Many women with early-stage breast cancer can skip chemotherapy: study

CHICAGO (Reuters) – Some 70 percent of women with early-stage breast cancer and an intermediate risk of cancer recurrence can safely skip chemotherapy after their tumors have been removed, U.S. researchers said on Sunday.

FILE PHOTO: A doctor exams mammograms, as part of a regular cancer prevention medical check-up at a clinic in Nice, south eastern France, January 4, 2008. REUTERS/Eric Gaillard/File Photo

“This is a major finding,” said Dr. Larry Norton, a breast cancer expert at Memorial Sloan Kettering Cancer Center in New York, who helped organize the government-funded study more than a decade ago.

“It means that maybe 100,000 women in the United States alone do not require chemotherapy,” Norton said.

The research, presented at the American Society of Clinical Oncology (ASCO) meeting in Chicago, studied how to treat women with early-stage breast cancer that responds to hormone therapy.

FILE PHOTO: A patient receives chemotherapy treatment for breast cancer at the Antoine-Lacassagne Cancer Center in Nice July 26, 2012. REUTERS/Eric Gaillard

Women were deemed to have a medium level risk of the cancer coming back based on a 21-gene panel known as Oncotype DX from Genomic Health (GHDX.O). The test predicts the likelihood of cancer recurrence within 10 years. Those who score low on the test – from zero to 10 – are already told to skip chemotherapy after their tumors are removed and they receive hormone therapy. Those who score high – 26 to 100 – receive both hormone therapy and chemotherapy.

The study, dubbed TAILORx, was also published in the New England Journal of Medicine. It involved more than 10,000 women with breast cancer that had not spread to nearby lymph nodes and whose tumors respond to hormone therapy and test negative for the HER2 gene.

Of those, 6,711 scored in the intermediate range of 11-25, and were randomly assigned hormone therapy alone or hormone therapy plus chemotherapy.

The study found that all women over 50 with this type of breast cancer could skip chemotherapy, a group that represented 85 percent of the study’s population. In addition, women 50 and younger who scored between zero and 15 could be spared chemotherapy and its toxic side effects.

However, chemotherapy did offer some benefit to women aged 50 and younger who had a cancer recurrence score of 16-25, researchers found.

Dr. Steven Shak, chief scientific officer at Genomic Health, said about four in 10 women in the United States with early stage breast cancers are not tested for recurrence risk. He expects the study’s results will change that practice.

“This is going to provide the highest level of evidence now for our test being indispensable in clinical practice,” Shak said.

The company currently provides tests to more than 900,000 patients in more than 90 countries, Shak said. In the United States, the test costs $4,000 and is covered by Medicare and all major private insurers.

For more ASCO coverage, see: here

Reporting by Julie Steenhuysen; Editing by Bill Berkrot

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FDA chief outlines new ways to speed cancer drug approvals

CHICAGO (Reuters) – The U.S. Food and Drug Administration is taking steps to streamline the approval process for cancer drugs, reviewing clinical trial data up front to make sure applications companies submit are complete.

FILE PHOTO: U.S. Food and Drug Commissioner Scott Gottlieb attends an interview at Reuters headquarters in New York City, U.S., October 10, 2017. REUTERS/Eduardo Munoz

The new approach, outlined on Saturday in a speech by FDA commissioner Dr. Scott Gottlieb at the American Society of Clinical Oncology (ASCO) meeting in Chicago, is part of an effort to remove regulatory barriers that drag out reviews of promising new cancer treatments.

The new review process, which Gottlieb called a “real-time oncology review,” is already being piloted in a number of applications for expanded use of already approved cancer drugs. Gottlieb believes the early peek at data would allow companies to address quality issues before submitting their the full application seeking approval.

If the process succeeds, it will be expanded to applications for new cancer treatments.

As part of the pilot program, FDA is trying out a shared application document that allows FDA reviewers to add their comments to background documents submitted by companies.

The FDA is also taking steps to streamline and standardize the review of manufacturing processes for gene therapies and cell based products, such as new chimeric antigen receptor T-cell therapies, or CAR-Ts, which involve removing and altering patients’ immune cells to recognize and attack cancer.

Gottlieb said such a move could enable more sites, such as hospitals or research facilities, to manufacture these cells, expanding treatment options for patients. Currently, harvested T-cells are shipped back to the companies for processing, and it takes about three weeks before the cells are returned and administered to patients.

FDA also plans to expand its database on the long-term safety issues related to CAR-T therapy to more than 1,000 patients by later this summer. The information will be used to study potential biomarkers that can predict long-term remission.

For more ASCO coverage, see: here

Reporting by Julie Steenhuysen; Editing by Bill Berkrot

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Roche drugs show limited benefit in lung, breast cancer trials

CHICAGO (Reuters) – In a disappointment for Roche Holding AG (ROG.S), two of its oncology drugs provided only modest protection from disease progression in lung cancer and breast cancer, according to data from separate clinical trials presented on Saturday.

FILE PHOTO: Bottles of medications line the shelves at a pharmacy in Portsmouth, Ohio, June 21, 2017. REUTERS/Bryan Woolston

Adding Roche’s high-profile immunotherapy Tecentriq to other standard cancer drugs extended by only about three weeks the median time patients with advanced squamous cell lung cancer lived before their disease progressed in one late stage study.

Meanwhile, Roche said it was scrapping development plans for its experimental drug taselisib after data showed adding it to hormone therapy extended by just two months the length of time women with advanced breast cancer lived before their disease worsened. Patients on the drug also experienced serious side effects.

The taselisib benefit to patients “was more modest than we had hoped for, and there is a risk of considerable side effects,” said Dr. José Baselga, the study’s lead investigator from Memorial Sloan Kettering Cancer Center in New York.

Roche in a statement also said the results were disappointing, adding “we will not be pursuing an FDA submission for taselisib based on the data presented at ASCO.”

The company also said it had no plans to further test taselisib in other types of cancer.

Both studies were being presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago. For more coverage of the meeting, see: here

Sales of Roche’s Tecentriq trail two rival lucrative therapies that also spur the body’s immune system to attack tumors: Keytruda from Merck & Co (MRK.N) and Opdivo from Bristol-Myers Squibb (BMY.N). Roche is under pressure to show success for the drug, which is central to replacing falling revenue from older, off-patent medicines.

Tecentriq is already approved for previously treated patients with advanced non-small cell lung cancer (NSCLC) and certain patients with advanced bladder cancer. Analysts are forecasting annual Tecentriq sales reaching about $6 billion by 2024, according to Thomson Reuters data.

Roche said it will continue to evaluate results from the study presented on Saturday.

“The study is one of eight Phase III trials from our extensive research program evaluating Tecentriq alone or in combination with other medicines in different types of lung cancer,” Roche said in a statement. 

Merck’s Keytruda, in combination with chemotherapy, is approved as an initial treatment for non-squamous NSCLC, the most common form of lung cancer. Keytruda is also approved as a stand-alone treatment for lung cancer patients whose tumors have high levels of a protein known as PDL1.

The new Tecentriq trial studied 1,021 patients with late-stage squamous NSCLC, which accounts for about 30 percent of lung cancer and is considered particularly difficult to treat.

One group of patients received the Roche drug plus the chemotherapy carboplatin and Celgene Corp’s (CELG.O) Abraxane, while a second group were only treated with carboplatin and Abraxane.

After 12 months, 25 percent of patients given the Tecentriq combination had not experienced disease progression compared with 12 percent in the chemotherapy group, Roche said.

But median progression-free survival was 6.3 months for Tecentriq patients versus 5.6 months for the standard chemotherapy combination.

The modest benefit was observed regardless of tumor PDL1 levels, researchers said. The analysis did not find an overall survival advantage with Tecentriq, although Roche said those data are not yet mature.

Merck last month said a study of Keytruda in combination with chemotherapy for squamous NSCLC showed a benefit in both overall survival and progression-free survival. [nL3N1SU48D]

In the study of taselisib, patients who received the Roche drug plus the hormone therapy fulvestrant saw their breast cancer worsen after a median of 7.4 months compared with 5.4 months for people who received fulvestrant alone.

The trial involved 516 postmenopausal women with advanced estrogen receptor-positive breast cancer, whose disease had progressed or returned after prior treatment.

Serious side effects in the taselisib group included diarrhea, high blood sugar and colon inflammation, leading 17 percent of treated patients to drop out of the trial.

Reporting by Deena Beasley; Editing by Bill Berkrot

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Domestic Violence’s Overlooked Damage: Concussion And Brain Injury

Hundreds of survivors of domestic violence have come through the doors of neurologist Glynnis Zieman’s Phoenix clinic in the past three years.

“The domestic violence patients are the next chapter of brain injury,” she said.

Zieman begins every new patient visit with a simple question: “What are the symptoms you hope I can help you with?”

For most, it’s the first time anyone has ever asked how they may have been injured in the first place. “I actually heard one patient tell me the only person who ever asked her if someone did this to her was a paramedic, as she was being wheeled into an ambulance,” Zieman said. “And the husband was at the foot of her stretcher.”

While many patients initially seek out the clinic because of physical symptoms, such as headaches, exhaustion, dizziness or problems sleeping, Zieman’s research shows that anxiety, depression and PTSD usually end up being the most severe problems, she said.

Studies of traumatic brain injury have revealed links to dementia and memory loss in veterans and athletes. And TBI has also been linked to PTSD in current or former service members.

But survivors of domestic violence may be suffering largely in silence.

About 70 percent of people seen in the emergency room for such abuse are never identified as survivors of domestic violence. It’s a health crisis cloaked in secrecy and shame, one that Zieman is uncovering through her work at the Barrow Concussion and Brain Injury Center.

She runs what she said is the first program dedicated to treating traumatic brain injury for survivors of domestic violence.

“About 81 percent of our patients had so many hits to the head, they lost count, which, you compare that to athletes, is astronomical,” Zieman said.

Zieman said it’s not just the sheer number of injuries that makes these patients’ cases so complex.

“One single athletic concussion is hard enough to treat, but these patients are beyond that,” she said. “Unlike athletes, they do not have the luxury, if you will, of recovering after an injury before they are injured again.”

Domestic violence is estimated to affect more than 10 million people each year. Head and neck injuries are some of the most common issues, and Zieman is uncovering how frequently traumatic brain injury is part of the picture.

Still, she said, the lack of recognition of the severity of the abuse-related problems has left many survivors without a definitive diagnosis. Many get blamed for their cognitive impairment.

“They have been labeled for so long with all these horrible things,” said Zieman. “And in the end, it’s not only not their fault but there is a true medical reason behind these issues and there are some things that can be done.”

Social worker Ashley Bridwell (left) and Dr. Glynnis Zieman run what they say is the country’s first program dedicated to treating traumatic brain injury among survivors of domestic violence.(Will Stone/KJZZ)

Data on domestic violence and traumatic brain injury are sparse because cases are so underreported, but Zieman said her team’s initial findings indicate the issue is more prevalent than previously thought.

A 2016 review of the medical files of patients in the program — almost all women — discovered only one-fifth of them had seen a physician for their injuries. Eighty-eight percent had sustained more than one head injury from abuse.

Zieman works with local domestic violence shelters to identify women who may be suffering from brain injuries. Workers will send them to Zieman’s clinic where their physical symptoms, such as headaches or dizziness, can be treated along with the cognitive and emotional effects of their abuse. Through grants and private donations, Zieman said, the care is free, whether or not people have insurance.

Ashley Bridwell, a social worker at Barrow, works with Zieman to help survivors manage life with a brain injury. “Some of these simple things like filling out an application or remembering an appointment, or being able to give a solid social or medical history — it’s close to impossible considering what they are experiencing,” she said.

Bridwell helped start the program six years ago after doing outreach to the homeless community and realizing many clients had traumatic brain injuries from domestic violence. She said patients often have long histories of emotional and physical abuse. Many have cognitive impairment from repeated mild traumatic brain injury.

Patients will sometimes arrive at the clinic with a constellation of seemingly unexplainable symptoms. Bridwell said she remembers one who lost her job because of her forgetfulness. The woman thought she had Alzheimer’s.

“And for her to come in and get some information about head injury, and about how multiple hits to the head can impact your memory, your attention, your concentration, your speed of processing, it was incredibly validating for her,” said Bridwell.

The diagnosis gave her a new way to talk about and understand her private struggle. “They realize it’s not their fault,” Bridwell said.

And Zieman said PTSD and trauma affect this population deeply.

“The significance of the mood symptoms in this population far exceeds what we see in our other patients,” she said.

Zieman said medical science is still in the early stages of understanding the effects of repetitive brain injury and how to better treat it. The trauma of domestic violence only complicates the picture, but the survivors she sees remain her favorite patients to treat.

“I feel that we can make the biggest difference for these patients,” she said.

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.


KHN’s coverage of women’s health care issues is supported in part by The David and Lucile Packard Foundation.

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Podcast: KHN’s ‘What The Health?’ Virginia, The VA, And Military Medicine

After a five-year fight, the Virginia legislature voted this week to expand the Medicaid program to an estimated 400,000 low-income residents who are not currently eligible for health coverage. And New Jersey became the second state to impose a state-level “individual mandate” requiring most residents to have health insurance or pay a fine, following last year’s repeal of the federal penalty.

Meanwhile, Congress has quietly passed a major bipartisan bill to overhaul and streamline health programs provided to the nation’s veterans. The bill includes an expansion of veterans’ ability to get private care paid for outside the Department of Veterans Affairs system, in certain cases.

Also this week, an interview with Dr. Arthur Kellerman, dean of the Uniformed Services University of the Health Sciences, the military’s medical school in Bethesda, Md.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Paige Winfield Cunningham of The Washington Post and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Two key factors helped push Medicaid expansion through the Virginia General Assembly. One was the Trump administration’s endorsement of work requirements for nondisabled adults and the other was the blue wave that shook the state last November when the House of Delegates nearly turned from a safe Republican majority to Democratic control.
  • New Jersey’s passage of a mandate that state residents get coverage or face a penalty was surprising because that provision was one of the most disliked parts of the federal Affordable Care Act.
  • Even as Congress sent the president the bill expanding VA programs, there is a widening debate in Washington about whether the system should be privatized. That debate has helped both create the vacancy at the top of the Department of Veterans Affairs and complicated efforts to fill it.

Plus, for “extra credit,” the panelists recommend their favorite health stories of the week they think you should read, too.

Julie Rovner: Bloomberg News’ “Is There a Doctor Aboard? Airlines Often Hope Not,” by Ivan Levingston

Joanne Kenen: The Atlantic’s “Ambien Doesn’t Cause Racism,” by Olga Khazan

Rebecca Adams: ProPublica’s “Why Your Health Insurer Doesn’t Care About Your Big Bills,” by Marshall Allen

Paige Winfield Cunningham: The New York Times’ “Origins of an Epidemic: Purdue Pharma Knew Its Opioids Were Widely Abused,” by Barry Meier

Also: The New Yorker’s “The Family That Built an Empire of Pain,” by Patrick Radden Keefe

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher or Google Play.

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France extends cheese recall after more E.coli cases, one suspected death

PARIS (Reuters) – More Reblochon cheese from a factory in the French Alps will be removed from the market after children were infected by E.coli bacteria linked to the raw milk-based product with one child possibly dying from it, health authorities said on Friday.

French food retailer Leclerc had already issued a recall of Reblochon products produced by cheesemaker Chabert and sold in its own shops under the “Nos regions ont du talent” (“Our regions have talent”) brand.

That was extended in mid-May to concern all distributors of the suspect cheese, including retailers Carrefour and Intermarché, which sold the cheese produced in Cruseilles in the Haute-Savoie region under their own brand.

The move came after health authorities linked seven cases of E.coli 026 bacteria among children between one-and-a-half and three years old to the cheese, which is a creamy specialty of the French Alps.

On Friday, the national public health center extended the recall after 14 suspected new cases of children between one and five were discovered.

Six of the 14 cases of infection involved hemolytic-uremic syndrome (HUS) with E.coli 026 bacteria, a potentially serious condition that can cause kidney failure among young children.

“The traceability survey conducted by health authorities after a new infection case … enabled the identification of new batches of Reblochon that were not targeted by the original recall,” the Ministry of Agriculture said in a statement.

The health center said the other eight cases were still being investigated. One of those children had died and had been infected with HUS, but it was still unclear whether or not it was linked to the child eating Reblochon.

It reiterated official guidance that raw milk and cheese made with raw milk should not be given to young children.

Reporting by John Irish; Editing by Adrian Croft

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Coal lobby fights black-lung tax as disease rates surge

PRINCETON, West Virginia (Reuters) – As a young man, Barry Shrewsbury dug coal in the West Virginia mines and spent his time off hunting and fishing in the rolling hills.

Now, at 62, he struggles to breathe and accomplish basic tasks such as shopping and showering, and relies on a federal fund for ex-miners with black lung disease to pay for an oxygen tank and doctor visits.

“The benefits are a lifeline,” Shrewsbury said between labored breaths after a treatment at the Bluestone Health Center, an industrial-style building set against a leafy landscape in Princeton, West Virginia.

That lifeline is threatened. The Black Lung Disability Trust Fund is at risk of insolvency due to soaring debt and a slashing of coal-company contributions through a tax cut scheduled for the end of the year, according to a report the U.S. Government Accountability Office plans to publish soon, two sources briefed on the study told Reuters.

That shortfall – which comes as black lung rates hit highs not seen in decades – could force the fund to restrict benefits or shift some of the financial burden to taxpayers, the sources said on condition of anonymity. The fund currently provides medical coverage and monthly payments for living expenses to more than 15,000 people, according to a Congressional report published this year.

(For a graphic on rising black-lung rates, see: tmsnrt.rs/2IHoOIf . For a WIDER IMAGE photo essay, see: reut.rs/2Lbj4HI .)

The coal industry, meanwhile, is lobbying Congress to ensure the scheduled tax reduction goes forward, arguing the payments have already been too high at a difficult time for mining companies and that the fund has been abused by undeserving applicants.

“More often than not, we are being called upon to provide compensation for previous or current smokers,” said Bruce Watzman, head of regulatory affairs for the National Mining Association.

He said that view was based on “discussions with those administering this program for companies” and initially said he had no research on black-lung benefits paying for smoking-related diseases.

Watzman later cited a study from 1989 by the University of Louisville School of Medicine. The researchers examined 1,000 black-lung benefit applications and found that coal miners judged “potentially eligible” for benefits smoked at higher rates that those who did not qualify.

Medical experts dispute the association’s argument, saying the disease – an incurable illness caused by inhaling coal dust – is easy to distinguish with x-rays.

“It is not caused by smoking,” said Dr. David Blackley, head of Respiratory Disease Studies at the National Institute for Occupational Safety and Health.

The Labor Department, which manages the fund, considers all potential causes of an applicant’s lung problems before awarding benefits, said Amy Louviere, a spokeswoman for the department’s Mine Safety and Health Administration. The approval rate for applications was about 20 percent last year, according to department data.

Coal companies are currently required to pay a $1.10 per ton excise tax on underground coal production to finance the fund. That amount will revert to the 1977 level of 50 cents at the end of the year if Congress does not extend the current rate.

The fund has already been forced to borrow more than $6 billion from the U.S. Treasury to finance benefits during the life of the program, according to the Treasury Department. About half of the fund’s revenue now goes to servicing that debt.

A bipartisan effort by lawmakers to extend the current coal tax failed this year after the mining association lobbied Republican House leadership not to take it up. Watzman said he was “not at liberty” to identify members of Congress who oppose extending the tax.

Matt Sparks, a spokesman for House Majority Leader Kevin McCarthy’s office, did not respond to requests for comment.

Lawmakers expect discussion of the tax to resume after the GAO report is released.

“We need to take care of the miners,” said Virginia Republican Congressman Morgan Griffith, who represents a district that has seen one of the biggest surges in the disease. “We first need to have all facts on the table.”

The mining association and large miners such as Peabody Energy (BTU.N), Arch Coal (ARCH.N), and Consol Energy (CEIX.N) are already pressing their case, according to Congressional lobbying records that show the black lung fund among the subjects discussed in their recent meetings with lawmakers.

Peabody spokeswoman Michelle Constantine declined to comment. Arch spokesman Logan Bonacorsi and Consol spokesman Zachary Smith did not respond to requests for comment.

The upcoming GAO report was requested in 2016 by Democratic Congressmen Bobby Scott of Virginia and Sander Levin of Michigan and has undergone review by the administration of President Donald Trump, who has focused on slashing regulation to help the coal industry.

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White House spokeswoman Kelly Love did not respond to a request for comment on the administration’s position on the excise tax.

BLACK LUNG RESURGENCE

The fund pays benefits to miners severely disabled by black lung in cases where no coal company can be found to directly provide support. That typically occurs when a company has gone belly-up – an increasingly common scenario as the nation’s utilities shift to cheaper natural gas and cleaner solar and wind power.

Some 2,600 medical claims were transferred from companies to the fund in 2017 due to bankruptcies, according to a Congressional report this year.

Government research shows the incidence of black lung rebounding, despite improved safety measures adopted decades ago – such as dust screens and ventilation – that had nearly eradicated the disease in the 1990s.

In February, the National Institute for Occupational Safety and Health confirmed 416 cases of advanced black lung disease in three medical clinics in rural Virginia from 2013 to 2017 – the highest concentration of cases ever seen. It also confirmed a 2016-2017 investigation by National Public Radio that found many hundreds more cases in southwestern Virginia, southern West Virginia and eastern Kentucky.

“This is history moving in the wrong direction,” said Kirsten Almberg, an assistant professor of environmental and occupational health at the University of Illinois at Chicago.

Almberg authored an analysis of Labor Department data showing that nearly half the 4,679 benefits claims from miners with the worst form of black lung disease were made since 2000.

Ex-miners and regional health experts blame the resurgence on longer hours spent in deeper parts of old, played-out mines, along with lax safety measures and the use of heavy machines to blast through layers of rock.

“We didn’t use curtains. We rarely used ventilators. We thought we were invincible,” said Greg Jones, who left mining in March and now coordinates benefits applications at the Tug River Black Lung Clinic in Gary, West Virginia.

Brandon Crum, a radiologist at the United Medical Group in Pikeville, Kentucky, said he has personally diagnosed more than 150 cases of advanced black lung disease since 2016, many in younger miners.

Crum, whose own family worked the mines for a century, said many of these people face a lifetime unable to work, inundated with medical bills.

“Any kind of asset or financial stability you would take away from these miners and their families would be devastating,” he said.

“APPLICATION REJECTED”

To qualify for benefits, a miner must apply to the Department of Labor, which screens the applications based on medical and employment documentation and then tries to find a responsible coal company to pay the costs.

Jim Werth, the black lung clinic director at Stone Mountain Health Services in St. Charles, Virginia, said his clinic has three people on staff helping patients file for benefits. He rejected the idea that the fund was covering undeserving applicants, saying the process already makes it hard to qualify, with coal companies often hiring doctors to dispute medical test results.

William McCool, 64, said it took him years to win benefits.

“I worked 40 years in the mines, and the benefits don’t come automatic,” said McCool, who wore a gray baseball cap emblazoned with a crossing pick-axe and shovel during an interview at the Mountain Health Center in Whitesburg, Kentucky, where he receives oxygen and physical therapy.

Kennith Adams – a 62-year-old former miner who survived stage-four colon cancer and is now suffering advanced black lung – had his first application rejected two years ago, he said. Consol argued he did not work for the firm when he became ill. Adams had worked at the Bishop Coal Company, which later got taken over by Consol.

Consol did not respond to a request for comment.

Adams and his wife Tammie are now hoping his latest application – sent last month – will be approved to help them pay medical bills of more than $12,000 a month.

“If he doesn’t get his medicine,” his wife said, “he doesn’t stand a chance.”

Reporting by Valerie Volcovici; Editing by Richard Valdmanis and Brian Thevenot

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Even “healthy” guys need health screenings

Are you the type of guy who puts off doing a task and later wishes he’d just done it? Do you think that if you don’t feel ill, then everything must be fine? If you’re a man with Medicare, now’s the time to talk with your doctor about whether you should get screened for prostate cancer, colorectal cancer, or both. Screening tests can find cancer early, when treatment works best.

Don’t put off screenings if you’re worried about the cost—if you’re a man 50 or over, Medicare covers a digital rectal exam and a prostate specific antigen (PSA) test once every 12 months. Also, Medicare covers a variety of colorectal cancer screenings—like the fecal occult blood test, flexible sigmoidoscopy, or colonoscopy—and you pay nothing for most tests.

Prostate cancer is the most common cancer in men, second only to lung cancer in the number of cancer deaths. Not sure whether you should get screened? You’re at a higher risk for getting prostate cancer if you’re a man 50 or older, are African-American, or have a father, brother, or son who has had prostate cancer.

Colorectal cancer is also common among men—in fact, it’s the second leading cause of cancer-related deaths in the United States among cancers that affect both men and women. If everyone 50 to 75 got screened regularly, we could avoid as many as 60% of deaths from this cancer.

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. If you’re 50 or older, or have a personal or family history of colorectal issues, make sure you get screened regularly for colorectal cancer.

June is Men’s Health Month. It’s the perfect time for you to take the steps to live a safer, healthier life. Watch our video on how Medicare has you covered on colorectal cancer screenings, and visit the Men’s Health Network website on Men’s Health Month for more information.

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Study finds reciprocal link between emotional distress and treatment side effects of prostate cancer

June 1, 2018

A new study published in the Journal of Urology® reports that men with prostate cancer who had worse urinary, bowel, and sexual function after surgery or radiotherapy than others experienced more emotional distress. Interestingly, the reverse was also true as experiencing more distress led to worse function. The likelihood of this reciprocal relationship highlights the importance of greater investment in psychosocial care to mitigate treatment side effects in prostate cancer survivors.

Patients with cancer frequently experience emotional distress, not only when they are diagnosed and during treatment, but also into long-term survivorship. Studies have shown that interventions to reduce the emotional burden of disease in patients with cancer can promote recovery and reduce associated costs.

Most of the 2.8 million survivors of prostate cancer in the United States have been treated with definitive therapy, typically surgery and/or radiotherapy, and have a favorable prognosis. Men treated surgically often experience some degree of urinary incontinence, especially in the first year following treatment, and most experience erectile dysfunction even two years after surgery. While emotional distress decreases in most prostate cancer survivors, some have high emotional distress that does not decline over time to a level consistent with the general population.

“There is growing appreciation for the need to support cancer survivors’ emotional well-being during survivorship, and for prostate cancer patients a key concern is mitigating the influence of treatment side effects on quality of life, including psychological well-being,” explained Heather Orom, PhD, Associate Professor, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA, and co-investigators.

In the current study the authors investigated whether urinary, sexual, and bowel dysfunction contributes to emotional distress during the first two years after treatment, and whether distress may in turn further decrease function. They assessed more than 1,100 men diagnosed with clinically localized prostate cancer who were treated with surgery (63 percent) or radiotherapy (37 percent). Urinary, sexual, and bowel function was assessed using the Expanded Prostate Cancer Index Composite and emotional distress was assessed using the National Comprehensive Cancer Network® Distress Thermometer. Patients were evaluated before treatment and six weeks thereafter, with follow-up at six, 12, 18, and 24 months. The investigators analyzed how function at one time point influenced distress at a subsequent time point and vice versa, taking into account differences in men’s pretreatment function and distress.

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Results highlight the likelihood of a reciprocal relationship between treatment side effects and emotional distress. Because the researchers followed the men over time, they were able to establish strong evidence of a causal relationship between urinary, sexual, and bowel function after definitive treatment and emotional distress. While men on active surveillance were not included in the analyses, the bidirectional relationship between function and distress applied to this group as well.

“These findings indicate that in addition to meeting an important need among some survivors, providing psychosocial support may help mitigate side effects,” explained Dr. Orom and colleagues. “It is not simply adequate to monitor patients with cancer for distress and physical quality of life issues. Intervention must be accessible.”

“As urologists, we want men who are treated for prostate cancer to return to their way of life. In order to do so, we must determine better ways to assist men through their emotional distress. Curing their cancer is only the beginning to making them whole,” said co-author Willie Underwood III, MD, Associate Professor of Urologic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.

The investigators propose two health policy changes that could improve survivor well-being: increased access to healthcare coverage for treatments of erectile dysfunction and better access to psycho-oncologic care at diagnosis and after treatment in men who experience a high level of distress. “Given the likely bidirectional nature of the relationship between side effects and emotional distress, it makes sense for facilities that have traditionally not incorporated psychosocial care into practice to consider doing so,” they advise.

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https://www.elsevier.com/

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Study: People taking immunosuppressant drugs less likely to develop Parkinson’s disease

May 31, 2018

People who take drugs that suppress the immune system are less likely to develop Parkinson’s disease, according to a study from Washington University School of Medicine in St. Louis.

The findings, published May 31 in Annals of Clinical and Translational Neurology, suggest that a person’s own immune system helps nudge him or her down the path toward Parkinson’s. Restraining the immune system with drugs potentially could prevent the neurological disorder, which is characterized by tremors, slow movements, stiffness and difficulty walking.

“The idea that a person’s immune system could be contributing to neurologic damage has been suggested for quite some time,” said Brad Racette, MD, the Robert Allan Finke Professor of Neurology and the study’s senior author. “We’ve found that taking certain classes of immunosuppressant drugs reduces the risk of developing Parkinson’s. One group of drugs in particular looks really promising and warrants further investigation to determine whether it can slow disease progression.”

Parkinson’s, a neurodegenerative disease, affects about a million people in the United States. Its causes are not well-understood.

Last year, Racette and colleagues analyzed millions of medical records and developed an algorithm to predict which people would be diagnosed with the disease. As they mined the data, they discovered that people with several types of autoimmune diseases, including ulcerative colitis, were less likely to be diagnosed with Parkinson’s than the general population. The autoimmune diseases were a mixed bag, linked to myriad glitches in the immune system and affecting a variety of organ systems. It was hard to see how such a hodgepodge of immune system malfunctions all could end up having the same beneficial effect.

The researchers noted, however, that many autoimmune diseases do have one thing in common: They are treated with drugs that dampen immune activity. Having an autoimmune disease may not be a good thing, but being treated for one might be, they decided.

Racette and colleagues analyzed Medicare Part D prescription drug data on 48,295 people diagnosed with Parkinson’s in 2009 and 52,324 people never diagnosed with Parkinson’s. They identified 26 commonly prescribed immunosuppressant drugs, representing six classes of medications. The researchers determined which people in the data set had been prescribed any of the drugs a year or more before the date of diagnosis or by a pre-set cutoff date. Prescriptions written in the 12 months before diagnosis or by the cutoff were excluded to rule out any chance that the prescriptions might have been linked to early signs of the disease.

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The researchers found that people taking drugs in either of two classes were significantly less likely to develop Parkinson’s than those taking no immunosuppressants. People taking corticosteroids such as prednisone were 20 percent less likely to be diagnosed with Parkinson’s, while those on inosine monophosphate dehydrogenase (IMDH) inhibitors were about one-third less likely.

When the researchers included specific autoimmune diseases in their analysis, the calculated risks didn’t change, suggesting that the difference was due to use of the drugs, not the underlying diseases they were treating.

The findings suggest that tamping down immunity with drugs may keep Parkinson’s disease at bay. But doing so also makes people more susceptible to infectious diseases and cancer. The benefits of immunosuppressive drugs outweigh the costs for people with serious autoimmune diseases like rheumatoid arthritis. But doctors probably would hesitate to prescribe risky drugs to healthy people to stave off Parkinson’s, especially since there is no reliable way to predict who is on track to develop the disease.

“What we really need is a drug for people who are newly diagnosed, to prevent the disease from worsening,” Racette said. “It’s a reasonable assumption that if a drug reduces the risk of getting Parkinson’s, it also will slow disease progression, and we’re exploring that now.”

Corticosteroids have many side effects, and doctors already try to minimize their use, so Racette and colleagues have turned their attention to IMDH inhibitors.

“Our next step is to conduct a proof-of-concept study with people newly diagnosed with Parkinson’s disease to see whether these drugs have the effect on the immune system that we’d expect,” Racette said. “It’s too early to be thinking about clinical trials to see whether it modifies the disease, but the potential is intriguing.”

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