GENERAL CANCER

Massage Therapy Helps Those With Advanced Cancer (HealthDay News-16/09/2008)

For people coping with advanced cancer, massage therapy may offer some relief from pain and depressed mood, according to a new study. Reporting in the Sept. 16 Annals of Internal Medicine, researchers found that people who received massage from a licensed, specially trained therapist reported greater improvements in pain and mood symptoms than did people who received simple touch. However, these improvements didn't last over time. "Our goal was to see if massage therapy compared to simple touch would be beneficial," said the study's lead author, Dr. Jean Kutner, an associate professor of medicine at the University of Colorado Denver School of Medicine. Measuring patient outcomes immediately after massage sessions, her team found that "massage was better than simple touch for pain and mood," she said. "But, on a weekly basis, there was no difference between the groups," she added. "So, massage was better in the immediate time frame, but didn't appear to have a sustained effect." The study included 380 adults with advanced cancer. All had at least moderate pain, and most were receiving hospice care. The types of cancer included lung, breast, pancreatic, colorectal and prostate. About half of the group received at least one massage therapy session, while the remaining half was given "simple touch" therapy. Simple touch consisted of having a therapist place both hands on the patient for three minutes at 10 specific body sites. The massage therapy was done by licensed therapists trained in oncology massage who had at least six months' experience in cancer massage. 

The therapists in both groups were asked to keep talking to a minimum and to simply provide instructions or answer therapy-related questions. No music or scented oils were used. The therapists interviewed patients before and after each session, asking about pain and mood. The patients were then re-interviewed three weeks later to assess if the therapy had any long-term effect. Pain was rated on a scale of 0 (no pain) to 10 (worst pain). Mood was rated on a scale of 0 (worst mood) to 10 (best mood). After massage therapy, mood scores immediately increased by an average of 1.58 points and pain scores decreased by 1.87 points. In the touch therapy group, mood immediately improved by an average of 0.97 points and pain decreased by an average of 0.97 points. After three weeks, however, there were no statistically significant sustained changes, according to the study. "If massage helps people with advanced cancer feel better, then I'd say great, do it," said Dr. Jay Brooks, chair of oncology and hematology at Ochsner Health Foundation in Baton Rouge, La. Brooks does recommend that anyone with cancer, especially those on active treatment regimens, should check with their doctor before getting a massage. Kutner said that, although massage appears perfectly safe from this study, they didn't include people who had a high risk of bleeding or fractures. If massage therapy is something you'd like to try, she advises finding a qualified therapist. Kathleen Clayton, a licensed massage therapist and a spokesperson for the American Massage Therapy Association, agreed. "Make sure the person giving you a massage knows what they're doing. They need to be a licensed massage therapist and someone who has taken courses in oncology massage," she said, adding, "Massage can be a form of symptom relief and can improve your quality of life." One caveat, however: Many insurance companies don't reimburse for the cost of massage therapy. But, Clayton said, some do, so be sure to check with your carrier.

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Survey finds causes of cancer little understood (Yahoo News-26/08/2008) 

People in rich and poor countries alike have faulty understanding of what causes cancer and need better education on how to ward off the disease, according to an authoritative report. In all parts of the world there is more willingness to believe that factors out of individual control, like air pollution, rather than life-style choices like heavy eating and drinking of alcohol, are the main dangers, the report said. The report, based on a survey sponsored by the International Union against Cancer (UICC) of nearly 30,000 people in 29 countries, was released at the start of a four-day World Cancer Congress in Geneva. UICC President-elect David Hill of Australia said the survey showed there was a global need for "education programmes to encourage and support behavior change." In high-income countries like Australia, Britain, Canada, Greece, Spain and the United States, the survey found, refusal to recognize that alcohol consumption increases the cancer risk ran at 42 percent of the population. By contrast, in middle-income countries like China, Indonesia, Mexico, Romania, Turkey, Ukraine and Uruguay, only 26 percent questioned for the survey thought that drinking did not make contracting cancer more likely. And in the two low-income countries included in the survey, Kenya and Nigeria, recognition of the alcohol danger ran highest, with only 15 percent of those questioned saying that it was not a cause of the disease. 

RISK RISES
In fact, said the UICC, the cancer risk rises as alcohol intake increases. In the high-income countries surveyed, while 9 percent offered no opinion 51 percent agreed that alcohol did increase the cancer risk. But many more, 59 percent, felt that not eating enough fruit and vegetables was a major danger. In fact, declared the UICC, the scientific evidence for the protective effect of fruit and vegetables is weaker than the evidence that a high alcohol intake is harmful. Similarly, people in rich countries had exaggerated perceptions of the danger posed by stress -- which 57 percent though increased the cancer risk -- and by air pollution, blamed by 78 percent. However, said the UICC, stress is not a recognized cause of the disease and air pollution is only a minor contributor to cancer rates compared with alcohol consumption. "In general, people in all countries are more ready to accept that things outside of their control might cause cancer, like air pollution, than things that are within their own control, such as overweight which is a well-established cancer risk factor," declared the UICC. The survey showed that in low and middle-income countries, people were more pessimistic about the chances of treatment curing cancer. In the poorest countries 48 percent felt not much could be done once the disease had taken hold. In middle-income countries 39 percent had the same view, but in the richest countries pessimists totaled only 17 percent. The problem with the fatalistic view, said the UICC, was that it could deter people not only from seeking treatment but also from participating in cancer screening programmes which can save many lives. The survey also assessed beliefs about other lifestyle factors including tobacco use and found most people were well aware of the increased risks of cancer from smoking. 

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In Cancer Therapy, There Is a Time to Treat and a Time to Let Go (Yahoo News-18/08/2008)

Thirty years ago Forbes Hill of Brooklyn learned he had prostate cancer. At age 50, with a young wife and a fear of the common side effects of treatment — incontinence and impotence — he chose what oncologists call “watchful waiting.” For 12 years, Mr. Hill was fine. Then in 1990 his PSA count, a measure of cancer activity, began to rise, and he had radiation therapy. That dropped the count to near zero. In 2000, with the count up again, he chose hormone therapy, which worked for a while. Three years ago, with his PSA level going through the roof, he learned that the cancer had spread to his bones and liver. It was time for chemotherapy, which Mr. Hill said he knew could not cure him but might slow the cancer’s progress and prolong his life. His oncologist was candid but not very specific. His doctor told him that with advanced metastatic hormone-resistant cancer like his, 90 percent of patients die within five years no matter what the doctors do, and about 10 percent survive six or more years. “I took that kind of hard,” said Mr. Hill, an associate professor of media studies at Queens College. “I always thought I would live to 90, but I guess now I won’t.” He has just started radiation to the brain, perhaps with infusions of an experimental drug afterward. “I’ll try chemo for six months, but if it gets too uncomfortable and inconvenient... ,” he said, trailing off. “Having lived 80 years, I’ve done a lot. I don’t have reason to think I’ve been badly treated by life.” Mr. Hill seems ready for a time when treating his cancer is no longer the right approach, replaced instead by a focus on preparing for the end of his life. But doctors who have studied patients like Mr. Hill say that often they do not know when to say enough is enough. In a desperate effort to live a month, a week, even a day longer, they choose to continue costly, toxic treatments and deny themselves and their families the comfort care that hospice can provide.

Tough Decisions
Specialists in ovarian cancer from University Hospitals Case Medical Center in Cleveland described a study of 113 patients with ovarian cancer in the journal Cancer in March. “Patients with a shorter survival time,” they found, “had a trend toward increased chemotherapy during their last three months of life and had increased overall aggressiveness of care [but] did not have improvement in survival.” The team concluded, “Our findings suggest that in the presence of rapidly progressive disease, aggressive care measures like new chemotherapy regimens within the last month of life and the administration of chemotherapy within the last two weeks of life are not associated with a survival benefit.” With aggressive therapy, the majority of the women in the study who died did so without the benefit of hospice. Dr. Thomas J. Smith, an oncologist and palliative care specialist at the Massey Cancer Center of Virginia Commonwealth University, said in an interview that patients needed to understand the tradeoffs of treatment. “Palliative chemotherapy, which is what most oncologists do, is meant to shrink cancer and improve the quality and quantity of life for as long as possible without making patients too sick in the bargain,” he said. The Cleveland team pointed out that the treatment goal can, and should, change. “There is a difference between palliative chemotherapy administered early in the trajectory of disease and near the end of life,” the researchers wrote. “The goal of end-of-life care should be to avoid interventions, such as cytotoxic chemotherapy, that are likely to decrease the quality of life while failing to increase survival.”

In fact, those who choose hospice over aggressive treatment often live longer and with less discomfort because the ill effects of chemotherapy can hasten death, Dr. Smith wrote in a review of the role of chemotherapy at the end of life, published in June in The Journal of the American Medical Association. Some patients are just unwilling to acknowledge that nothing can save them, and want toxic treatment even if it means only one more day of life. And sometimes patients are reluctant to relinquish treatment because they are terribly afraid of dying, of being alone cut off from care, Dr. Smith said in the interview. Patients may fear, with some justification, that if treatment stops the doctor will abandon them. It is not only patients and their families who may insist on pursuing active treatment to the bitter end. Sometimes, doctors subtly or overtly encourage it. Oncologists may be reluctant to acknowledge that they can no longer sustain a patient. They may fear destroying a patient’s hope. Or they may be covertly influenced by the fact that their income comes from treatment, not from long discussions with patients and families about why palliative therapy should yield to supportive care. Dr. Smith says that cancer treatments “have a huge price tag of up to $100,000 a patient per year,” which can impoverish even insured patients when there is a 20 percent co-pay. He urges doctors to talk about hospice early, while treatment options are still available, and to assure patients they will not be abandoned in hospice.

Switching to Comfort Care
While there is no official definition of futile care, Dr. Smith suggests that it represents care that is “very unlikely to help and likely to harm.” The National Comprehensive Cancer Network has established some guidelines about when to switch to comfort care. They vary according to the type of cancer and nature of available treatments, but in general they include when a patient has already been through three lines of chemotherapy or when their performance status — how well they can function in daily life — is poor. Dr. Smith said most chemotherapy regimens had been tested only in patients who are relatively well, independently mobile and able to perform most of the tasks of daily life. For those who are confined to a bed or a chair for half or more of the day, “it is time to think long and hard about continuing treatment,” he said. “It’s time to have an extensive discussion with patients about their goals and the risks and benefits of chemotherapy.” He suggested that doctors “put everything in writing — here’s what you have, what we can do for it, what will happen with treatment and without it — so that everyone is on the same page,” eliminating the risk that wishful thinking colors what patients hear. When faced with a patient who says, “I’ll do anything to live two minutes longer,” Dr. Smith said the doctor should ask: “What is your understanding of your illness? What would you like to do with the time remaining?” For most people, he added, the time left would be far better spent putting their affairs in order, preparing their funeral or memorial service, repairing damaged relationships, leaving lasting legacies and saying their goodbyes.

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Gene Therapy Anti Cancer Work (Yahoo News-23/08/2008)

Scientific American magazine focused on two University of Alabama at Birmingham (UAB) Comprehensive Cancer Center researchers in a news story on experimental next-generation anti-cancer therapies. David T. Curiel, M.D., Ph.D., is a UAB professor of medicine and director of the human gene therapy division, and Ronald Alvarez, M.D., is a UAB professor of medicine and director of the gynecologic oncology division. Both doctors are featured in a Scientific American special cancer edition, and both served as co-authors on the story "Tumor-busting viruses." The editors chose Curiel and Alvarez because of their research into a field call viral gene therapy, or virotherapy. Virotherapy involves an experimental technique to target viruses to cancer cells while leaving healthy cells untouched. The viruses are genetically engineered to kill tumor cells in different ways. One way is by adopting the viruses' natural ability to invade and reproduce as a way to deliver target genes that make tumor cells more susceptible to existing chemotherapies. Curiel and Alvarez have been testing this concept with a virus compound called adenovirus in women with recurrent ovarian or other gynecological cancers. The clinical trial is still in the early stages, yet the compound has shown anti-tumor effects that appear safe to most patients, Curiel said. "We envision a substantial role for viruses that is, therapeutic viruses in 21st-century medicine," Curiel and Alvarez wrote in wrote in the story. First proposed in the 1940s, virotherapy now relies heavily on adenoviruses, a cause of the common cold that has been studied and altered extensively for medical research. Adenoviruses have the ability to shuttle targeted segments of DNA into a tumor cell and make biochemical changes that minimize damage to healthy cells.

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LDL Cholesterol Tied to Increased Cancer Risk in Diabetics (HealthDay News-25/08/2008)

Low or high levels of LDL cholesterol are associated with an increased risk of cancer in patients with type 2 diabetes, according to a Chinese study that noted the increasing evidence of an association between type 2 diabetes and cancer risk. The study included 6,107 diabetes patients. None of the patients were taking cholesterol-lowering statins. The researchers found that LDL levels below 2.80 mmol/L were associated with an increased risk of cancers of the digestive organs and peritoneum, genital and urinary organs, and lymphatic and blood tissues. LDL levels above 3.80 mmol/L were associated with increased risk of oral, digestive, bone, skin, connective tissue and breast cancers. The findings suggest "the use of these levels as risk markers may help clinicians to assess their patients more fully and thus to prevent premature deaths in patients who have high risk," wrote the team from the Hong Kong Institute of Diabetes and Obesity, the Li Ka Shing Institute of Health Sciences and The Chinese University of Hong Kong. The study was published in the Canadian Medical Association Journal. The researchers recommended a re-analysis of data from clinical trials to confirm or refute their findings. Confounding factors such as lifestyle, socioeconomic status and indication for use of statins need to be considered when examining the association between LDL levels and cancer risk, Drs. Frank Hu and Eric Ding of the Harvard School of Public Health, wrote in an accompanying commentary. "Low serum cholesterol is commonly observed in individuals with ill health (e.g., cancer patients) and those with unhealthy lifestyle characteristics such as smoking and heavy drinking," they noted.

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Terminal cancer patients not given chemo info (Reuters Health-01/08/2008) 

Patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy, according to the study results published in BMJ Online First. As a result, British investigators say, patients may lack sufficient knowledge make a decision based on informed consent. Palliative chemotherapy is not intended to cure patients of cancer, only to make their lives more tolerable. Nonetheless, this treatment may slightly improve survival. Dr. Suzanne Audrey, at the University of Bristol, and colleagues observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed. In all cases, patients were informed that their cancer could not be cured, and the purpose of palliative chemotherapy was explained. They were also informed about treatment options, common side effects and associated risks. In 8 cases, survival was not discussed at all. In 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Only 6 patients were given numerical data about how much longer they would probably live if palliative chemotherapy were used. "If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.

"Perhaps most difficult of all is when a patient, or their partner or carer, makes it clear that they do not want to receive any more bad news. Talking about life expectancy can seem cruel at this point," they continue. "But... supplying basic information about the survival benefit of treatment need not entail giving 'intrusive' data about prognosis." Instead of evading the subject, the authors recommend that oncologists receive coaching on how to inform patients without taking away hope. In a related editorial, Dr. Daniel F. Munday at Myton Hamlet Hospice in Warwick and Dr. E. Jane Maher at Mount Vernon Hospital in Middlesex urge researchers to investigate the dynamics of end-of-life consultations and to develop "decision aids" to help patients fully understand and interpret the information they are given.

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Cancer patients often use "complementary methods" (Reuters Health-01/08/2008)

In addition to conventional treatments aimed at improving survival, most cancer patients use "complementary methods" (CMs) to relieve symptoms and side effects and increase overall wellness, according to findings from a large study. "We receive thousands of phone calls each year about CMs at the American Cancer Society (ACS) national cancer information center, and our web pages on CM are among the most popular on our website," lead author Dr. Ted Gansler told Reuters Health. "The very large number of randomly chosen volunteers in the ACS Studies of Cancer Survivors and the availability of personal, medical, and psychological information provided an opportunity to study this topic in very precise detail and in some new ways," he added. The study by the Atlanta-based research team included 4139 adults diagnosed with one of 10 common cancers who were surveyed 10 to 24 months after diagnosis. The results are reported in the medical journal Cancer. Of 19 CMs included in the survey, the most frequently cited was prayer/spiritual practice, reported by 61 percent of respondents. Use of relaxation, faith/spiritual healing, and nutritional supplements/vitamins were each reported by more than 40 percent. Between 10 and 15 percent were involved in meditation, religious counseling, massage, and support groups. Female gender, younger age, white race, higher income, and educational achievement were all predictive of using CMs. However, African Americans had a greater tendency to use "mind-body methods," including spiritual practices. "One result we find especially interesting is the substantial differences in use of CMs by gender and type of cancer," Gansler said. The gender gap was particularly wide for energy medicine (tai chi and yoga) and for massage, while CMs in general were much more popular among breast and ovarian cancer survivors than among people with other cancers.

"Although complementary care providers at major cancer centers have conducted research on quality-of-life outcomes, I'd like to see that even more," the researcher continued. "Learning more about which CMs help cancer survivors with pain, fatigue, anxiety, depression, overall psychological adjustment, and overall physical functioning is very feasible," Gansler noted. "That information could increase attention and resources for providing CMs that are helpful and reducing the time and money spent on ones that are not." For example, "recent studies suggest that acupuncture helps relieve some symptoms of cancer and some side effects of treatment, but it was used by only 1.2 percent of participants in our study." "On the other hand, vitamins seem to be very popular," Gansler said. "Nonetheless, with the exception of people with clinically diagnosed deficiencies or those unable to eat enough, there is little evidence that high-dose vitamins help people with cancer and there is increasing evidence that high doses of some vitamins can be harmful."

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Beyond PTEN: Alternate Genes Linked To Breast, Thyroid And Kidney Cancer Predisposition (ScienceDaily-09/08/ 2008) 

A new discovery may lead to more effective screening and treatment for patients with a difficult to recognize syndrome characterized by tumor-like growths and a high risk of developing specific cancers. The research, published by Cell Press in the August 7 issue of the American Journal of Human Genetics, is the first in over thirteen years to identify an alternate susceptibility gene for Cowden syndrome (CS) and related disorders. Mutations of the common tumor suppressor PTEN are associated with most cases of CS, a poorly recognized, inherited cancer syndrome that causes benign and malignant breast, thyroid and uterine tumors. However, about 15% of CS patients do not exhibit PTEN mutations and the cause for the disorder in these patients is unknown. Further, many patients present with a poorly understood CS-like syndromes that do not meet the diagnostic guidelines for CS. "Other susceptibility genes for CS and CS-like phenotypes must exist," says lead study author Dr. Charis Eng, the Hardis Chair and Director of the Genomic Medicine Institute at the Cleveland Clinic. Succinate dehydrogenase (SDH) is a mitochondrial enzyme that is responsible for energy production and is therefore vital to all organs and organisms. Mutations in both copies of the SDH genes cause a rare devastating brain and heart condition resulting in death in infancy and childhood. Surprisingly, mutations in one of the pair of genes for various forms of SDH (referred to as SDHx) have been linked to a group of rare tumors called paragangliomas and pheochromocytomas. Dr. Eng noticed, however, that 1-5% of individuals with these rare tumors also had thyroid cancers similar to those observed in CS and CS-like patients. "We hypothesized that SDHx might represent susceptibility genes, other than PTEN, for CS/CS-like syndromes," explains Dr. Eng.

Dr. Eng and colleagues screened samples from CS/CS-like individuals that did not possess PTEN mutations for mitochondrial dysfunction. They identified a subset of patients with CS or CS-like syndrome that had various SDH mutations that were unrelated to PTEN mutations. Compared with PTEN mutation positive CS/CS-like individuals, those with SDH mutations exhibited a consistently increased risk for breast, thyroid and kidney cancers. Interestingly, in the absence of PTEN alteration, CS/CS-like-related SDH mutations exhibited perturbations of cellular signaling pathways similar to those seen in PTEN dysfunction. "Our data have important implications for both patient care and genetic counseling. I would like to see others independently repeat our observations. Nonetheless, clinicians should consider SDH testing for PTEN mutation-negative CS/CS-like individuals, especially if these individuals have a strong personal history and/or family history of breast, thyroid or kidney cancer. In fact, patients with SDHx mutation should be more rigorously screened for these cancers compared to those with PTEN mutations," concludes Dr. Eng.

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Leading Organizations Call for Recognition of Palliative Care and Pain Treatment as Human Right (Yahoo News-01/08/2008)

Houston, TX, USA and London, UK–The International Association for Hospice and Palliative Care (IAHPC), the Worldwide Palliative Care Alliance (WPCA) and different organizations from around the world will issue today a Joint Declaration and Statement of Commitment calling for the recognition of Palliative Care and Pain Treatment as Human Rights. The Declaration and Statement have been jointly developed and signed by representatives of several international and regional organizations from Africa, Latin America, Eastern Europe, Western Europe, Asia and North America. The Declaration will be presented on Monday, August 4th at the XVII International AIDS Conference in Mexico City. This is the first time that a Joint Declaration has been developed and signed by a collection of leading international organizations in the field of palliative care, hospice, pain, cancer, HIV/AIDS and others. According to data from the World Health Organization (WHO) and the International Narcotics Control Board (INCB), only a minority of the more than 1 million people who die each week receive palliative care to alleviate their suffering. Developing countries, which represent about 80 percent of the world's population, account for only about six percent of global consumption of morphine, a mainstay therapy for palliative care and pain control. “Even today, many health care plans, laws and treatment strategies for life-limiting conditions, such as cancer and HIV/AIDS, do not allow adequate access to palliative care and pain management,” according to Liliana De Lima, Executive Director of the IAHPC. “Patients have physical symptoms and special psychosocial and spiritual needs which require appropriate care. Their family members and their caregivers also suffer the emotional and social consequences of the diseases and their treatments. With adequate palliative care and pain treatment, most patients and their families can be relieved from their suffering, and the quality of their lives can be improved significantly. We want to bring this to the attention of policy makers and funders with this Declaration so that palliative care is included as a component of care in addition to prevention, early detection and active treatment.”

Sharon Baxter, Executive Director of the Canadian Hospice Palliative Care Association and Chair of the WPCA Advocacy Committee stated that “This is an unprecedented collective effort by representatives from healthcare and patient advocacy organizations from around the world working together to achieve seven specific goals in palliative care and pain management.” 
The seven goals in the Declaration are:

1/ Identify, develop and implement strategies for the recognition of palliative care and pain treatment as fundamental human rights.
2/ Work with governments and policy makers to adopt the necessary changes in legislation to ensure appropriate care of patients with life-limiting conditions.
3/ Work with policy makers and regulators to identify and eliminate regulatory and legal barriers that interfere with the rational use of controlled medications.
4/ Advocate for improvements in access to and availability of opioids and other medications required for the effective treatment of pain and other symptoms common in palliative care, including special formulations and appropriate medications for children.
5/ Advocate for adequate resources to be made available to support the implementation of palliative care and pain treatment services and providers where needed.
6/ Advocate for academic institutions, teaching hospital and universities to adopt the necessary practices and changes needed to ensure that palliative care and pain positions, resources, personnel, infrastructures, review boards and systems are created and sustained.
7/ Encourage and enlist other international and national palliative care, pain treatment, related organizations, associations, federations and interested parties to join this global campaign for the recognition of palliative care and pain treatment as human rights.

“The Declaration will be used by non-governmental organizations, professional organizations, federations, alliances and civic-minded individuals to bring palliative care and pain treatment to the attention of policy makers, regulators, governments and organizations in order to improve the care of patients with life-limiting conditions, and to provide support to their families and loved ones,” Ms. Baxter stated. The Joint Declaration and Statement of Commitment is also scheduled to be presented in meetings sponsored by cancer, palliative care and pain management organizations throughout the rest of the year. The IAHPC and WPCA invite other interested organizations and individuals to sign the Declaration using the online signature page at http://www.hospicecare.com/resources/pain_pallcare_hr/ Signatures will be collected until October 11th, the date of World Hospice and Palliative Care Day, at which point list of individuals and organizations singing on the Declaration will be published. Both Ms. De Lima and Ms. Baxter remarked: "We are very grateful with the board members of IAHPC, WPCA and the representatives of several organizations who collaborated in this process. We are especially grateful with Mr. Jonathan Cohen and Ms. Tamar Ezer from the Open Society Institute for their technical and legal support in the preparation of the Declaration. We are also very grateful with Dr. Eduardo Ibarra, president of the Latin American Federation of IASP Chapters, for his valuable suggestions."

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Cancer Cases Up But Survival More Than Doubles In Breast And Bowel Cancer (Yahoo News-06/07/2008)

The number of people surviving some of the most common types of cancer for at least five years has doubled since the National Health Service was founded 60 years ago. Comparisons have shown that survival for colon cancer has risen dramatically from 18 per cent to 47 per cent while breast cancer survival has more than doubled from 37 per cent to 77 per cent between 1946 and 1998. Cancer Research UK and the National Cancer Intelligence Network (NCIN) have compared cancer statistics in England and Wales from the inception of the NHS to the present day; survival and mortality statistics are based on recorded data; incidence statistics are estimated for England only. In 1950 the Registrar General said that cancer killed nearly as many people in a single year as all the men who were killed during the six years of the Second World War. The disease would clearly become a growing burden for the NHS. Professor David Forman, based at the University of Leeds and NCIN, who helped prepare the figures, said: "We can only estimate the cost of cancer to the NHS because we have been collecting good quality data on incidence, mortality and survival over a long period. Cancer is a substantially more common disease now than in 1948. And the NCIN will help us really understand the effects of improved treatment and earlier diagnosis on better survival." Cervical cancer survival rates have increased substantially from 35 per cent to 61 per cent while rectal cancer has more than doubled from 22 per cent to 50 per cent. In contrast, although survival for cancer of the stomach has improved (4 per cent to 13 per cent) and lung cancer survival has gone up (3 per cent to 6 per cent), they both remain sites of cancer with an extremely poor prognosis. 

Because people are living longer now than in the post-war years and because the population is much larger, the overall number of cases of cancer has increased. The NHS screening programmes and improved diagnostic tests have also contributed to a higher incidence of cancer. The statistics show a shocking increase in the rates of malignant melanoma - the potentially fatal form of skin cancer. Even after allowing for the population increase, melanoma incidence rates in men have increased 13 fold since 1948, when less than 200 men were diagnosed each year compared with 2008 when more than 3,000 men will be diagnosed. In women the rates increased more than six fold. Experts say such a rise in incidence can be partially attributed to the package holiday explosion that began in the 1960s allowing tens of thousands to holiday in the sun for the first time. Sunburn doubles the risk of skin cancer. The estimated number of breast cancer cases has risen from around 10,000 in 1948 to more than 40,000 in 2008. Lifestyle factors have played their part in this - particularly having fewer children later in life. The NHS Cancer Screening Programme has also meant that many more breast cancers are detected earlier. But early detection and improved treatment account for the huge improvement in survival. Harpal Kumar, chief executive of Cancer Research UK, said: "The improvement in cancer survival, over the years, is a testament to the world class research that has resulted in earlier diagnosis and better treatments for patients. "But we must not be complacent; we want to see further improvements in survival in the future as we improve our ability to detect cancer early and as treatments become increasingly tailored to individual patients." 

Prostate cancer cases were estimated to have risen dramatically from around 3,000 in 1948 to over 40,000 in 2008. Allowing for population growth and living longer this equates to a six-fold increase. The introduction of the Prostate Specific Antigen (PSA) test in the early 1990s is largely responsible for the increase in the number of cases diagnosed. Rates of non-Hodgkin lymphoma increased six fold in 60 years with cases rising from just under 1,000 in 1948 to more than 10,000 in 2008. The increase is partly due to better diagnostic techniques. Smoking patterns in the population lie behind the statistics for lung cancer in men and women. There were around 13,500 cases in men in 1948; this peaked in the mid-seventies at around 27,000 but has since dropped back to 16,500 in 2008 as more men have given up smoking. As more and more women started smoking after the Second World War, so more and more cases of lung cancer were diagnosed. In 1948, around 2,000 women were diagnosed with the disease. But in 2008, that figure leapt to more than 12,000. This equates to an incidence rate of less than 10 cases in every 100,000 women in 1948 rising to over 30 cases in every 100,000 women now. Although incidence rates have increased, better treatments have contributed to a general drop in mortality rates. In particular, bowel cancer death rates have dropped by well over half despite the increase in incidence. Deaths from stomach cancer have plummeted from 14,400 in 1948 to 5,000 in 2008. This is largely attributable to the drop in the H.pylori infection due to better living conditions and the advent of refrigeration keeping food fresh. Male lung cancer mortality rates were 45 per 100,000 in 1948. They peaked in 1974 when they were around 110 per 100,000 and dropped substantially in 2005 when they were 50 per 100,000. Professor Mike Richards, National Cancer Director, said: "Figures like these show the benefit of collecting data over a long period of time. The NCIN was set up with the aim of creating the best cancer information system in the world by 2012. 

"The improvements in survival rates over the past 60 years for breast, colorectal and some other cancers are extremely encouraging, as is the fall in mortality rates. But the estimated increase in incidence of some cancers emphasises the need for further attention to be given to prevention and early diagnosis of cancer." 

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Survive Cancer, Have Baby (Yahoo News-26/07/2008)

The emerging field of oncofertility offers hope to patients who worried that they couldn't conceive. When Annie Dauer's oncologist told her she'd need a stem-cell transplant to cure her non-Hodgkin's lymphoma, Dauer's first thought wasn't about death but about life. "I asked what would happen to my fertility," she says. Her oncologist dismissed the question: " 'Honey, you're fighting for your life; forget the fertility at this point,' she told me." But Dauer, then 30 and newly married, pressed the subject until the oncologist referred her to a fertility specialist. Since Dauer's chemotherapy regimen would most likely destroy her body's egg supply, the specialist, in an experimental procedure, removed one of her ovaries, froze it and reimplanted it when Dauer recovered. Three years later, Dauer, now cancer-free, and her husband, Greg, have a 2-year-old daughter, Sienna, and a second baby on the way. Welcome to the burgeoning world of oncofertility. As cancer survival rates climb and patients focus on quality-of-life issues, especially fertility, Dauer and others like her are forcing two very different medical specialties—oncology and assisted reproduction—to come together. "The narrative of cancer is no longer that it's a death sentence; it's a bump in your medical history that you overcome and go back to what we hope is a healthy lifestyle," says Teresa Woodruff of Northwestern University's Feinberg School of Medicine, who last fall received a first-of-its-kind $21 million NIH grant to develop ways of protecting cancer patients' reproductive health.

Of the 125,000 people under the age of 45 who are diagnosed with cancer each year, roughly half will receive treatments that will affect their fertility. The cancers that most commonly strike the young—leukemias, lymphomas and breast cancers—require some of the most toxic forms of chemotherapy, which target rapidly growing and fragile cells like hair follicles, sperm and eggs. The good news: patients who would like to become parents have a growing array of options. Men are benefiting from a procedure that allows urologists to find a single live sperm to bank, which can then be used in an in vitro fertilization method that requires just one sperm. Women can freeze eggs or ovarian tissue, though success rates are still low. Those with partners (or donor sperm) can freeze embryos, the procedure with the best track record, though, like egg freezing, it's available only to patients who have two to six weeks before starting treatment. On the horizon are less toxic chemotherapy agents as well as methods of shielding eggs and sperm from harm. Up to now, few oncologists passed this vital information to patients, either because they were not aware of fertility advances, or because they were understandably preoccupied with saving lives. As the field grows (at least 50 centers now provide oncofertility services), more cancer docs are tackling the issue, and even altering treatments to aid fertility. Advocacy groups like Fertile Hope, which educate cancer patients about assisted reproduction, deserve credit for spreading the word. "It's being talked about more," says Nancy Lin, an oncologist at Boston's Dana-Farber Cancer Institute. "There's a growing awareness among doctors, and patients are more proactive." 

Two years after Dauer completed her cancer treatment, her doctor, Kutluk Oktay, founder of New York City's Institute for Fertility Preservation, sutured a one-inch strip of ovary, containing tens of thousands of microscopic eggs, under the skin just below Dauer's belly button. "Every month, I would feel little eggs, sometimes pea-sized, sometimes as big as a quarter," says Dauer. Normally, Oktay, who pioneered this procedure, would have harvested mature eggs, fertilized them with Greg's sperm and implanted them into Dauer's uterus. But in an unexpected development, Dauer became pregnant naturally; somehow, the implanted ovary jump-started her remaining, inactive ovary and she began to ovulate. Oktay is at a loss for an explanation. "The healthy ovary may contain signals or hormones that may enable the [dormant] ovary to regenerate eggs," says Oktay. "That's the theory, other than a miracle." When cancer's involved, even joy can be shadowed by uncertainty. Ronny Villarreal, 32, survived breast cancer, then, with her oncologist's OK, stopped a common hormone-suppressing treatment early in order to conceive. Unfortunately, the cancer recurred during her second trimester of pregnancy. Villarreal's daughter, Maddy Hunt, now 4 months old, is healthy, but Villarreal is facing more chemotherapy and a cloudy prognosis. "We are trying our hardest to stay positive," she says. "We have so much to live for." More, certainly, than if she never had the chance to get pregnant at all.

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Study Shows U.S., Japan, and France Have Highest Cancer Survival Rates (Health News-16/07/2008)

Where you live plays a role in cancer survival, according to a new study that shows the U.S., Japan, and France recorded the highest survival rates among 31 nations for four types of cancer. Algeria had the lowest survival rates for all four cancers. "This is the first direct comparison of so many countries as far as I am aware," says Michel Coleman, MD, a professor of epidemiology and vital statistics at the London School of Hygiene and Tropical Medicine and the study's lead author. While Coleman and other epidemiologists have long known that cancer survival rates vary country by country, and even within a country, the study lends hard numbers to the fact. Still, there were surprises. "I think the surprises were that the range in global survival is really quite wide," Coleman tells WebMD. "Survival in the USA is high on a global scale but varies quite widely among individual states as well as between blacks and whites within the USA," he tells WebMD. 
Cancer Survival by Country
Coleman and colleagues drew on data from nearly 2 million cancer patients, ages 15 to 99, whose medical information was entered into 101 population-based cancer registries in 31 countries. The patients had been diagnosed with one of four cancers: breast, colon, rectum, or prostate cancers during the years 1990-1994. They were followed up to 1999, with the researchers comparing five-year survival rates. The highest survival rates were found in the U.S. for breast and prostate cancer, in Japan for colon and rectal cancers in men, and in France for colon and rectal cancers in women, Coleman's team reports. In Canada and Australia, survival was also high for most cancers. The lowest cancer survival rates for all four cancers were found in Algeria. Cancer Survival: A Closer Look at the U.S.
Survival rates varied among the 16 states and six metropolitan areas included in the study.

Idaho had the best survival rates for rectal cancer in men and Seattle was highest for rectal cancer in women. Patients in Seattle also had the best survival rates for prostate cancer. For all other cancers studied, patients in Hawaii had the highest survival rates. Patients in New York City had the lowest survival rates for all four cancers except rectal cancer in both men and women. For those, patients in Wyoming had the lowest survival rate. A racial gap in survival was evident, with white patients more likely than blacks to survive, especially breast cancer. "The comparison is confirmed right across the USA, in all 16 states," Coleman says of the racial gap. For the study, the researchers estimated relative survival, adjusting for such factors as wide differences in death rates from country to country and for age. 
Cancer Survival Study: Second Opinion
"This is a very good way of presenting data worldwide, using the same method of analysis," says Ahmedin Jemal, PhD, strategic director for cancer occurrence for the American Cancer Society, who reviewed the study for WebMD. The state-by-state differences in cancer survival rates do not surprise him, he says. "Previous studies have shown differences in treatment for breast cancer, for example, across states." Differences in screening have also been detected, he says, with the percentage of women getting regular mammograms, found to vary widely from state to state. Coleman and Jemal hope the study results will motivate public health policy makers. "What is required here on a policy level is understanding why those differences occur and remedying those differences so the entire population can benefit from the improvement," Coleman says. Within the U.S., Jemal says, he is hopeful the report will motivate cancer control program organizers at the state level. Policymakers in a state with lower cancer survival rates could consult with neighboring state policymakers with higher survival rates and adopt some of their programs, he says. The study is published early online and in the August edition of The Lancet Oncology. Funding was provided by the CDC, the Department of Health in London, and Cancer Research UK in London.

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Beating Depression For Cancer Patients (Yahoo News)

A new treatment programme for cancer patients with clinical depression can significantly boost their quality of life according to new research published in the Lancet. Cancer Research UK scientists devised the treatment programme which offers patients one-to-one sessions with specially trained cancer nurses to help them manage their depression more effectively. They found that, after three months of receiving the new treatment, almost 20 per cent fewer patients were depressed compared with patients who received standard NHS treatment. The difference was still evident after one year. The study recruited 200 cancer patients with clinical depression and compared the new strategy - "Depression Care for People with Cancer" - with the standard NHS treatment. Half were given standard care for depression either from their GP or hospital specialist. The other half received the special programme which entailed sessions on: understanding depression and the effects of antidepressants; problem-solving therapy to help patients overcome feelings of helplessness; liaison with oncologist and GP to collaborate in treatment of depression; monthly monitoring of progress by telephone and providing optional "booster" sessions. 
After three months, the patients who were treated in this way found there was an improvement in anxiety and fatigue as well as depression. Professor Michael Sharpe, from the Psychological Medicine Research group at the University of Edinburgh which carried out the study, said: "Ten per cent of cancer patients experience clinical depression and, unfortunately, it is not always adequately treated. This new treatment could substantially improve the way we manage depression in people with cancer and also in people with other serious medical conditions. 

"This is the first time that this type of depression treatment has been evaluated in cancer patients and the results are very encouraging." Cancer Research UK, which funded the study, has recently awarded Professor Sharpe's research team more than £4 million to continue their work in finding better ways to treat depression and other symptoms in cancer patients. Dr Lesley Walker, Cancer Research UK's director of cancer information, said: "As well as finding ways to prevent and treat cancer, the charity is committed to improving the quality of life for people who are living with the disease." 

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U.S. cancer death rate drop tied to education levels (Yahoo News-08/07/2008) 

Declines in death rates from the four leading types of cancer in the United States since the early 1990s have been driven largely by progress among college-educated men and women, researchers said. The study, published in the Journal of the National Cancer Institute, was the latest to illustrate how a person's health can be closely tied to socioeconomic factors such as education and income level. Researchers at the American Cancer Society and Emory University in Atlanta calculated death rates for lung, breast, prostate and colorectal cancer by level of education among U.S. blacks and whites ages 25 to 64 for 1993 through 2001. Death rates for each of these types of cancer decreased from 1993 to 2001 in men and women with at least 16 years of education -- a college degree -- except for lung cancer among black women, for whom death rates were stable, they found. By contrast, among people with less than 12 years of education -- those who did not finish high school -- a statistically significant decrease in death rates during the same period was registered only for breast cancer among white women, according to the study. Death rates among people with less than 12 years of education increased for lung cancer in white women and for colon cancer in black men and were stable for the rest of the cancer types, the researchers said. "The recent reductions in death rates from major cancers in the United States have bypassed less-educated working-age people, suggesting that persons in lower socioeconomic groups have not yet benefited equivalently from recent advances in prevention, early detection and treatment of the major fatal cancers," the researchers wrote.

The researchers offered several possible explanations. They noted that less-educated adults are more likely to smoke. They added that in breast cancer, less-educated women may be less likely to get a mammogram that could provide early detection of the disease. And less-educated people may be less likely to get colorectal cancer screening tests. Less-educated people may be less likely to get the best types of cancer treatment, they added. Income levels track closely with education levels, they noted, and many lower income people are less likely to have health insurance than people who are more highly paid.

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Poorer Patients Have Poorer Survival After Cancer Diagnosis (HealthDay News-23/06/2008)

Low socioeconomic status increases a cancer patient's risk of dying, say U.S. researchers who analyzed data on almost 14,000 breast, prostate and colorectal patients in seven states. The study found that cancer patients with low socioeconomic status had more advanced cancers at time of diagnosis, received less aggressive treatment, and had a higher risk of dying within five years of diagnosis. For example:
Poorer women were less likely to receive radiation treatment after a lumpectomy or to receive anti-estrogen therapy when diagnosed with an estrogen receptor-positive (ER+) tumor. 
Prostate cancer patients who lived in less affluent areas were less likely to have a prostatectomy or receive radiation treatment than men who lived in areas of high socioeconomic status. 
Colorectal cancer patients of low socioeconomic status were less likely to receive chemotherapy. While blacks and Hispanic patients were more likely than whites to live in poorer areas, but the link between increased risk of cancer death and low socioeconomic status applied to all racial and ethnic groups. However, this was not true for patients 65 and older, perhaps because they have more universal access to cancer screening and treatment via Medicare, regardless of socioeconomic status, the researchers said. "These findings support the need to focus on socioeconomic status as an important underlying factor in cancer disparities by race and ethnicity," wrote Dr. Tim Byers, of the University of Colorado Denver, and colleagues.

"We need better information on how access to health care contributes to differences in cancer outcomes by socioeconomic status in order to address the root causes of racial and ethnic cancer disparities in the United States," they added. The study is published in the Aug. 1 issue of the journal Cancer. Another study in the same issue found that initiatives designed to increase awareness and use of breast cancer screening may improve breast cancer survival rates for black American women, who have a higher risk of death from the disease than white women. Researchers in Atlanta looked at the impact on black women of a program that included public education about the importance of mammography screening, breast self-exams, and seeing a trained health care provider. The program also included breast cancer survivors who supported newly-diagnosed breast cancer patients by encouraging them to follow-up with recommended medical care and helping them access financial, transportation and support services. Between 2001 and 2004, the program conducted 1,148 community interventions for more than 10,000 participants. During that time, a total of 487 women were diagnosed and treated for breast cancer (89 percent black, 5 percent white, 2 percent Hispanic, and 4 percent other race/ethnicity) at the AVON Comprehensive Breast Center at the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta. Over the study period, the proportion of Stage 0 (early) non-invasive breast cancers increased from 12.4 percent to 25.8 percent, and the proportion of Stage IV (late) invasive breast cancers decreased from 16.8 percent to 9.4 percent.

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Regular exercise programs are becoming part of the prescription for avoiding recurrence (Yahoo News-22/07/2008)

The standard weapons in the fight against cancer - surgery, chemotherapy and radiation - may soon be joined by something far simpler: exercise. Angelo Chiusano, 81, joined a YMCA workout program after 43 radiation treatments for prostate cancer and surgery for an aortic aneurysm. New research shows that regular exercise can help reduce the risk of recurrence for breast cancer and prostate cancer survivors. Buy a link hereNew research shows that regular physical activity helps reduce the risk of recurrence of breast cancer and slows the advance of prostate cancer. In a few years, exercise probably will be prescribed regularly for cancer rehabilitation, said Melinda Irwin, an expert on cancer and exercise at Yale University School of Medicine. Personal trainers may join oncologists, surgeons and radiologists as members of the cancer treatment team. Exercise will become a “targeted therapy, similar to chemotherapy or hormonal therapy,” Irwin said. Any regular physical activity — the equivalent of a 30-minute walk, five times a week — will do. “Don’t think you have to work up a sweat or train for a marathon to benefit,” Irwin said. Exercise offers many other advantages: It fights the fatigue caused by cancer treatment, calms anxiety and helps survivors feel better about themselves and their bodies. Some personal trainers now specialize in working with cancer patients and more will soon be certified through a program of the American College of Sports Medicine. The Ridgewood YMCA offers a 12-week strength-training and fitness program for cancer survivors.

There are 10 million cancer survivors in the United States, 22% of them women who have had breast cancer, 17% of them men who’ve had prostate cancer. Exercise makes sense for most of them — to live longer, avoid other health problems, and just feel better. Heart attack patients are now routinely put on exercise plans. But workouts for cancer patients are neither prescribed by doctors nor covered by health insurance. “We’re where cardiac rehab was 20 years ago,” Irwin said. Once exercise was shown through research to prevent fatal heart attacks, 12 weeks of rehabilitation became the standard of care for most heart patients. Experts expect that to happen with cancer patients.

Even with a low level of exercise, people benefit psychologically, said Rita Musanti, an oncology nurse-practitioner at the Cancer Institute of New Jersey who earned her doctorate studying exercise and cancer recovery. With so many cancer survivors, she’d like to see informal networks created to encourage recovering cancer patients. Feeling good Beth Wajts joined the YMCA’s free “Living Healthy, Living Strong” class in January after her second surgery for breast cancer, followed by chemotherapy and radiation. “I cannot believe the way I walked in, and the way I walked out,” she said. “I never believed I would get out of that slump,” Wajts said. “Now I feel incredible.” One of her classmates, Joyce Murray, had three surgeries in an eight-week period last summer, then chemotherapy with many complications. No amount of sleep could cure her fatigue, she said. After she started the twice-weekly program of resistance training and cardiac fitness, “I was surprised at the quick rebound,” she said. “I really feel better.” Recovering from cancer was her “job for the last year,” she said, but at the program’s conclusion, she was looking forward to getting back to work as a school nurse. Angelo Chiusano, 81, joined after 43 radiation treatments for prostate cancer and surgery for an aortic aneurysm. Thanks to the camaraderie in the weight room, “I’ve gained a new family,” he said. “It’s made such a difference in my feelings.” After doing the weight-resistance circuit in the gym each session, he swam. “Then, when I go home, I walk a mile,” he said. 
Benefits abound
Researchers are working to understand how physical activity helps fight cancer. Their findings so far suggest that exercise:
• Reduces blood levels of insulin, a substance in the body that causes cells to divide and grow more quickly. Women with high levels of insulin have a slightly higher risk of breast cancer and a much higher rate of recurrence and death.
• Helps repair infection-fighting T-cells, restoring the immune system after it has been damaged by chemotherapy.
• Reduces levels of circulating estrogen and testosterone, two hormones linked with breast, endometrial and prostate cancers. Even with medication to suppress estrogen production, some estrogen is stored in fat cells. Exercise may help by converting fat to muscle.
• Prevents weight gain and promotes weight loss, important because obesity is associated with lower rates of survival for many forms of cancer. For women with breast cancer, obesity at the time of diagnosis, and weight gain afterward, are associated with worse outcomes. 

Workout wonders
Most of the scientific work so far has focused on women with breast cancer. But studies have also shown exercise has positive effects for survivors of colorectal and prostate cancers. Among men older than 65, three hours of vigorous activity a week was associated with a decline in death from prostate cancer. Exercise is now considered so beneficial that cancer experts are even encouraging patients to begin or resume exercise while treatment is under way. Workouts might need to be scaled back in intensity and pace, but “evidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning and some aspects of quality of life,” according to the American Cancer Society. Lockey Maissoneuve, a 41-year-old personal trainer, went through two mastectomies and chemotherapy two years ago. She is now training for a triathlon. “If you’re in treatment, the first week or two you try to do anything, you need to take a nap,” she said. “If there’s a day you want to exercise, do it.”

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Cancer risk factors to be studied in large-scale study.300,000 Canadians will be monitored in long-term effort. (CBC News- 11/06/ 2008)

A sweeping study on how genetics, environmental factors and lifestyle choices play a part in the development of cancer was launched Wednesday. The study of 300,000 Canadians will take place over the next 20 to 30 years and gather information on cancer risk factors through surveys and blood collection. Participants will range in age from 35 to 69 and be randomly selected from across Canada. The study involves health-related organizations in a number of regions. The Canadian Partnership Against Cancer, a federally funded organization, is providing $42 million for the project and will help co-ordinate the overall effort, a CPAC spokesperson said. The information gathered will be used by researchers and policy makers in the study and treatment of cancer. "The Canadian Partnership for Tomorrow Project will build an enormous bank of information that Canadian and international researchers can draw upon in the short term and create a legacy for future generations," said Jeff Lozon, chair of the Canadian Partnership Against Cancer, in a release. "We have made significant progress in preventing many cancers and in managing and treating others, but the information from this research will fuel better prevention and screening programs — the cornerstones of reducing the number of Canadians getting cancer," said Heather Bryant, a vice-president with the partnership. Partner organizations in five regions will be involved in the survey: the B.C. Cancer Agency, the Alberta Cancer Board, Cancer Care Ontario with the Ontario Institute for Cancer Research, Quebec's CARTaGENE project and Cancer Care Nova Scotia with Dalhousie University. The Canadian Partnership Against Cancer will commit $42 million to the project, with the regions contributing $41 million. The survey's organizers aim to raise over $100 million in the next six to nine months.

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Most Cancer Doctors Avoid Saying It's the End (Yahoo News)

One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived. He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care. "At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" — things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home. Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.
New research shows they are wrong.
Just a third of cancer patients got end-of-life talks; those who did benefited, study finds. Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care. Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care, and their loved ones were more at peace after they died. Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate. Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks.

"That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore. Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices. "Boiled down, it's 'Talking about dying will kill you,'" she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it." The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston. It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care. Of the 323 who have died so far, those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated. About 7 percent of all patients in the study developed depression. Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not.

That rings true, said Marshall, who is Mulligan's doctor at Georgetown University's Lombardi Comprehensive Cancer Center. Patients often are relieved, and can plan for a "good death" and make decisions, such as do-not-resuscitate orders. "It's sad, and it's not good news, but you can see the tension begin to fall" as soon as the patient and the family come to grips with a situation they may have suspected but were afraid to bring up, he said. From an ethics point of view, "it's easy — patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle. "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment — you earn that trust or you blow it," he told doctors at a training session at the cancer conference on how to break bad news. People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University. "There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said. "Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said. Sometimes it's doctors who have trouble accepting that the end is near, or think they've failed the patient unless they keep trying to beat the disease, said Dr. Otis Brawley, chief medical officer at the American Cancer Society. "I had seven patients die in one week once," Brawley said. "I actually had some personal regrets in some patients where I did not stop treatment and in retrospect, I think I should have." James Rogers, 67 of Durham, N.C., wants no such regrets. Diagnosed with advanced lung cancer last October, he had only one question for the doctor who recommended treatment. "I said 'Can you get rid of it?' She said 'no,'" and he decided to simply enjoy his final days with the help of the hospice staff at Duke. "I like being told what my health condition is. I don't like beating around the bush," he said. "We all have to die. I've had a very good life. Death is not something that was fearful to me."

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Training boosts cancer patients' quality of life (Reuters Health-18/06/2008) 

Physical training should be included in rehabilitation programs for cancer patients, Dutch researchers say. After being treated for cancer, people showed significant improvements in physical function and vitality for up to three months after completing a 12-week training program. They also felt healthier, Dr. Bart van den Borne of Maastricht University and colleagues found. Adding cognitive behavioral therapy to the mix didn't result in additional improvements, van den Borne and his team report in the medical journal Psychosomatic Medicine, but they say it's too early to conclude that this type of counseling has no value for patients. More and more people are surviving cancer, the researchers note, but as many as 30 percent say their quality of life has been reduced and that they could use help with both physical and psychosocial issues. To investigate what type of rehab program might be most effective, van den Borne and his colleagues randomly assigned 209 patients who had completed cancer treatment to a physical training program, or to physical training plus a weekly cognitive behavioral training session, or to a waiting list. The physical training program included aerobic exercise, strength training, and group sports and games, while the cognitive behavioral therapy was offered in a group format.

Compared to people on the waiting list, those in the physical training group and the training-plus-therapy group showed similar and substantial improvements in their limitations due to physical problems, their physical function, their vitality, and their subjective sense of health. These improvements continued for up to three months after the programs ended. The physical training program wasn't just exercise, the researchers note, but included group activities that gave participants a chance to gain social support, and used a self-management approach intended to help them feel better able to cope with physical challenges. Few patients dropped out of the study, and attendance was high, van den Borne and his team point out. "This indicates that participants who on average reported a low quality of life at baseline were highly motivated and that both rehabilitation programs were highly feasible in these cancer survivors," they conclude.

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Deaths from cancer, heart disease, crashes to soar: (AFP-20/05/2008)

Deaths from road accidents, cancer and heart disease are set to soar over the next 20 years as the developing world's populations get richer and live longer, according to a study out this week. As low and middle-income economies grow by 2030, mortality rates from noncommunicable diseases such as cardiovascular disease and cancer, and road crashes due to increased car ownership, will make up more than 30 percent of deaths worldwide, the World Health Organisation (WHO) found. Meanwhile, deaths from factors currently associated with the developing world, such as nutritional deficiencies, malaria and tuberculosis, will fall, the Geneva-based organisation said in its "World Health Statistics 2008." "Globally, deaths from cancer will increase from 7.4 million in 2004 to 11.8 million in 2030, and deaths from cardiovascular diseases will rise from 17.1 million to 23.4 million in the same period," the survey said. Deaths due to road traffic accidents will increase from 1.3 million in 2004 to 2.4 million in 2030, mainly owing to increased motor vehicle ownership and use associated with economic growth in low- and middle-income countries. The four main causes of death by 2030 will be ischaemic heart disease, strokes, chronic obstructive heart disease (COHD) and lower respiratory infections such as pneumonia, the WHO said. The rise in COHD is mainly seen coming from increased tobacco consumption, it added. Tobacco-related illnesses caused some 5.4 million deaths in 2004 and are expected to soar by more than half to 8.3 million by 2030, with 80 percent of these cases in developing countries, the WHO said.

Every tobacco user loses on average 15 years of life due to their habit, and use is particularly high in eastern and central Europe and southeast Asia. Nearly two thirds of the world's smokers live in just 10 countries: Bangladesh, Brazil, China, Germany, India, Indonesia, Japan, Russia, Turkey and the US, the WHO said. Moreover, although anti-smoking measures such as advertising restrictions, health warnings and higher taxation do have an impact, not more than five percent of the world's population is fully covered by any one of these measures, the WHO warned. Conversely, the WHO statistics found that the increase in deaths from noncommunicable diseases will be accompanied by "large declines in mortality for the main communicable, maternal, perinatal and nutritional causes, including HIV infection, tuberculosis and malaria." However, deaths worldwide from HIV/AIDS are expected to rise from 2.2 million in 2008 to a maximum of 2.4 million in 2012 before declining to 1.2 million in 2030.

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