Melatonin no help for late-stage cancer weight loss

By Kathryn Doyle

NEW YORK | Fri Mar 1, 2013 3:00pm EST

NEW YORK (Reuters Health) – Despite encouraging results in the past, melatonin pills did nothing to help advanced cancer patients eat more or stave off weight loss in a new clinical trial.

“We had great enthusiasm for it also based on these other trials, and were quite disappointed when it didn’t work,” lead author Dr. Egidio Del Fabbro told Reuters Health.

Some previous studies had suggested the hormone, which is involved in appetite and metabolism as well as sleep cycles in healthy adults, may increase appetite in cancer patients when taken in supplement form. But those studies did not include a group of patients given dummy pills for comparison.

“The reason for these other trials being positive was the placebo effect,” said Del Fabbro, who studies rapid loss of muscle mass in cancer patients – a condition known as cachexia – at the University of Texas MD Anderson Cancer Center in Houston.

Del Fabbro and his colleagues divided 70 patients with advanced lung or gastrointestinal cancer, poor appetite and recent unintentional weight loss into two groups. One group took 20 milligrams of melatonin every night for 28 days, and the other group took a placebo for the same period.

At the end of four weeks, the melatonin and placebo groups had essentially the same appetite, weight changes, pain levels and quality of life scores, Del Fabbro’s team reports in the Journal of Clinical Oncology.

For example, one representative patient in the melatonin group with a starting weight of 147 pounds lost almost two pounds during the study period, and one in the placebo group who started at 145 pounds also lost two pounds.

In late stage cancer, the body aggressively breaks down its own muscle mass, and patients have decreased appetite, nausea and reduced ability to absorb the nutrients they do eat.

“It’s vital, it’s probably the most under-recognized condition in advanced cancer,” and often bothers families the most, Del Fabbro said. “Families feel (the patient) should just eat more, they should try harder,” he said.

Treatment options are currently very limited, said Vickie Baracos, a professor of palliative care medicine who wrote an editorial accompanying the study.

High dose steroids can stimulate appetite, but extended use also causes muscle wasting and diabetes-like insulin resistance, so doctors often avoid using them, said Baracos, of the University of Alberta in Edmonton, Canada.

Melatonin, which is produced naturally in the body and available in supplements, does affect appetite, metabolism and control of body weight in healthy adults, according to Baracos. But that doesn’t mean it will work for people with cancer, she said.

Melatonin is available in pill form in the U.S. without a prescription. A bottle of 5- or 10-milligram capsules costs about $10 at a drugstore.

Many cancer patients turn to potential remedies found on the Internet that have not been studied, Baracos said. She has known late-stage cancer patients to take up plant extracts, juices from tropical fruits, horse milk, and diets consisting mostly of cottage cheese.

“It’s important to vet these other options, the trouble is getting federal funding,” said Del Fabbro, whose department financed the melatonin study without outside support.

The hormone didn’t cause any negative side effects, even at the high dose of 20 milligrams per day, he said, and it could be tried in another trial with cancer patients earlier in the progression of the disease to see if the results are different.

If advanced cancer patients still want to take melatonin, Baracos said, this trial indicates at least that it’s unlikely to hurt them.

“Now a doctor has some evidence of good quality to stand on: it doesn’t work, but it also doesn’t do any harm,” she said.

SOURCE: bit.ly/WtQ0en Journal of Clinical Oncology, online February 25, 2013.

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Coronary Calcium Is Stroke Risk Barometer

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By Todd Neale, Senior Staff Writer, MedPage Today

Published: February 28, 2013

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

Action Points

  • Note that this large cohort study demonstrated an association between coronary artery calcification and stroke.
  • Be aware that the addition of coronary artery calcification information to traditional risk factors only marginally increased predictive model performance.

Among individuals at low-to-intermediate cardiovascular risk, coronary artery calcification (CAC) score predicts the occurrence of stroke, even after accounting for traditional risk factors, researchers found.

After adjustment for variables in the Framingham risk score, calcification score was significantly associated with a greater risk of incident stroke overall (HR 1.52, 95% CI 1.19 to 1.92), although the relationship was not significant for those with a high cardiovascular risk at baseline, according to Dirk Hermann, MD, of University Hospital Essen in Germany, and colleagues.

Further adjustment for atrial fibrillation weakened — but did not eliminate — the association, the researchers reported online in Stroke: Journal of the American Heart Association.

“That CAC, as we now have shown, is able to predict stroke events independent of established risk factors, [makes] this marker promising for risk stratification not only in the hands of cardiologists but also in the hands of neurologists,” they wrote, adding that the radiation exposure involved in the assessment needs to be considered.

Calcification measured by electron-beam CT has been shown to predict myocardial infarction (MI) in the general population and also has been shown to enhance the discrimination of cardiovascular risk, particularly in patients with intermediate risk.

To examine its ability to predict stroke risk, Hermann and colleagues turned to the population-based Heinz Nixdorf Recall study, which enrolled a random sample of individuals ages 45 to 75 from three cities in the industrialized Ruhr area of Germany.

The current analysis included 4,180 individuals (mean age 59) who did not have a history of stroke, coronary heart disease, or MI at baseline. They were followed for an average of 7.9 years.

During that time, 2.2% of the study population had a stroke — 82 ischemic strokes and 10 hemorrhagic strokes.

The median coronary artery calcification Agatston score at baseline was significantly higher among those who had a stroke during follow-up (104.8 versus 11.2, P<0.001), and the rate of stroke increased along with each successive calcification category.

In a multivariate analysis that included age, sex, systolic blood pressure, LDL and HDL cholesterol, diabetes, and smoking, calcification score was an independent predictor of stroke, along with age (HR 1.35 per 5 years, 95% CI 1.15 to 1.59), systolic blood pressure (HR 1.25 per 10 mm Hg, 95% CI 1.14 to 1.37), and smoking (HR 1.75, 95% CI 1.07 to 2.87).

Calcification score also remained a significant predictor when hemorrhagic strokes were excluded.

The score predicted stroke in both sexes. It was a significant predictor among individuals younger than 65 (HR 2.21, 95% CI 1.59 to 3.06) but not in the older age group (HR 1.11, 95% CI 0.80 to 1.54).

When the study participants were divided into Framingham risk groups, calcification score predicted stroke only in those with low (less than 10%) or intermediate risk (10% to 20%).

“These observations indicate that among cohorts without apparent risk, subjects exist that nonetheless exhibit a high stroke incidence,” the authors wrote. “On the basis of our data, CAC is suitable to identify those subjects.”

The researchers noted that three previous population-based studies — the Cardiovascular Health Study (CHS), Rotterdam study, and Multi-Ethnic Study of Atherosclerosis (MESA) — failed to show a significant association between coronary artery calcification and stroke after adjustment for traditional risk factors.

That was “most likely because of lack of power related to lower stroke numbers observed in the population sample,” they wrote. Total stroke numbers ranged from 28 to 59 in those studies, compared with 92 in the current study.

The study was supported by the Heinz Nixdorf Foundation in Germany, the German Ministry of Education and Science (BMBF), and the German Research Foundation (DFG). Sarstedt AG supplied laboratory equipment.

The authors reported that they had no conflicts of interest.

Primary source: Stroke: Journal of the American Heart Association
Source reference:
Hermann D, et al “Coronary artery calcification is an independent stroke predictor in the general population” Stroke 2013; DOI: 10.1161/STROKEAHA.111.678078.

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Eating Helps Dementia Patients Avoid Depression

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By John Gever, Senior Editor, MedPage Today

Published: February 28, 2013

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania

Action Points

  • Note that this small Taiwanese study demonstrated that an individualized intervention targeting healthy-eating habits improved nutrition and depression scores among institutionalized adults with dementia.
  • Be aware that the effects waned rapidly once the intervention ceased.

Institutionalized dementia patients who received a tailored educational program on good eating habits were less likely to show symptoms of depression 6 months later, results of a Taiwanese study indicated.

Mean scores on the Chinese version of the Cornell Scale for Depression in Dementia declined 0.73 points (95% CI -1.19 to -0.27) among patients assigned to a individualized program, whereas a control group receiving usual care showed an average increase of 0.79 points (95% CI 0.23 to 1.34), according to Li-Chan Lin, PhD, RN, of National Yang-Ming University in Taipei, Taiwan, and Hua-Shan Wu, PhD, RN, of Shan Medical University in Taichung, Taiwan.

A third study arm, in which patients received a non-individualized version of the educational program, showed no change in depression scores (mean -0.07 point change, 95% CI -0.63 to 0.48), the researchers reported online in the Journal of Advanced Nursing.

Nutritional status and body mass index likewise increased with the individualized program, decreased in the control group, and showed little change with the non-individualized program, Lin and Wu indicated.

“The improvement in nutritional status may have led to reduced fatigue and increased vitality,” they wrote. “Once the participants perceived the improvements in their health, pessimism, the sense of multiple illnesses, hopelessness, or even worthlessness seldom emerged.”

Multiple aspects of proper nutrition are often compromised in dementia. As Lin and Wu explained, “identifying foods, transferring foods, chewing, and swallowing” become progressively difficult for patients with cognitive deficits. Moreover, several previous studies have linked poor nutritional status to depression, in otherwise healthy adults as well as in those with dementia.

In the current study, Lin and Wu tested an approach combining a technique called “spaced retrieval” with Montessori-type methods aimed at helping dementia patients eat more and eat more regularly.

Spaced retrieval is a teaching method to help people with information recall. It involves challenging the person to remember something for increasing time intervals. If it is successfully recalled after 2 minutes, a second challenge will require recall after 4 minutes. When recall fails, the challenge is done again at the last successful interval.

Lin and Wu chose Montessori-based activities to reinforce healthy eating behaviors because cognitive abilities in dementia patients in some ways resemble those of young children.

The combination of the two techniques “activate the effects of repetition priming and procedural memory in the nondeclarative memory,” the researchers explained, leading to development of desired habits.

They randomized 90 patients to usual care or two versions of the program. Both versions were built around sessions lasting 35-40 minutes three times a week. The training focused on eight basic eating behaviors, from remembering mealtimes to swallowing after chewing.

In the individualized program, training was progressively intensified for individual patients if they demonstrated mastery at a given level. The number of sessions also depended on individual patients’ needs, such that participants with mild dementia could receive up to 23 sessions whereas the maximum in moderate or severe dementia was 35.

For patients assigned to the non-individualized program, training intensity was stepped up only when more than half the participants had shown mastery. The number of sessions was fixed at 24 over an 8-week period.

Patients were recruited from veterans’ homes in Taiwan. About 40% had scores on the Chinese version of the Mini-Mental State Examination of 6 t0 11 (severe dementia), and another 40% had scores of 12 to 17 (moderate dementia).

From 4% to 18% of each study arm were taking antidepressants, 32% to 45% were taking antipsychotic medications, and 20% to 29% were on anti-anxiety drugs.

Mean BMI at baseline ranged from 20.3 to 22.9 in the three arms. Scores on the Chinese version of the Mini-Nutritional Assessment averaged 19.2 to 21.5. On the Cornell depression scale, mean baseline scores were 0.26 to 1.55.

Over the 6-month post-training evaluation period, changes in Cornell and nutritional scores were strongly correlated in the individualized intervention group, with an R2 value of 0.44 (P=0.001). Changes in nutritional scores also correlated strongly and significantly in this group with nutritional scores at baseline (R2=0.45, P=0.001).

“The greatest improvement of nutritional status and depressive symptoms resulting from the individualized intervention occurred between the immediate post-training period and the 1-month follow-up,” Lin and Wu noted.

They suggested that, therefore, additional “booster sessions” may be helpful in maintaining or increasing the short-term gains.

Limitations to the study included its restriction to residents of veterans’ homes and the small number of outcome measures.

The study was funded by the National Institute of Health Research.

Study authors declared they had no relevant financial interests.

Primary source: Journal of Advanced Nursing
Source reference:
Wu H-S, et al “The moderating effect of nutritional status on depressive symptoms in veteran elders with dementia: a spaced retrieval combined with Montessori-based activities” J Adv Nursing 2013; DOI: 10.1111/jan.12097.

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More Regular Meals May Improve Dementia Care

News Picture: More Regular Meals May Improve Dementia Care

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  • More Regular Meals May Improve Dementia Care
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THURSDAY, Feb. 28 (HealthDay News) — Helping people with dementia to eat more regularly improves their physical health and may lower symptoms of depression, a small new study from Taiwan suggests.

The research included 63 dementia patients who were trained to remember proper eating habits and 27 patients who received usual care. The memory training used a method called spaced retrieval, which requires people to recall a piece of information over increasingly longer time intervals. Another memory-training tool involved practicing tasks associated with daily living.

The patients underwent tests for nutrition, body-mass index (a measurement of body fat based on height and weight) and depression before the start of the study and again six months later.

People who underwent the combination memory training showed improved nutrition and a healthy increase in body-mass index, as well as reduced depression scores, according to the study published online Feb. 28 in the Journal of Advanced Nursing.

Depression scores declined for patients who got the nutrition training, as well, the researchers said.

Li-Chan Lin, of the National Yang-Ming University in Taiwan, and colleagues said health care professionals may want to consider using this type of approach in dementia patients who have poor nutrition and signs of depression.

— Robert Preidt

MedicalNews
Copyright © 2013 HealthDay. All rights reserved.

SOURCE: Journal of Advanced Nursing, news release, Feb. 28, 2013



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Get regular screenings for colorectal cancer

Did you know colorectal cancer is the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women? If everyone 50 or older got screened regularly, as many as 60% of deaths from this cancer could be avoided.

In most cases, colorectal cancer develops from precancerous polyps (abnormal growths) in the colon or rectum. Fortunately, screening tests can find these polyps, so you can get them removed before they turn into cancer. Screening tests also can find colorectal cancer early, when treatment works best.

It’s National Colorectal Cancer Awareness Month – do what you can to reduce your risk for colorectal cancer. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened for colorectal cancer regularly. Don’t worry about the cost—Medicare covers a variety of colorectal cancer screenings, and you pay nothing for most tests.

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