no one has a right to withhold your health information from you," said Megan Allyse from the Stanford University Center for Biomedical Ethics. "But it's problematic to suggest the inverse: that the medical system should give you information you didn't ask for and don't want. No one should be able to interfere with your ability to accept or decline access. We think that's where these recommendations are problematic, because they do suggest that your physician should interfere in that decision by essentially saying, 'You have to accept this information.' And there is certainly evidence that some people do not want information about long-term health risks, especially in children."

The ACMG recommendations were prompted by the increasing use of genome sequencing in medical care. A challenge in sequencing whole genomes or exomes (protein-coding sequences only) is the sheer quantity of information that results. For instance, a patient may undergo sequencing in an effort to individualize their cancer therapy, but their genome sequence might contain information about their risk of developing Alzheimer's disease in old age. The questions are these: Should patients receive those "incidental findings" or not? And who decides?

The ACMG recommends that anyone undergoing genome sequencing for any reason should be tested for a list of clinically actionable conditions, including predispositions to various forms of cancer and to cardiomyopathy (but not to Alzheimer's disease). Furthermore, the recommendations are that physicians have a duty to then pass that information on to the patient, like it or not.

Not only would such an approach to medicine be a challenge for patient autonomy, but it would also be costly, the bioethicists say.

"It's not clear how those costs would be passed along, either to insurers or to patients themselves," Allyse said. "For the moment, from a patient perspective, the affected population is pretty small, because few people currently undergo whole-genome sequencing. But there are definitely signs that this practice is growing, especially in cancer diagnosis, and so we can envision that this issue of how to define and report incidental findings is likely to affect more and more people in the future. The issue of cost will of course affect any patient who has limited resources - along with the hospitals, insurance companies, and government programs that pay for much of the care patients receive."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our genetics section for the latest news on this subject. Trends in Biotechnology, Allyse et al.: "Not-so-incidental findings: the ACMG recommendations on the reporting of incidental findings in clinical whole genome and whole exome sequencing."
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Study Examines Use Of Creative Arts Therapies Among Patients With Cancer

Main Category: Cancer / Oncology
Also Included In: Depression;??Anxiety / Stress
Article Date: 13 May 2013 - 13:00 PDT Current ratings for:
Study Examines Use Of Creative Arts Therapies Among Patients With Cancer

JAMA Internal Medicine Study Highlights

Creative arts therapies (CATs) can improve anxiety, depression, pain symptoms and quality of life among cancer patients, although the effect was reduced during follow-up in a study by Timothy W. Puetz, Ph.D., M.P.H., of the National Institutes of Health, Bethesda, Md., and colleagues.

Authors reviewed the available medical literature and included 27 studies involving 1,576 patients. Researchers found that during treatment, CAT significantly reduced anxiety, depression and pain, and increased quality of life. However, the effects were greatly diminished during follow-up, the study concludes.

"Future well-designed RCTs are needed to address the methodological heterogeneity found within this field of research," according to the study.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our cancer / oncology section for the latest news on this subject. JAMA Internal Med. Published online May 13, 2013. doi:10.1001/jamainternmed.2013.836. Please use one of the following formats to cite this article in your essay, paper or report:

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Lumpectomy without Radiation an Option for Some Older Breast Cancer Patients

Among women aged 70 or older with Stage I, estrogen receptor-positive breast cancer, treatment with lumpectomy and tamoxifen resulted in a higher rate of cancer recurrence but similar overall survival as treatment with lumpectomy, tamoxifen, and radiation therapy. These results, which will be presented at the 2010 annual meeting of the American Society of Clinical Oncology, suggest that some older women may be able to forego radiation therapy without adversely affecting survival.

Surgery for early-stage breast cancer typically involves either mastectomy or lumpectomy. A mastectomy involves removal of the entire breast, whereas a lumpectomy involves removal of the cancer and a portion of surrounding tissue.? Because a lumpectomy alone is associated with a higher rate of cancer recurrence than mastectomy, patients who elect to have a lumpectomy are generally also treated with radiation therapy. The combination of lumpectomy and radiation is called breast-conserving therapy. Studies have shown that breast-conserving therapy is associated with a lower risk of local cancer recurrence than lumpectomy alone.

Although the addition of radiation therapy to lumpectomy reduces the risk of local cancer recurrence, radiation therapy typically takes place over several weeks and requires a large commitment of time from the patient. This has prompted interest in whether there are certain groups of women with early breast cancer who can safely forego radiation therapy after lumpectomy.

The current study involved 636 women aged 70 or older with Stage I, estrogen receptor-positive breast cancer. After lumpectomy, women were assigned to additional treatment with tamoxifen alone or tamoxifen plus radiation therapy.

Women have now been followed for over 10 years.

The risk of cancer recurrence in the same breast was lower among women who received radiation therapy: a local cancer recurrence developed in 2% of women treated with tamoxifen and radiation therapy and 8% of women treated with tamoxifen alone.Breast cancer-specific and overall survival were similar in the two study groups: 10-year overall survival was 61% among women treated with tamoxifen and radiation therapy and 63% in women treated with tamoxifen alone.

These results suggest that among older women treated with lumpectomy and tamoxifen for Stage I, estrogen receptor-positive breast cancer, skipping radiation therapy increases the risk of local cancer recurrence but does not adversely affect overall survival.

Older women with early breast cancer may wish to talk with their doctor about the risks and benefits of all treatment options.

Reference: Hughes KS, Schnaper LA, Cirrincione C et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 or older with early breast cancer. To be presented at the 2010 annual meeting of the American Society of Clinical Oncology. June 4-8, 2010. Chicago, IL. Abstract 507.

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Xgeva Approved for Patients with Bone Metastases

Xgeva? (denosumab) has been approved by the US Food and Drug Administration (FDA) for the prevention of bone complications such as fracture in patients with bone metastases from solid (not blood-related) cancers. It is not approved for patients with multiple myeloma or other cancers of the blood.

Metastatic cancer refers to cancer that has spread to distant sites in the body. Several types of cancer have a tendency to spread to the bone. Bone metastases can lead to serious problems such as fracture and spinal cord compression and may require treatment with surgery or radiation therapy.

Denosumab is a drug that targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Denosumab was initially approved under the trade name ProliaR for the treatment of osteoporosis in postmenopausal women; it is now also approved under the trade name Xgeva for patients with bone metastases. Xgeva is administered using a higher dose and with more frequent dosing than Prolia.

The safety and efficacy of Xgeva were established in three clinical trials that compared Xgeva to the bisphosphonate drug ZometaR (zoledronic acid). One of the studies enrolled patients with breast cancer, one enrolled patients with prostate cancer, and the third enrolled patients with a variety of cancer types.

The studies assessed the frequency and timing of bone complications (“skeletal related events”). The bone complications that were evaluated were fracture, radiation to the bone, surgery to the bone, and spinal cord compression. In the studies of breast and prostate cancer patients, Xgeva delayed bone complications to a greater extent than Zometa. In the study of patients with other cancer types, Xgeva and Zometa produced similar results.

The approval of Xgeva expands the treatment options available to patients with bone metastases.

Reference:? US Food and Drug Administration news release. FDA approves Xgeva to help prevent cancer-related bone injury. November 19, 2010.

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