High-risk cancer patients benefit from new image-guided radiotherapy system(ANI- 9/12/2007) 

Cancer specialists at Stony Brook University Medical Center say that a new radiotherapy system that combines high-tech imaging with precision tumour-targeting capability is proving to be very beneficial for the patients.  The doctors say that people with medically inoperable tumours or the ones who do not want surgical treatment may benefit most from the ExacTrac X-ray 6D System for image-guided radiotherapy. 

They have revealed that the system adds to patient options for stereotactic body radiation therapy (SBRT), a technique that features high radiation doses with pinpoint precision to tumours.  This procedure is the least invasive method available to treat his disease. "Other than mild redness, I experienced no side effects from the treatment and feel very good," says Denis Keefe, a 63-year-old lung cancer patient, whose tumour has shrunk since the treatment.

"I was comfortable during the procedure and only needed to go for three treatment sessions," he added.  The power and precision of the system also allows for short therapeutic duration. Treatments take one-to-two weeks to complete and require only three or four doses, compared to conventional beam therapy that often lasts many weeks and many doses.

"We have had substantial success in treating patients with tumours of the lung, brain, spine, head and neck, and prostate with the ExacTrac system," says Dr. Allen G. Meek, Chair of the Department of Radiation Oncology, indicating that the system has become an integral part of the department's therapeutic options after several months in operation. 

"ExacTrac enables us to deliver treatment to some previously irradiated sites without damaging critical structures like the spinal cord. This greatly improves our ability to treat some inoperable tumours and cancers that spread from primary sites," Dr. Meek added. Dr. Bong S. Kim, Assistant Professor of Clinical Radiation Oncology, said: "The imaging component is critical to the process. We can position the patient within two millimetres precision, which maximizes radiation treatment directly to the tumour." (ANI)

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NRI creates mice resistant to cancer( Yahoo News- 30/11/2007)


An Indian-origin researcher at the University of Kentucky has led a team to create mice that are resistant to aggressive types of cancer. The might of the mouse comes from a tumour-suppressor gene in the prostate called Par-4, discovered by Vivek Rangnekar, professor of radiation medicine at the UK College of Medicine, who had completed his doctoral studies at the University of Bombay.  The researchers discovered that the Par-4 gene kills cancer cells, but not normal cells.

“The implications for humans could be that through bone marrow transplantation, the Par-4 molecule could potentially be used to fight cancer cells in patients without the toxic and damaging side effects of chemotherapy and radiation therapy,”’ said the University’s media statement announcing the breakthrough. “If you look at the pain that cancer patients go through, not just from the disease, but also from the treatment, it’s excruciating,” Rangnekar was quoted as saying. “If you have someone in your family, like I did, who has gone through that, you know you can see that pain. If you can not only treat the cancer, but also not harm the patient, that’s a major breakthrough. That’s happening with these animals and I think that’s wonderful.”

Funded by grants from the National Institutes of Health, Rangnekar’s study is unique in that mice born with this gene are not developing tumours, said the statement. Rangnekar says there is more work to be done before this research can be applied to humans, but agreed that it is the most logical next step.

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Off-target in the war on cancer (Reuters- 08/11/2007)

We've been fighting the war on cancer for almost four decades now, since President Richard M. Nixon officially launched it in 1971. It's time to admit that our efforts have often targeted the wrong enemies and used the wrong weapons. Throughout the industrial world, the war on cancer remains focused on commercially fueled efforts to develop drugs and technologies that can find and treat the disease -- to the tune of more than $100 billion a year in the United States alone. Meanwhile, the struggle basically ignores most of the things known to cause cancer, such as tobacco, radiation, sunlight, benzene, asbestos, solvents, and some drugs and hormones. Even now, modern cancer-causing agents such as gasoline exhaust, pesticides and other air pollutants are simply deemed the inevitable price of progress.

They're not. Scientists understand that most cancer is not born, but made. Although identical twins start life with amazingly similar genetic material, as adults they do not develop the same cancers. As with most of us, where they live and work and the habits that they develop do more to determine their health than their genes do. Americans in their 20s today carry around in their bodies levels of some chemicals that can impair their ability to produce healthy children -- and increase the chances that those children will develop cancer.

Consider the icon of American cancer, the cyclist Lance Armstrong. He's hardly alone as an inspiring younger survivor. Of the 10 million American cancer survivors who are alive five years after their diagnosis, about one in 10 is younger than 40. Could exposure to radiation and obesity-promoting chemicals help explain why, according to a study in the Journal of the National Cancer Institute, the rates of the testicular cancer that Armstrong developed nearly doubled in most industrialized countries in the past three decades? Should we wait to find out?

I'm calling for prudence and prevention, not panic. The Centers for Disease Control and Prevention and the Environmental Working Group have confirmed that American children are being born with dozens of chemicals in their bodies that did not exist just two decades earlier, including toxic flame retardants from fabrics. A new study by Barbara Cohn and other scientists at the Public Health Institute in Berkeley, Calif., finds that girls exposed to elevated levels of the pesticide DDT before age 14 are five times more likely to develop breast cancer when they reach middle age.

Yes, the war has had some important successes: Cancer deaths in the United States are finally dropping, chiefly because of badly belated (and still poorly supported) efforts to curb smoking, reductions in the levels of some pollutants and significant advances in the control of cancers of the breast, colon, prostate and cervix. But new cases of cancer not linked to smoking or aging are on the rise, such as cancer in children and non-Hodgkin lymphoma in people older than 55. And according to the CDC, cancer is the No. 2 cause of death for children and middle-age people, second only to accidents. The longer view is troubling: The National Cancer Institute reports that from 1950 to 2001, the number of cancers of the bone marrow, the bladder and the liver doubled.

Both public health and social justice demand that we focus more on the things that cause cancer. For example, blacks and other minorities still die of many forms of cancer more often than do whites. Could this be tied to the fact that so many African-Americans hold blue-collar jobs, which may bring them into contact with carcinogens? Or because poor blacks are more likely to live in polluted neighborhoods, or eat diets higher in cancer-causing fats? We can't say, and we're not even trying to find out. The vast cancer-fighting enterprise has decidedly different priorities.

Even our triumphs in battling cancer can leave us with tragic shortcomings. Consider one irony of oncology: Many of the agents that can so effectively rout cancer early in life, such as chemotherapy and radiation, can also increase the risks of falling prey to other forms of the disease later on. According to a study in the Journal of the Royal Society of Medicine, one out of every three girls treated with radiation before age 16 to arrest Hodgkin's disease -- a cancer of the lymphatic system that often occurs in young people -- will develop breast cancer by age 40. 

The Food and Drug Administration, the Consumer Product Safety Commission and the Environmental Protection Agency often lack the authority and resources to monitor and control tobacco smoke, asbestos, tanning salons and the cancer-causing agents in food, water and the everyday products we use on our bodies and in our homes. Under antiquated laws, chemical and radiation hazards are examined one at a time, if at all. Of the nearly 80,000 chemicals regularly bought and sold today, according to the National Academy of Sciences, fewer than 10 percent have been tested for their capacity to cause cancer or do other damage.

As a result of these policy failures, the United States often stands alone -- and not in a good way. Unlike Italy, Ireland, France, Albania, Argentina, Uruguay and many other countries, the United States has failed to ban smoking in public spaces nationwide. Unlike European children, American kids are exposed to small levels of known carcinogens in their food, air, shampoos, bubble baths and skin creams. Our growing dependence on many unstudied modern conveniences makes us the subjects of vast, uncontrolled experiments to which none of us ever consents. True, there are many uncertainties about environmental cancer hazards. But these doubts should not be confused with proof that environmental factors are harmless. 

The confusion arises for three different reasons. First, studying the ways that our surroundings affect our cancers is genuinely hard. Second, public and private funding levels for research and control of environmental cancer are scandalously low. Finally, those who profit from the continued use of some risky technologies have devised well-financed efforts to sow doubt about many modern hazards, taking their cue from the machinations of the tobacco industry. The best crafted public relations campaigns masquerade as independent scientific information from unimpeachable authorities.

Controlling cancer, like controlling global warming, can take place only on an international scale. We can -- and must -- do better. Devra Davis, a professor at the University of Pittsburgh's Graduate School of Public Health, directs the Center for Environmental Oncology. Her most recent book is "The Secret History of the War on Cancer." This is adapted from a longer article in The Washington Post.

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Breast cancer survivors face another battle as patients live longer, they face heart complications caused by the cure (Reuters- 10/11/2007)

When Susan Heun showed up at Froedtert Hospital last month, all she wanted was a second opinion on her breast cancer.At Froedtert Hospital in Wauwatosa, Susan Heun reviews a test with cardiologist William Choi this fall. She believes that a cancer drug was responsible for her going into heart failure. 
She wasn't expecting that heart doctors would get involved in her treatment.
Heun, 58, collapsed and went into cardiac arrest at the Wauwatosa hospital while awaiting routine tests. She was revived, only to get disturbing news: Her heart was not pumping as well as it should, which might have been the result of the breast cancer treatments she received a couple of years earlier.

"Now I'm going home with heart medication," Heun said while lying in her bed at the hospital, with her husband, Tom, sitting next to her. "I didn't come in with heart medication. Now we've got two problems." For years, physicians have known that some chemotherapy drugs and radiation can damage the heart. But doctors and patients have ratcheted up their concern as cancer patients live longer and as alternative therapies less toxic to the heart have become available.

"In the old days, cardiac death (for cancer patients) was a blessing," said Byung-il William Choi, a Froedtert cardiologist. "No more." Recent research published in the Journal of the American College of Cardiology suggested that breast cancer patients might be at even higher risk because of what's known as the "multiple-hit" hypothesis. The authors noted that physical inactivity and obesity - two independent risk factors for breast cancer and heart disease - are more common in breast cancer patients. Then, add in the various therapies breast cancer patients must go through. The result is a series of "cardiovascular insults," the authors wrote.

The insults make the heart even more susceptible to injury and the patient more at risk of dying prematurely. Heun's situation is complicated. Froedtert doctors say they do not think her cancer treatments led to the arrhythmia that caused her heart to stop. However, they found another problem with her heart that they do believe was caused by the cancer treatments. Her heart wasn't pumping efficiently. Cardiologists use a measure known as ejection fraction to describe how much blood is pumped out of the left ventricle, the heart's main pumping chamber, with each beat. A normal ejection fraction is 55% to 75%.

Heun's ejection fraction is 35%, indicating damage to the heart muscle and a condition known as heart failure."I knew that the chemotherapy and the radiation had something to do with this," said cardiologist Choi, who also is a professor of medicine at the Medical College of Wisconsin in Wauwatosa. Twenty-five years ago, Choi co-wrote a paper in the American Heart Journal highlighting the cardiovascular concerns of a particular cancer drug and offering recommendations on how and when it should be used to limit heart damage.
Today, with 2.3 million American women living with a history of breast cancer and a 24% drop in the breast cancer death rate alone from 1990 to 2000, the concern is even more magnified.

More and more doctors are looking to replace old-line cancer drugs that have known toxic heart effects with ones that might work as well but without the heart problems, said Jim Stewart, an oncologist at the University of Wisconsin Hospital and Clinics in Madison.

"We have to assume that a woman with breast cancer will be alive 20 or 30 years later," said Stewart, also a professor of medicine at UW. Indeed, since aging is an independent risk factor for heart disease, longer survival for breast cancer patients who also might have been exposed to heart-damaging drugs is likely to mean more cases of cardiovascular disease in the years to come. "It's a reflection of success," Stewart said. "They are surviving long enough to be at risk."

In September, a study of 43,338 older women treated for breast cancer between 1992 and 2002 found a 26% higher rate of subsequent heart failure in those treated with anthracycline cancer drugs compared with non-anthracycline drugs. Anthracyclines are a class of drugs used on a variety of cancers and still are a mainstay in breast cancer treatment. The research was published in the Journal of Clinical Oncology. 

Although anthracycline drugs are of more concern, most of the drugs used to treat breast cancer pose some short-term and long-term potential for heart complications, doctors say. In March, a study in the Journal of the National Cancer Institute raised concerns about radiation therapy. The study noted that doctors have modified radiation therapy since the 1970s so that it is less harmful to the heart. However, it still can have an adverse effect on the heart, according to the study.

The study involved 1,979 women who underwent radiation therapy of the internal mammary chain lymph nodes. They had higher rates of heart failure and heart valve dysfunction than those who received only breast irradiation. In addition, women who received radiation therapy and who smoked were three times more likely to have a heart attack. At some hospitals, oncologists now are using non-anthracycline drugs in selected breast cancer patients who already have heart problems that might be worsened by the drugs.

John Charlson, an oncologist at Froedtert and an assistant professor of medicine at the Medical College, pointed to recent preliminary research suggesting that another class of cancer drugs called taxanes might be less toxic to the heart than anthracyclines. As a result of that research, about 10% of breast cancer patients at Froedtert now are treated with the new drugs while doctors wait for more research to see if the drugs can be used in larger groups of breast cancer patients, he said. Already, some Internet-savvy patients are asking about other drug options because of concerns about heart damage, he said. 

The other good news is that by lifestyle changes and controlling other cardiovascular risk factors, cancer patients might be able to reduce their heart risk significantly, said Pamela Douglas, co-author of the paper last month in the Journal of the American College of Cardiology. That includes maintaining a healthy weight, exercising and being vigilant about controlling their blood pressure and cholesterol, said Douglas, a professor of cardiology at Duke University Medical Center in Durham, N.C. 

Indeed, she said the success of breast cancer treatment means doctors increasingly are telling patients two things: "Congratulations, you've been cured of cancer. Since you've been given a second chance at life, here's what you need to do to optimize it."

In addition to radiation therapy and anthracycline drugs, the journal article noted other heart concerns associated with breast cancer treatment:

• Another common breast cancer drug, Herceptin, is associated with a 2% to 4.1% increased incidence of heart failure.

• Although endocrine therapy drugs such as tamoxifen are not known to be damaging to the heart (and might actually be beneficial for the heart), those drugs cause a small increase in formation of clots.

• Promising new drugs that interfere with the blood supply to tumors might also increase the risk of clots, reduce the pumping ability of the heart and worsen high blood pressure.

• At the same time, physical inactivity and weight gain can worsen heart problems for cancer patients. Some research suggests that breast cancer patients decrease their physical activity by two hours a week. Another study found that more than 70% of patients increased their body weight by 5 to 14 pounds.


It's not just breast cancer patients who are at risk.In 1999, Sue Northey of Franklin underwent extensive radiation therapy for Hodgkin's disease, treatment that would damage her heart a few years later. Northey, 49, said she doesn't remember being told about the potential for heart problems, although things were such a blur and she was so worried about the cancer that any warnings might have slipped her mind."How would I have made a different decision?" she added. "It was choosing between life and death, and I chose life."Her cancer has been in complete remission since 1999, but a few years ago the first signs of other problems started cropping up. She began feeling short of breath in 2004.

"By the end I couldn't even walk up a flight of stairs," said Northey, an advertising executive. "I just didn't have any life anymore." Tests showed she had a condition known as constrictive pericarditis, a condition in which the pericardium, the sac around the heart, becomes inflamed, calcified and thick. A normal pericardium is about 1 to 3 millimeters thick; Northey's was between 5 and 8 millimeters. In July, Northey underwent a five-hour heart operation at Froedtert to remove scar tissue and part of the pericardium. Her shortness of breath has gone away, and she easily can walk for a half-hour on the treadmill."I have a new lease on life," she said. "I feel the best I've felt in a decade." 

Her case, though, is an example of how cancer patients should be especially vigilant about taking care of their hearts because of the problems that can occur long after treatment, said Northey's doctor, Lee Biblo, a cardiologist at Froedtert.  "It's like a chess game where you're trying to stay five or 10 years ahead," said Biblo, vice chairman of medicine at the Medical College. "In women, heart disease is still the number one killer."

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Organizing cancer care after diagnosis Cancer survivors share tips for moving from shock to action (MarketWatch- 21/11/2007)

Virtually no one is prepared to hear the words "You have cancer." Yet roughly half of men and a third of women will develop a form of it in their lifetimes, according to the American Cancer Society. When cancer strikes, it typically turns patients' lives upside down with fear and uncertainty. But as more people live longer with cancer -- 10.5 million Americans have a history of it -- a movement is afoot to help the newly diagnosed build a support network that can assist when problems crop up, whether they're physical, social or psychological. 

A growing number of cancer centers, health-care providers and advocacy groups are trying to integrate care that goes beyond the strictly medical and addresses quality-of-life issues such as fatigue, anxiety, sexual dysfunction, and family and work problems. Upon diagnosis, patients often face a double whammy of having to learn quickly about their complex medical conditions while dealing with the household changes that result, said Dr. Derek Raghavan, chair of Cleveland Clinic's Taussig Cancer Institute in Cleveland. "They have a whole bunch of financial considerations that come out of nowhere," he said.

Taussig Cancer Institute offers patients, regardless of their location, a host of support programs, including the Cancer Answer line to connect people with resources in their area and the 4th Angel mentoring program, which links cancer patients with survivors. Even in the best of circumstances where resources are abundant, patients often become overwhelmed and need help retaining information that can assist them, Raghavan said. 

Last month, a report from the Institute of Medicine (IOM) found that many health-care providers fall short when it comes to identifying and offering local resources for peer support, counseling and other assistance. The report called for bolstering personalized service in order to meet patients' myriad needs. 
Adult cancer centers are where pediatric cancer centers were 30 years ago in evaluating these questions, said Dr. Melissa Hudson, director of the After Completion of Therapy Program, a long-term follow-up clinic at St. Jude Children's Research Hospital in Memphis, Tenn. 

"They're curing more; they're thinking we can do better as we're taking care of our patients," she said. "We need to see to all their needs because that approach will help them have a better quality of life in their survival." Children often have more public insurance available to them than adults, but if they're uninsured St. Jude won't charge families for treatments, Hudson said. It's unusual in its fundraising-supported capacity, which allows eligible families to receive free housing, transportation help and food subsidies. 

"Many adults are having issues with basic things: Who can take care of them at home? How do you get a ride to your treatment? How do you pay for your treatment?" said Hudson, who took part in the IOM study. "In pediatrics, we can't make the situation perfect but we can alleviate some of that stress." 
Still, some cancer centers are better at being comprehensive than others, she said. "Pediatrics needs to work on improving the transitions, particularly as we transition a patient from acute cancer care to long-term care and community care." 

Helping patients establish a productive relationship with a primary-care doctor or move into adult care can be difficult, Hudson said. "It's extra challenging at that point because many doctors are fearful of taking these patients." In adult care, cancer centers are far from uniform in their approaches, Raghavan said. "It's very much dependent on the culture in different institutions and the personality and interests of directors of various cancer centers. Some view their role as totally science and clinical trial-based and others ... put a softer component or heart into the product they're developing." 

Deirdre Maguire has experienced extremes in her care. She was diagnosed with ovarian cancer in mid-2004 after spending several years trying unsuccessfully to make her gynecologist listen to her. "Anytime I said something was wrong with me he would look at me like I was crazy," said Maguire, 49. "That's a horrible position to put a woman in ... I was misdiagnosed the whole way. It gets to the point where you do start to believe maybe you are crazy." After a problematic surgery close to her home in Cape Cod, Mass., she was taken to Women & Infants' Hospital about 100 miles away in Providence, R.I., which is where she said she would've gone first had she known better. "I would've dealt with someone who primarily deals with cancer all the time." 

Her care team consisted of social workers, nutritionists and clergy to help her son deal with her illness. "I had plenty of support, which then carried over with the Visiting Nurses Association when I went home." "Women need to learn to be their own advocates," said Maguire, who's on her third round of chemotherapy. "I'm proof positive that I should've done it." She advised the newly diagnosed to stay in touch with friends even if it's a little awkward. "Don't lock yourself away. Don't hide. Stay in communication with the people who are trying to communicate with you and take any help you can get." 

Dave Christensen, a construction superintendent in San Diego, is coming up on five years after his diagnosis of non-Hodgkins lymphoma. "The first step I took was probably the worst step anyone with cancer can do, is go on the Internet. You're going to find a gazillion articles published for whatever you have," said Christensen, 46. "Most of us are average Joes. We're not doctors or clinical research scientists. It can be overwhelming." Gari Julius Weilbacher, a personal life coach in Philadelphia, also avoided online sites after being diagnosed with breast cancer five years ago. She didn't want to contact the big cancer groups, but she called a hotline she found through her radiation oncologist's group, Living Beyond Breast Cancer.

"They offered me a breast-cancer survivor who couldn't make me any promises," said Weilbacher, 50. "It was this wild combination of hope and frustration that she wasn't going to tell me anything that she didn't know. But I valued that call a lot." She recommends learning to "advocate for yourself while you're terrified." "I took my husband with me a lot in the beginning when the doctors were giving us information," she said. Having confidence in her doctors was key. "When you create a team for yourself with people you can communicate with, you're a few steps into your healing." 

Christensen, an avid cyclist before and during his cancer, said he draws inspiration from rides he's done with the Leukemia & Lymphoma Society and the Lance Armstrong Foundation. Not long after starting chemotherapy treatments in 2003, his hair began coming out in clumps. He tried to portray it as cool to his kids, then age 11 and 9. "I got one of those hair buzzers out and let my daughters buzz my hair down to bald. I tried to make light of it instead of this 'Oh my God. I have no hair.'" 

Barbara Meltzer recalls going for a routine colonoscopy in 1998 on a Saturday and having surgery for colon cancer the following Wednesday. She was concerned about facing cancer as a single person. Meltzer, 65, runs her own public-relations business in Los Angeles. She didn't tell clients when she was going through chemotherapy. But she attended a cancer support group at her local Wellness Community for about two years so she wouldn't suppress her feelings. 

"I really encourage people to do that because no matter how many people you have around you who love you, if they aren't going through this or haven't gone through this they really don't get it," Meltzer said. "There also may be things you want to say but not to people who love you," such as thoughts about death. Assigning friends and family specific tasks helps them stay involved, she said. "Tell people what you need. Don't make them guess." 

Resources for people with cancer
American Cancer Society - www.cancer.org or 1-800-ACS-2345 
Lance Armstrong Foundation - www.livestrong.org 
The Wellness Community - www.thewellnesscommunity.org 
National Cancer Institute - www.cancer.gov 
Cancer Care --- www.cancercare.org 
American Society of Clinical Oncology's People Living with Cancer --- www.plwc.org 
American Association for Cancer Research - www.aacr.org 
Cleveland Clinic Taussig Cancer Institute - http://cms.clevelandclinic.org/cancer/ 
(Cancer Answer Line: 866-223-8100) 
St. Jude Children's Research Hospital - www.stjude.org

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PET Scans Useful For Some Cancer Treatment, But How Do Patients Fare?- (ScienceDaily 18/11/ 2007)

Positron emission tomography or PET scans can help clinicians diagnose and treat some cancers, but it is not clear yet whether the imaging technology helps people with cancer live longer and healthier lives, according to a comprehensive review by the U.K. National Health Service.

PET scans are one of the latest tools used to detect and determine a cancer's activity in the body. PET is generally more accurate than other imaging technologies such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans. Using tiny radioactive elements, a PET scan can zero in on the distinctive biochemical fingerprints that distinguish cancerous cells from normal tissue.

The most common type of PET scan, called FDG-PET, appears to lead to the best therapy for patients who have a newer diagnosis of non-small cell lung cancer and in those who have undergone treatment for Hodgkin's lymphoma. FDG-PET can also help identify the best treatment for patients with colorectal cancer, and it can detect small, potentially malignant lung growths called solitary pulmonary nodules, say review authors led by Karen Facey. 

"For other cancers, PET can often improve the accuracy of detecting a tumor, but it is unclear how this affects a patient's treatment and ultimately their outcome," said Facey, an evidence-based health policy researcher. The most reliable evidence "would suggest that FDG-PET is cost-effective [in the United Kingdom] in non-small cell lung cancer and Hodgkin's lymphoma," she added.

Facey said this is the first comprehensive review of PET for determining how well patients are responding to chemotherapy and for determining the sites for radiation therapy. "It has identified many interesting new studies, but these are difficult to interpret given their different designs, so there's a real need for larger, better quality studies of this kind to be performed in the U.K.," she said.

The review is published in the latest issue of Health Technology Assessment, the international journal series of the Health Technology Assessment programme, part of the National Institute for Health Research in the United Kingdom. Facey and colleagues combed through the results of six systematic reviews and 158 primary studies that examined the effect of PET scans on the management of breast, colorectal, head and neck, lung, lymphoma, melanoma, esophageal and thyroid cancers. 

For instance, did PET scans diagnose these cancers better than an MRI or CT scan" Could a PET scan give a better idea of a cancer's severity or spread" Would they be better than other imaging techniques at detecting the recurrence of a cancer or monitoring a tumor's response to treatment"

For many of the cancers examined in the review, the answers are still inconclusive and require larger, more careful study, the HTA authors found. While research continues, physicians are already using combination PET/CT scans to help diagnose and treat cancer patients. Facey and colleagues also reviewed this new technology and say that the PET/CT scans appear to be "slightly more accurate" so far.

In September, the Society of Nuclear Medicine, whose members use PET technology, updated its "scope of practice" guidelines to reflect this trend.
"Since many of the state-of-the-art nuclear medicine cameras as well as PET scanners have CT scanners attached to them, performing CT scans becomes one of the nuclear medicine technologist's tasks," said Cindi Luckett-Gilbert, the chair of the society's special task force on the scope of practice.

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Breast cancer rates surge in China (Yahoo News- 31/10/2007)

An increasing taste for Western-style junk food and unhealthy lifestyles have caused the rate of breast cancer among urban Chinese women to jump sharply over the past decade, a state-run newspaper said Tuesday. In China's commercial center of Shanghai, 55 out of every 100,000 women have breast cancer, a 31 percent increase since 1997, the China Daily reported. About 45 out of every 100,000 women in Beijing have the disease, a 23 percent increase over 10 years.

"Unhealthy lifestyles are mostly to blame for the growing numbers," professor Qiao Youlin of the Cancer Institute and Hospital of the Chinese Academy of Medical Sciences told the newspaper. Poor diets, environmental pollution and increased stress are among the provoking factors, he said. The report is the latest illustration of how Chinese are increasingly being diagnosed with diseases more common in the developed world, even while the national health care system remains fragile, expensive and out of reach to many Chinese.

Rising affluence has led to more fat and junk food in Chinese diets, which traditionally consisted mainly of vegetables, tofu and grains such as rice. An estimated 60 million Chinese — equal to the population of France — already are obese and rates of high blood pressure and diabetes are climbing. Earlier research has linked alcohol, tobacco and unhealthy diets — full of fat and salt — to various types of cancer.

China's breakneck economic growth has not only affected the health of city dwellers; state media said Monday that birth defects in newborns have soared in coal mining regions as an apparent result of heavy pollution. The report did not give figures, but data posted earlier this month on the Web site of the government's National Population and Family Planning Commission said the national rate of birth defects had increased by nearly 50 percent between 2001 and 2006, rising to 145.5 per 10,000 births.

Results from eight main coal mining areas in Shanxi province show levels far higher than the national average, according to a Xinhua News Agency report. Shanxi is one of China's most heavily polluted regions, mainly as a result of heavy mining and use of high-sulfur coal, demand for which is soaring with the rising economy. Breast cancer is the leading form of the disease attacking women in Asia, followed by cervical cancer. Both can greatly be reduced by screening — such as mammograms and pap smears or the new HPV vaccine that protects against a virus that can cause cervical cancer. However, cost, cultural barriers and lack of awareness have hampered early detection.

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Cancer death rates dropping fast ( AP Medical- 15/10/2007)

Good news on the cancer front: Death rates are dropping faster than ever, thanks to new progress against colorectal cancer. A turning point came in 2002, scientists conclude Monday in the annual "Report to the Nation" on cancer. Between 2002 and 2004, death rates dropped by an average of 2.1 percent a year. That may not sound like much, but between 1993 and 2001, deaths rates dropped on average 1.1 percent a year. The big change was a two-pronged gain against colorectal cancer.

While it remains the nation's No. 2 cancer killer, deaths are dropping faster for colorectal cancer than for any other malignancy — by almost 5 percent a year among men and 4.5 percent among women. One reason is that colorectal cancer is striking fewer people, the report found. New diagnoses are down roughly 2.5 percent a year for both men and women, thanks to screening tests that can spot precancerous polyps in time to remove them and thus prevent cancer from forming.

Still, only about half the people who need screening — everyone over age 50 — gets checked. "If we're seeing such great impact even at 50 percent screening rates, we think it could be much greater if we could get more of the population tested," said Dr. Elizabeth Ward of the American Cancer Society, who co-wrote the report with government scientists.

The other gain is the result of new treatments, which are credited with doubling survival times for the most advanced patients.In 1996, there was just one truly effective drug for colon cancer. Today, there are six more, giving patients a variety of chemotherapy cocktails to try to hold their tumors in check, said Dr. Louis Weiner, medical oncology chief at Philadelphia's Fox Chase Cancer Center and a colorectal cancer specialist.

"I can tell you the offices of gastrointestinal oncologists around the country, and indeed around the world, are busier than ever because our patients are doing better," he said.

Among the report's other findings:

_Cancer mortality is improving faster among men, with drops in death rates of 2.6 percent a year compared with 1.8 percent a year for women.

_Lung cancer explains much of the gender difference. Male death rates are dropping about 2 percent a year while female death rates finally are holding steady after years of increases. Smoking rates fell for men before they did for women, so men reaped the benefits sooner.

_Overall, the rate of new cancer diagnoses is inching down about one-half a percent a year.

_New breast cancer diagnoses are dropping about 3.5 percent a year, a previously reported decline due either to women shunning postmenopausal hormone therapy or to fewer getting mammograms.

The report includes a special focus on cancer among American Indians and Alaskan natives. Overall, cancer incidence is lower among those populations than among white Americans, except for cancers of the stomach, liver, kidney, gallbladder and cervix.The annual report is a collaboration of the American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries. 

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Post traumatic stress hits kids of cancer patients- (Reuters- 26/09/2007) 

Children whose parents have cancer often suffer post-traumatic stress symptoms that adults underestimate, Dutch researchers said on Wednesday. The study, which the researchers said was the first to track post traumatic stress symptoms in adolescents over an extended period of time, found many children of cancer patients suffered telltale signs of the disorder.
These symptoms included recurring nightmares, an inability to stop thinking about the disease as well as conscious efforts to avoid hearing or knowing anything about their parent's condition, they told the European Cancer Conference.

"We thought the symptoms would decline after time but even after one to five years after the diagnosis, the children still had symptoms," said Gee Hazing, a health scientist at the University Medical Centre in Groningen, who led the study. Experts say post traumatic stress disorder symptoms include irritability or outbursts of anger, sleep difficulties, trouble concentrating, extreme vigilance and an exaggerated startle response. A person may initially respond to the trauma with horror or helplessness, then may persistently relive the event.

The recently completed study did not actually test whether children had the disorder but rather looked for symptoms of PTSD in 49 youths aged 11 to 18 years old starting during the first year after a parent's cancer diagnosis. After first learning a parent had cancer, 29 percent of the children showed post traumatic stress symptoms serious enough to justify psychological help, the researchers said. This number dropped by the end of the first year as kids seemed to adjust to the fact a parent had cancer, especially if the parent's health improved, Huizinga said.

But surprisingly, as time wore on, another group of children started showing an increase of symptoms, perhaps due to the cancer returning or having the time to think more - and fret - about the disease, she added. "We thought the symptoms would decline over time," Huizinga said. The study also found that girls seemed to have the most problems, perhaps because these children may feel responsible for taking on more duties at home with a sick parent, Huizinga said.

The team also suggested that the effect on children whose parents have cancer was bigger than many serious, chronic diseases because dying from cancer was so possible. "We think cancer may have more impact because a parent might die of the disease," Huizinga said. "With a lot of chronic diseases that is often not the case."

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WHO seeks better care for cancer victims in developing world( AFP- 5/10/2007)

The World Health Organisation on Friday launched new guidelines to improve care for terminal cancer sufferers, particularly in developing countries where nearly two thirds of all deaths from the disease occur. "Palliative care is an urgent need worldwide for people living with advanced stages of cancer," said Dr. Catherine Le Gales-Camus, the WHO's assistant director general for noncommunicable diseases and mental health.

The need is particularly acute in the developing world, where over 70 percent of all cancer deaths occur and many people are only diagnosed after it is too late to receive treatment."Everyone has a right to be treated, and die, with dignity. The relief of pain - physical, emotional, spiritual and social - is a human right," Le Gales-Camus said in a statement.

The WHO's new guidelines are chiefly aimed at public health policymakers, with the aim of both improving the quality of life of cancer sufferers and their families, and ensuring care is provided in an equitable and sustainable way. "Simple and low-cost public health models of palliative care can be implemented to reach the majority of the target population," said Benedetto Saraceno from the WHO's chronic diseases and health promotion division.

"These models consider the integration of palliative care services in the existing health system, with a special emphasis on community- and home-based care," he added. The new guidelines aim at a minimum to ensure that within 10 to 15 years, over 60 percent of terminal cancer patients get "relief from pain and other physical, psychosocial and spiritual problems," the WHO said. The global health body said that some 7.6 million people worldwide died from cancer in 2005, and that this is expected to rise to around 9 million people in 2015.

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HEALTH-INDIA: Novartis Patents Case Far From Dead-(Yahoo News)

Cancer patients in India have reason to be relieved at a high court ruling this week which dismissed a petition by Swiss pharmaceuticals multinational corporation (MNC) Novartis challenging an Indian law which denies patents for minor or trivial improvements to known drugs. At immediate stake is the cost of a leukaemia drug, imatinib mesylate. Novartis prices its brand of the medicine, Gleevec/Glivec, at Rs 120,000 (3,000 US dollars) per dose. Indian generic drug manufacturers sell it at Rs 8,000 (200 dollars). 

India’s average per capita annual income is equivalent to only a fifth of the price of a single dose of Gleevec/Glivec. Had Novartis been granted a patent on its version of the drug, tens of thousands of Indians would have been deprived of life-saving treatment. The Novartis judgment will have far-reaching implications for generic drugs used in many countries of the world for the treatment of countless diseases and disorders, including vaccines for HIV-AIDS, as well as medicines for cancer, asthma, heart disease and mental illness. 

Health activists the world over, including Medicins Sans Frontieres (MSF), the Berne Declaration group, as well as the All-India Drug Action Network (AIDAN) based in this country, have welcomed the verdict in the Novartis case for its "positive impact on public health" and the cause of promoting patients’ access to affordable medicines. They see the judgment as a vindication of India’s Patents Act, in particular its Section 3(d), which disallows frivolous patents for "the mere discovery of a new form of a known substance which does not result in the enhancement of the known efficacy of that substance". They have also appealed to Novartis not to contest the judgment. 

However, the Indian government is itself reportedly planning to amend that very Section to allow the "evergreening" of patents on the original molecule of a new drug through its marginal modification which does not constitute an original invention. This will in effect achieve more than Novartis can by appealing the Madras (Chennai) High Court verdict in India’s Supreme Court. 

"That would make a travesty of the very rationale of one of the few measures in the Patents Act of 1970, amended in 2005, which protects the public from the abuse of a monopoly patent right granted to corporations," says Mira Shiva, a long-standing health activist with AIDAN. Adds Shiva: "The sour irony is that by changing Section 3(d), the government would be sanctifying the discredited report of an official committee on patent laws, headed by the former director general of the Council of Scientific and Industrial Research (CSIR), R.A. Mashelkar, which had recommended just such an amendment." 

The Mashelkar report created a scandal six months ago because it plagiarised text pertaining to "incremental innovations" (or marginal modifications to patented drugs) from a document prepared for a pro-Big Pharma think-tank based in Europe, funded by drug multinationals, including Novartis. Disgraced and embarrassed, Mashelkar himself withdrew the report, although he unconvincingly denied the plagiarism. 

But India’s commerce ministry is now trying to smuggle his recommendation into law though the backdoor. "The Economic Times" reported Thursday, quoting a senior bureaucrat, that the government is planning to allow "incremental innovation" by redefining "efficacy" enhancement. That would entirely negate the effect of the Madras High Court judgment, dismissing Novartis’ contention that section 3(d) is "vague, arbitrary and violative of Article 14" of the Indian Constitution, which guarantees the right to equality and non-discrimination. 

Novartis also claimed that the Section does not comply with the Trade-Related Intellectual Property Rights (TRIPS) agreement of the World Trade Organisation, mandating a strict patent regime, which India has signed. The Court ruled that it had no jurisdiction to decide whether Indian patent laws comply with TRIPS; and that Section 3(d) does not suffer from "vagueness, ambiguity and arbitrariness" and contains reasonable "in-built protection" for patent applicants. 

Novartis can appeal against the judgement in the Supreme Court, or get the Swiss government to move the WTO’s Disputes Settlement Body against it. The company has not announced what it intends to do. The fate of Section 3(d) of the Indian Patents Act will have a huge impact on the health situation in the countries of the Global South. 

India, called "the medicine factory of the Third World", is a leading manufacturer of generic drugs and has successfully developed cheap but high-quality medicines across a wide spectrum. Indian-made generics cost only a fraction of the same chemical entities manufactured in the West, which enjoy monopolistic privilege through strict product patents. 

More than half the medicines currently used for AIDS treatment in the developing countries come from India. Indian-made products are also used to treat over 80 percent of the 80,000 AIDS patients in (MSF) projects. Currently, nearly 10,000 drug patent applications await examination in India. If India grants "evergreening" patents, that would spell the end of affordable medicines in the developing countries. 

That is why the Novartis case triggered widespread protest in global civil society. Over 420,000 people worldwide signed a petition asking Novartis to drop the case. Among them were Archbishop Desmond Tutu, the former Switzerland president and health minister Ruth Dreifuss (currently chair of the World Health Organisation board on intellectual property and TRIPS), and several members of the European Parliament and the U.S. Congress. 

"Given this context, it would be utterly treacherous for the Indian government to amend or drop Section 3(d)," says Dinesh Abrol, a specialist in intellectual property issues at the National Institute of Science, Technology and Development Studies in New Delhi. "The arguments commerce ministry bureaucrats advance for doing so are largely specious and wrongly hold that India will lose foreign direct investment in the drugs industry and offshoring opportunities in pharmaceuticals research and development (R&D)." 
Many researchers argue that R&D offshoring is largely a function of low costs and the state of the pharmaceutical sciences in India, and not of the degree of patent protection. "There is no evidence that India has lost contracts because of poor intellectual property protection or lack of confidentiality in pharmaceuticals research," says Abrol. 

He adds: "What the government needs to do after the Madras judgment is to systematically set out in a Patents Office manual the criteria for judging the enhanced efficacy of a drug, including reduced side-effects, contraindications and hard data on assessing greater bio-availability. That's the best way of defending and preventing the abuse of Section 3(d)." However, it is far from clear if the Indian government, in particular its commerce ministry, itself deeply compromised with the WTO, can summon up the will to defend the public interest against predatory multinational corporations. 

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American Cancer Society focuses on health reform (Reuters- 17/09/2006)

The American Cancer Society said on Monday it was dropping its usual emphasis on stopping smoking and other prevention messages to focus on a need for U.S. healthcare reform. The non-profit group said it was switching gears on its advertising and public education campaigning this year to stress the need for a coordinated health care system that covers the 47 million Americans who do not have health insurance. "As a member of civil society, we have made tremendous progress in the fight against cancer, but that progress will not continue unless all Americans have access to quality health care," John Seffrin, the group's chief executive officer, said in a statement.

"To make the next significant leap, we have to make it easier for Americans to get the tests and treatments they need to fight cancer," Seffrin added. Health care is a major issue in the 2008 presidential campaign. Most candidates have plans -- New York Democratic Sen. Hillary Clinton unveiled proposals for universal health care on Monday -- and groups such as labor unions, employers and insurers are also teaming up to propose plans. Cancer is the No. 2 killer in the United States, after heart disease, with 1.4 million new cases estimated to be diagnosed in 2007 and nearly 560,000 deaths.

In 2005, a Harvard Medical School study found that half of all U.S. bankruptcies were caused by medical bills."Is the choice between losing your life and losing everything really a choice?" Seffrin asked. The group also said even people who have health insurance are not always adequately covered for cancer care. "Unfortunately, millions of Americans think they are covered, but find out too late that their insurance is inadequate," Dr. Richard Wender, national volunteer president of the Society, said in a statement.

As a consequence they often face substantial financial burdens, including being denied the care they need, he said, adding: "No-one should have to choose between taking care of their health and paying their bills." The group cited research showing that people who are uninsured, and people with certain types of public health insurance, are more likely to be diagnosed with more advanced cancer compared to those with private insurance, and thus are more likely to die.The findings imply that such people are missing opportunities to have their cancer detected at an earlier stage, when it is more curable.

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Herbs, Massage or Hypnosis? Cancer Patients Get Advice- (Yahoo News- 11/09/2006)

Every day, cancer patients walk into their doctors' offices and neglect to mention the other treatment they are pursuing on the side: the herbal supplements, the hypnosis, the trip to the acupuncturist. And doctors, with little information to offer on such therapies, often don't ask.

New guidelines on lung cancer, published today as a supplement to the medical journal Chest, aim to help change that. In a sweeping set of recommendations that also advise against using CT scans to screen patients for lung cancer, the American College of Chest Physicians offers what it says is a comprehensive look at the use of alternative and complementary medicine in lung cancer. Many of the report's recommendations on prevention and treatment jibe with more widely known guidelines from other medical groups such as the American Society of Clinical Oncology and the American Cancer Society. But these groups haven't offered guidelines for complementary therapies.

Half of all Americans have used complementary and alternative therapies, according to a federal survey. And cancer patients are especially likely to do so, according to Barrie Cassileth, chief of integrative medicine at Memorial Sloan-Kettering Cancer Center and lead author of the complementary-therapy guidelines. So she and her colleagues surveyed the landscape of published research, examining more than 100 studies on treatments ranging from acupuncture to herbal remedies. The aim was to offer useful guidance for doctors and patients on which therapies may be helpful and which may not.

"Doctors aren't comfortable discussing these subjects with their patients," says Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, who wasn't involved in the guidelines. The new report "gives you that anchor you need as a professional to have a conversation with your patient." Among the recommendations, the ACCP report notes that some herbal supplements may interfere with chemotherapy or radiation. But other therapies, such as acupuncture, may help some patients deal with pain and other symptoms. The report also makes clear that any benefits of these therapies are limited to treating the often debilitating effects of cancer and cancer treatment, and not the disease itself. So patients shouldn't forgo standard treatment in favor of alternative therapies. But guidelines may apply beyond lung cancer, because many symptoms are common to many kinds of cancer, says Dr. Cassileth.

Among the alternative therapies that are recommended, acupuncture for pain relief was found to be helpful when drugs aren't enough, or when the side effects of pain medications become a problem and the patient wants to reduce the dose. Acupuncture is also recommended to control nausea and vomiting associated with chemotherapy, when symptoms aren't well controlled with drugs. Patients who are likely to bleed excessively should be cautious in seeking acupuncture, the report says, and should be treated only by a practitioner qualified to treat cancer patients.

Several "mind-body" approaches are endorsed as well. Meditation may reduce stress; yoga and relaxation techniques may improve sleep; hypnosis may alleviate pain and anxiety. Massage given by a therapist trained in treating cancer patients can reduce anxiety, pain, fatigue and distress, but the "application of deep or intense pressure" isn't recommended in patients with a greater-than-normal tendency to bleed. The guidelines generally don't recommend the use of herbal supplements. For the most part, there is little clear evidence that they help, Dr. Cassileth says. And in some cases, supplements may even interfere with chemotherapy and other mainstream cancer treatments.

But some dietary supplements are appropriate in certain circumstances, the researchers note. For example, patients receiving the chemo drug pemetrexed should take vitamin B12 and folic-acid supplements. In general, supplements should be "evaluated for side effects and potential interaction with other drugs," the researchers say. Annette Dickinson, a consultant to the Council for Responsible Nutrition, a supplement-industry trade group, says, "It would be going too far to say that all supplements are likely to have a negative interaction with treatment."

And many experts note that the body of research on complementary therapies is limited, which can make it difficult to draw firm conclusions. Nancy Davidson, a Johns Hopkins oncologist and the president of ASCO, said her group doesn't have complementary therapy guidelines because its experts believe there isn't enough rigorous evidence on the subject. Edward Garon, a UCLA lung-cancer specialist who reviewed the guidelines, says that "many of the conclusions are based on fairly small studies, and things that are very difficult to evaluate." But he adds that it shows "there is credible scientific work that is going into evaluating complementary and alternative therapies."

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Cancer drug withdrawn from market-(Yahoo News- 15/12/2006)


Breast and prostate cancer patients have lost access to a commonly used hormonal treatment which can slow down or prevent the return of the cancer.
The drug, Zoladex, is used to suppress the production of hormones which feed the cancers. Its maker, AstraZeneca, has withdrawn the drug because it says the government's drug funding agency, Pharmac, is cutting funding for it by 20%. The company says that makes Zoladex commercially unviable in New Zealand. The chairperson of the Breast Cancer Advocacy Coalition says patients should not have to suffer for a cost savings.

Libby Burgess says Pharmac should go to the Government for more money, rather than doing deals with drug companies to save money. She says the agency should have also consulted more widely before making the decision to cut funding for the drug. A cancer specialist says the withdrawal of the drug from the New Zealand market means people with prostate and breast cancer will suffer. Pharmac says another drug, Lucrin, is a viable alternative, but a Wellington oncologist says that is not the case. The Head of Radiation Oncology at the Wellington Cancer centre, Dr David Lamb, says clinical trials on Lucrin have used a dose twice the size of that Pharmac is funding

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Experts to Create Genetic Map of Cancer-(Yahoo News)

Cancer is a disease of genes run amok, and scientists have found only a fraction of the bad actors. Tuesday, the government unveiled a $100 million project to speed discovery of culprits and cures, the first step toward a comprehensive map of cancer's genetic makeup. It's an audacious project — the technology to even try it wasn't available just a few years ago. And it comes at a crucial time: Half of U.S. men and one in three women will develop cancer in their lifetimes, and cases are poised to jump as the baby boomer population begins hitting 60 next year. The Cancer Genome Atlas will "tackle the cancer problem like it's never been tackled before," said Dr. Francis Collins, genetics chief at the National Institutes of Health.

A cascade of critical genetic alterations — a domino effect — is required to cause any of the 200 diseases collectively called cancer. But despite 30 years of laborious work, scientists have found only a fraction of them. Those alterations differ by cancer type, and other genetic changes determine how aggressive each person's malignancy will be and even whether a particular treatment is likely to work.

"The challenge of cancer is its complexity," said leading cancer geneticist Dr. Ronald DePinho, of Harvard Medical School and the Dana Farber Cancer Institute. "There are a staggering number of genetic alterations that occur." But the time is right for a massive, government-led push to unravel cancer's genetic underpinning because of recent successes mapping the human genome, a molecular blueprint of our species, said NIH Director Elias Zerhouni. "Through this project I think what we will see is an acceleration of discovery," he said. "This is really the beginning of an era."

The project will bring researchers who now work independently together to hunt not just specific cancerous gene mutations, but chromosome rearrangements, faulty on/off switches and other abnormalities. All the data from The Cancer Genome Atlas — abbreviated, in a bit of scientist humor, TCGA to reflect the four "letters" of DNA's code — will be made public for use by scientists anywhere in the world.

The first step is the three-year pilot project announced Tuesday, to focus on two or three cancer types, chosen within the next few months, to ensure the larger goal of a complete cancer gene map is technologically doable. After all, it's a far bigger project than mapping humans' genetic makeup. "We're talking about basically thousands of Human Genome Projects," said Collins, who directed that program. Even the pilot project will require collecting hundreds of tumor samples from hundreds of patients.

"We have the opportunity, because of advances in technology, to really look at the global nature of what is wrong with the cancer cell in a way that frankly we could not have dreamed of even a few years ago," Collins added. The payoff could be huge. A handful of so-called targeted drugs — Herceptin, Gleevec, Iressa, Tarceva — are proving remarkably effective at battling certain cancers in patients with specific faulty genes.

That's only a small portion of patients: About 20 percent of breast cancer patients have the genetic aberration that Herceptin targets, and just 10 percent of lung cancer sufferers harbor the mutation that Iressa and Tarceva target. But for those patients, the targeted therapies are proving effective — in Iressa's case doubling, to two years, some patients' survival, said Dana Farber lung cancer researcher Dr. Bruce Johnson. Every new gene abnormality that's discovered is a potential target for another therapy.

"I personally have lost every member of my family to cancer. Every one is more difficult than the last, and I personally believe that this kind of project is going to change" treatment, said Dr. Anna Barker, a deputy director of the National Cancer Institute, which is running the new project with Collins' National Human Genome Research Institute. While the project won't offer immediate new therapies, she acknowledged, "it's going to give a lot of hope to patients."

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'Targeted' cancer treatment effective in older patients-(USA TODAY)

Patients over 50 make up the bulk of those diagnosed with cancer. Yet these patients are often considered too old and frail for potentially lifesaving treatments such as bone-marrow transplants, says John Pagel, a blood cancer specialist at the Fred Hutchinson Cancer Research Center in Seattle.
"If we could get enough therapy into people, we could cure them," says Pagel, who presented early results of experimental treatments Monday at the annual meeting of the American Society of Hematology in Atlanta. Pagel and others are experimenting with methods that "target" cancer cells more precisely. His team focused on patients 50 and older who had either acute myeloid leukemia or high-risk myelodysplastic syndrome, a condition that often leads to cancer. Other Seattle researchers presented a study of patients over 60 with lymphoma, a cancer of the lymph nodes.

Instead of exposing the body to a wide beam of radiation, which can injure vital organs, scientists in each case attached radioactive particles to man-made versions of immune system proteins called antibodies, says Ajay Gopal of the University of Washington in Seattle. The antibodies were engineered to stick only to the types of white blood cells that are afflicted by these cancers. That brings radiation directly to tumor cells but mostly spares other parts of the body, Gopal says.Because doctors targeted cancerous tissue, they were able to give much stronger doses, Gopal says. In his study, 56% of patients are alive after three years. In Pagel's study, about 55% are alive after about 10 months. Without treatment, all of the patients were expected to die from their disease, Pagel says.

Doctors didn't compare the new treatments with other therapies, so they can't say that the new strategies are superior, says Thomas Shea, director of bone-marrow transplantation at the University of North Carolina Lineberger Comprehensive Cancer Center in Chapel Hill, who did not work on the study. Although larger studies are needed to confirm the findings, Shea says, they are encouraging. "Not only can older patients tolerate these treatments well, but they had a good response."

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Unaddressed psych disorders common with cancer (Reuters- 14/11/2006)


A study shows that about one of every ten adults with advanced cancer are plagued by major psychiatric disorders, yet many cancer patients with mental health problems aren't getting help from a mental health professional, according to the study. This finding speaks to the need for cancer doctors and patients to discuss psychological concerns during cancer care. "Willingness on the part of the patient did not seem to be a barrier to mental health service use," Dr. Nina S. Kadan-Lottick from Yale University School of Medicine in New Haven, Connecticut told Reuters Health, noting that "93 percent of the patients in the study who met criteria for a psychiatric disorder stated that they would pursue mental health services if they were aware that they had a problem."

In the study, the researchers determined the rate of psychiatric disorders and the use of mental health services in some 250 adults with advanced cancer participating in the "Coping with Cancer Study," an ongoing NIH-funded multicenter study of advanced cancer patients and caregivers. Trained interviewers used established diagnostic tools to spot various psychiatric disorders including depression, anxiety disorder, panic disorder, post-traumatic stress disorder or PTSD. Overall, 12 percent of the cancer patients met criteria for a major psychiatric illness -- 5 percent suffered panic attacks -- yet only 45 percent of affected patients accessed mental health services, according to a report in the journal Cancer."In our study of advanced cancer patients undergoing cancer therapy, fewer than half of the patients with active major psychiatric complaints received care from a mental health provider," Kadan-Lottick noted in comments to Reuters Health.

Caucasian cancer patients and patients who had discussed their psychological concerns with mental health staff were much more likely than others to receive mental health care. "Our study," the authors write, "identified the underutilization of mental health services among advanced cancer patients." They encourage patients with cancer to discuss their mental health with their doctors, noting that if left untreated, psychiatric disorders may have a harmful effect on compliance with cancer therapy and overall outcome

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Patients confused by cancer care- (Yahoo News- 15/11/2005)

Jargon can be confusing for many, almost two-thirds of cancer patients do not fully understand what their diagnosis means, research suggests.Only half of those surveyed knew that when their doctor said "the tumour is progressing", it was not good news.

Experts say the study, based on more than 200 responses, shows many patients are lost in a "maze of information". The research was carried by the charity Cancer BACUP, campaigning group Ask About Medicines, and the Association of British Pharmaceutical Industries. It also found that almost one in three cancer patients feel that those who are better informed get better care.

Yet nearly four out of 10 did not feel they knew what questions to ask about their treatment options - and only half felt encouraged to ask questions at all. The findings are to be presented to the Department of Health by Ian Gibson, chair of the All Party Parliamentary Group on Cancer. Campaigners are calling for health professionals to develop ways to provide patients with easy-to-understand information, and to encourage them to ask questions.

Joanne Rule, chief executive of CancerBACUP, said: "Information is set to replace money as the health currency of the future which suggests a whole new debate about equality between the well informed and those who are left in the dark."Cancer patients today are faced with increased treatment options, including innovative medicines. "But if they lack information, they are unable to be as involved as they should be in all aspects of their care."

Joanne Shaw, director of Ask About Medicines, said: "It's vital that people with cancer are encouraged and empowered to ask questions, as patients who have a better knowledge of their condition are better equipped to manage their symptoms as well as being more positive." Kate Tillett, of the ABPI, said the study proved there was no substitute for a good open relationship between cancer patients and healthcare professionals. "We hope it will serve as a call to action to healthcare professionals to develop information prescriptions for their patients and encourage them to ask questions about their treatment."

National Cancer Director Professor Mike Richards accepted that good information and face-to-face communication were essential to the delivery of high quality care.He said: "We know that the provision of information to cancer patients has improved over the past five years."This is almost certainly due to the establishment of specialist cancer teams and the vital contribution of clinical nurse specialists. "However, the report highlights the gaps remaining in the provision of information to cancer patients. "That is why the Department of Health is working closely with cancer charities to improve services."

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Debating Cancer Screening: Too Old to Test? (Yahoo News- 15/10/2005)

When is a person too old to benefit from cancer screening tests? The answer, experts say, depends less on age than on the type of cancer, the test and individual characteristics of the person to be screened.It would seem logical that screening for cancers in their earliest, most curable stages would benefit anyone who might develop the cancers in question. But while the lives of some people over 65 or 70 could be saved by screening, for others the potential for harm associated with screening could outweigh the benefits. All screening tests have risks, and experts suggest that these possible hazards, as well as the known benefits of screening, should be taken into account when deciding whether to undergo periodic screening late in life. Furthermore, the experts say, the benefits and risks of testing should be discussed with patients beforehand.

Since such discussions are problematic in the hurry-up climate of today's medical care, prospective older candidates for cancer screening would be wise to consider the issues on their own. Screening is meant to be used for healthy people - those with no cancer symptoms. Its main benefit is its ability to reduce deaths by finding and treating early cancers that most likely would be lethal in a patient's remaining years.

The possible risks of screening include complications of the tests themselves or with follow-up exams when screening finds something suspicious that turns out not to be cancer; detection and treatment of a cancer that would never have become a problem in a patient's lifetime; and emotional distress even after an initial positive finding turns out to be negative.In a recent issue of The American Journal of Medicine, evidence for the pros and cons of screening older people for cancers of the colon and rectum, breast and cervix was reviewed by Dr. Louise C. Walter of the University of California, San Francisco, and her co-authors.

These experts considered only medical issues, not the costs of tests and treatment. They emphasized that "decisions about screening for cancer in older persons require weighing potential benefits and harms for each person rather than relying on arbitrary age cutoffs." They also said that "older patients who would decline follow-up or treatment should not be screened." And, for those bothered by the discomfort and risks of screening, "the decrease in the quality of life in the present may outweigh the small chance of future benefit."

Cancers of the colon and rectum are more common as people age, and they are no less aggressive or less responsive to treatment than comparable cancers in younger people. When treated while localized, these cancers in older people are associated with less sickness and better survival chances. Three main screening tests are in use today: fecal occult blood testing of stool samples; sigmoidoscopy, the use of a scope to examine the left half of the colon; and colonoscopy, the use of a flexible scope to examine the entire colon.

Occult blood tests are noninvasive and have been shown to reduce deaths from colorectal cancer in people 70 to 80 by about 15 percent. Hemorrhoids and other factors, however, can lead to blood in the stool, and in about 90 percent of cases in which the test is positive, follow-up testing, usually with colonoscopy, finds no cancer. In patients 45 to 91, sigmoidoscopy has been shown to reduce deaths by 59 percent from cancers in reach of the scope. But older people have an increased incidence of cancers on the right side of the colon not seen through this scope.

Colonoscopy, the most sensitive of tests, is also the most involved and costly and the most likely to cause serious complications, especially in older people. Major complications, which in one study afflicted 3 patients in 1,000 among men 70 to 75, included perforation of the colon, bleeding, stroke, heart attack and blood clots.Colorectal cancers start in adenomatous polyps, which can be found in as many as a third of older people. Fewer than 10 percent of these polyps progress to cancer within a decade. Thus, the experts concluded, "patients who have a life expectancy less than five years are more likely to be harmed from screening than to benefit."

They suggested that in addition to age and life expectancy, the decision to screen an older person for colorectal cancer should be based on factors that increase the likelihood of developing cancer, like a history of inflammatory bowel disease or previous multiple or large adenomas, as well as factors that increase the risk of complications from screening or treatment, like the presence of cardiopulmonary disease.

Breast cancer is more common in older women, but it tends to be a slower growing, less aggressive disease. It is also easier to find by mammography because the breast tissue of older women is less dense. While all well-designed studies done in women 50 to 69 found a protective effect of mammographic screening, only one such trial in eight included women over 70.

This study, done in Sweden, did not show a significant reduction in breast cancer deaths among women 70 to 74 who had two routine mammograms. In the first round of screening, 88 percent of the women with positive mammogram findings turned out not to have cancer on follow-up tests, which included breast biopsies. The experts suggested that the decision to continue screening after 70 consider factors like the presence of a family history of breast cancer and a longer duration of exposure to estrogen (natural and in medication), as well as advancing age. They said, however, that women with other serious diseases and life expectancies of less than five years were not likely to gain from screening.

Cervical cancer in older women is not a more aggressive disease and, when localized, it responds well to treatment. By now, every woman should know that Pap smears save lives. They can reduce the incidence of invasive cervical cancer by 60 percent to 90 percent. Yet few screening studies have included older women.

According to an analysis of Medicare claims, about 39 of 1,000 older women would need at least one follow-up procedure within eight months of having a Pap smear. These procedures range from in-office tests to surgical excisions and include colposcopy, endometrial biopsy, D and C, and cone biopsy, all with certain risks. Another problem involves trying to determine which cervical abnormalities are likely to progress to cancer, since most resolve on their own without any treatment.

In addition, changes in the anatomy of older women can make it harder to get an accurate reading from a Pap smear. After menopause, there is an increased risk of inflammation that can mimic cancerous cell changes. The experts suggest that Pap smears should be done in women over 70 who have not been previously screened, but that women who have had repeated normal Pap smears can stop screening at age 65 or 70, as can women with a short life expectancy and those who have had a total hysterectomy.

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Cancer Survivors May Not Get Needed Care (AP Medical - 7/10/2005)

The nation's 10 million cancer survivors require customized follow-up for years that too few now receive, says a major study that calls for oncologists to create a "survivorship plan" to guide every patient's future health care. Half of all men and one-third of women in the United States will develop cancer in their lifetimes. Thanks to advances in early detection and treatment, the number who survive has more than tripled over the past three decades.

When active treatment ends, these people's special needs may be just beginning, said the study, released Monday. Yet, the legacy of physical, psychological and social consequences has largely been ignored by doctors, researchers, even patient-advocacy groups, leaving survivors too often unaware of simmering health risks or struggling to manage them on their own, said the report by the Institute of Medicine. "Successful cancer care doesn't end when patients walk out the door after completion of their initial treatments," said Dr. Sheldon Greenfield of the University of California, Irvine, who led the study for the institute, an arm of the National Academy of Sciences.

Yet, "you fall off a cliff when your treatment ends," said report co-author Ellen Stovall, president of the National Coalition for Cancer Survivorship, who speaks from personal experience as a two-time survivor. Busy oncologists' priority is to treat patients and they may have little time for the survivor, while physicians who don't specialize in cancer care may not know what special needs survivors have.

"Nobody can take custody," said Stovall, who praises her own doctors but said even they lack information about long-term follow-up for the Hodgkin's disease that first struck her 33 years ago. "The doctor says you're done" with cancer treatment, she added. "But you're just beginning a whole new phase of your health care. Nobody's got the roadmap for that." Survivors are at risk of their initial cancer returning or a new one forming, and may need not just screening to detect that but also help handling the inevitable fear.

Then there are the lingering health effects that various cancer treatments can cause: problems with mobility or memory, nerve damage, sexual dysfunction or infertility and impaired organ function. There may be distress over cosmetic changes. Other hurdles include keeping health insurance after that costly first cancer bout and discrimination from employers. Whether long-lasting effects seem acute or subtle, start to emerge just as treatment ends or not until years later, the report is unequivocal: "Importantly, the survivor's health care is forever altered."

There are ways to avoid or ameliorate cancer's late health effects. But survivors, and their future doctors, have to know they're at risk to take those steps, the report stressed. For instance, it said, certain dosages of the chemotherapy doxorubicin can damage the heart, and survivors who know they're at risk can have their heart checked and early signs of failure treated. Some work is beginning to try to provide that kind of survivor care, sparked by the pediatric cancer community. The Children's Oncology Group, a leading research group, developed long-term follow-up guidelines that say every child cancer survivor should be given an explicit treatment record — complete with physicians' addresses and doses of every drug — to provide every doctor who treats them in the future. And the Lance Armstrong Foundation has begun funding centers at some leading hospitals to focus on specialized survivor care. Monday's recommendations by the Institute of Medicine, chartered by Congress to advise the government on medical matters, is sure to add momentum to those still-fledgling efforts.

Among the recommendations:

_Every patient completing cancer treatment should be given a customized "survivorship care plan" to guide future health care.

_That plan should summarize their cancer care down to drug and radiation dosages, cite guidelines for detecting recurrence or new malignancies, and explain long-term consequences of their cancer treatment. It also should discuss prevention of future cancer, and cite the availability of local psychosocial services and legal protections regarding employment and insurance.

_Specialists and primary care providers should coordinate to ensure survivors' needs are met.

_Health insurers should pay for this report.

_Scientists must improve, or in some case create, guidelines on exactly what screenings are needed for different cancers and their therapies.

_Congress should fund research of survivorship care, to assess their needs and provide evidence for quality care.

 

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