Viagra may cause long lasting visual disturbances finds study

In a new study scientists have reported that Sildenafil or Viagra pills used for erectile dysfunction could lead to longer lasting visual disturbances than known before. The study titled, “Ocular Side Effects of Sildenafil That Persist Beyond 24 h—A Case Series,” was published in the latest issue of the journal Frontiers in Neurology.

Image Credit: PaulSat / Shutterstock

Image Credit: PaulSat / Shutterstock

There have been reports of visual disturbances seen with use of Sildenafil before but no confirmed association has been noted before wrote researcher Dr. Cüneyt Karaarslan of the Dünyagöz Adana hospital in Turkey. He explained that this drug is widely being used for treatment of erectile dysfunction and while cardiac side effects of this drug have been reported and studied, little is known about its visual side effects. This new case series of a series of 17 male patients taking the highest recommended dose of the drug revealed that they faced problems such as light sensitivity and impairment of colour vision. The patients had all presented to the clinic between August 2017 and March 2019.

Sildenafil, or Viagra was initially developed for raising blood pressure because it has been found to dilate the blood vessels. As an additional function, it was found to relax the smooth muscles of the penis and thus achieving and maintaining an erection was possible. The drug has been widely prescribed for men with erectile dysfunction since 1998. The effects of the drug may last for a few hours but is usually accompanied by headaches and blurred vision in some individuals. In addition some may experience skin flushing, chest pain, heart burn etc. said Karaaslan. The effects of the drug usually begin within half an hour to one and half hours and lasts for around three to five hours.

Dr. Karaarslan reported that the patients treated with Sildenafil at its higher recommended doses complained of visual disturbances. They had abnormally dilated pupils that led to blurred vision and increased sensitivity to light. There was also a disturbance in colour vision with many of the men complaining of intensely blue coloured vision and inability to perceive and detect red and green colours. The author of the study wrote that of the 17 patients, “nine had photophobia, 13 had disrupted color perception, nine had impaired visual acuity, three had deficiencies in stereopsis, six had disrupted contrast sensitivity, and eight had abnormally dilated pupils”.

Related Stories

These men, wrote Karaaslan, had taken the drug for the first time and took doses of around 100 mg without prescription. Even after 24 to 48 hours of taking the drug, the men showed persistent disturbance of vision, wrote Karaaslan. The effects of the drug usually last for around 5 hours but in these cases the visual disturbances persisted, he explained. In addition to visual disturbances the men also complained of headache, heartburn, wrote Karaaslan.

The patients were followed up and by 21 days the visual symptoms were cleared in all the 17 men. Detailed eye examination and tests were conducted for them during this period. Some of the tests conducted for these men included, “Snellen chart test of visual acuity, a cone contrast test of color vision, a stereo butterfly test of depth perception (Keeler, USA), a Pelli Robson test of contrast sensitivity, an Orbscan® corneal topographic assessment, and a pupil diameter measurement,” the paper says.

Karaarslan said in a statement, “Many men use non-prescription performance enhancing drugs to help with sexual anxiety and erectile dysfunction. For the vast majority of men, any side-effects will be temporary and mild. However, I wanted to highlight that persistent eye and vision problems may be encountered for a small number of users.”

According to Karaaslan, the drug may be metabolized differently in these individuals and may remain in their body for longer than others. This could be the reason behind the adverse visual effects he wrote. In addition, the higher first dose could be the reason behind the visual side effects and new users should start with a lower dose of the drug to prevent such effects. The high doses taken by the men were also due to the fact that they had self-medicated themselves and were not prescribed these medications.

He wrote in conclusion the despite the fact that the condition resolved spontaneously, there needs to be awareness related to the possible visual side effects of higher doses of Sildenafil especially if taken without prescription. Ideally the drug should be started at 50 mg he wrote. Karaarslan said, “Although these drugs, when used under the control of physicians and at the recommended doses, provide very important sexual and mental support, uncontrolled and inappropriate doses should not be used or repeated.”

Journal reference:

Karaarslan Cüneyt, Ocular Side Effects of Sildenafil That Persist Beyond 24 h—A Case Series, Frontiers in Neurology, 10.3389/fneur.2020.00067, https://www.frontiersin.org/articles/10.3389/fneur.2020.00067/full

Visit the Source Site

Powered by WPeMatico

Drug to improve fetal growth may increase blood pressure and blood sugar levels in offspring

Research suggests that a drug recently assessed as a potential treatment for fetal growth restriction may cause high blood pressure and raise blood sugar levels in offspring. The study, which urges practitioners to consider both short- and long-term effects when treating people with this pregnancy complication, is published in the American Journal of Physiology-;Heart and Circulatory Physiology. It was chosen as an APSselect article for February.

Fetal (intrauterine) growth restriction is a condition in which an unborn baby is not growing to its full potential in the womb. Babies with fetal growth restriction have a lower-than-average birth weight and much higher risk of being stillborn. The condition is difficult to treat, in part because many medications carry the potential risk of damage to the fetus.

Related Stories

Sildenafil citrate-;a vasodilator most often used as a treatment for erectile dysfunction-;has recently been tested in international clinical trials in severe cases of fetal growth restriction. The results did not show the beneficial effect of fetal weight gain. “The focus of previous studies has been to assess [sildenafil citrate’s] effects on the mother, fetus and in some cases, [newborn], but only one study has examined the effects of antenatal [sildenafil citrate] in the long term,” researchers of the current study wrote.

To learn more about how sildenafil citrate affects offspring after birth, the researchers studied a mouse model of fetal growth restriction. One group of female mice received daily subcutaneous injections of the drug-;equivalent to a human dose-;during pregnancy (“treated”), while another group was left untreated (“control”). The research team then measured blood pressure, body weight and blood sugar levels of the pups born to both groups. Both males and females born to the treated group had higher blood pressure than those born to the control mice. Body weight did not change in male mice born to treated mothers, but female offspring from the treated group were significantly heavier than those born to the control group. In a test which helps look for evidence of diabetes, females born to treated dams also showed increased blood sugar levels following a sugar challenge, but males were unaffected.

“This study highlights the importance of assessing both the short- and long-term consequences of therapeutics administered during pregnancy,” the researchers wrote. Results from animal models of fetal growth restriction may lead to “a more informed choice for the obstetrician and patient on the potential short- and long-term risk vs. benefits of treatments in utero.”

Source:

American Physiological Society (APS)

Journal reference:

Renshall, L. J., et al. (2020) Antenatal sildenafil citrate treatment increases offspring blood pressure in the placental-specific Igf2 knockout mouse model of FGR. Translational Physiology. doi.org/10.1152/ajpheart.00568.2019.

Posted in: Child Health News | Medical Research News | Pharmaceutical News

Tags: Baby, Birth Weight, Blood, Blood Pressure, Blood Sugar, Diabetes, Erectile Dysfunction, Heart, High Blood Pressure, In Utero, Knockout, Knockout Mouse, Newborn, Physiology, Pregnancy, Research, therapeutics, Womb

Visit the Source Site

Powered by WPeMatico

Prostate cancer is the most commonly diagnosed cancer in England

Prostate cancer has become the most commonly diagnosed cancer in England, according to the newest data from Public Health England.

In the health agency’s report, there were 49,029 diagnoses made in 2018, which is about 8,000 more than the previous year, surpassing breast cancer with 47,476 cases. Lung cancer followed with 38,996 cases. The new data reveals that there were more cancers detected in 2018 in men than in women, with a total of 15,228 cases and 151,452, respectively.

Overall, there were 868 new diagnoses of invasive cancer every day in 2018, with a total of 316,680 new diagnoses.

Doctors believe that the increase in diagnoses was due to the Fry and Turnbull effect, which influenced patients to seek medical attention. The effect occurred after former BBC Breakfast presenter Bill Turnbull and broadcaster Stephen Fry raised awareness about prostate cancer and urged men to have their check-up.

Man receiving radiation therapy treatments for prostate cancer. Image Credit: Mark_Kostich / Shutterstock

Man receiving radiation therapy treatments for prostate cancer. Image Credit: Mark_Kostich / Shutterstock

The number of deaths increasing

The number of men dying from prostate cancer in the U.K. has hit an all-time high, with data revealing that there were 12,031 deaths in 2017, up from 11,637 the previous year.

Health experts believe that the increase in deaths related to prostate cancer is not due to the disease becoming more deadly, but may be due to an aging population, with more men diagnosed with the illness.

What are the symptoms?

Related Stories

Prostate cancer is the type of cancer that affects the prostate gland, which is located just below the bladder. The gland helps in the production of healthy sperm cells and having problems with it can affect urination and sexual function.

Prostate cancer develops when a mutation can lead to cells growing uncontrollably, forming a tumor. When the tumor cells spread to surrounding areas and other parts of the body, they can cause potentially fatal complications.

However, prostate cancer has a good prognosis as long as it gets diagnosed early. In the early stages of cancer, there are no symptoms but as the disease progresses, it can cause frequent urination, the urge to urinate more frequently at night, blood in the seminal fluid or urine, erectile dysfunction, weak or interrupted urine flow, and pain or burning sensation when urinating.

How is prostate cancer diagnosed?

Some men may be at a higher risk of developing prostate cancer than the others, especially those who are more than 50 years old, have a family member or close relative who had prostate cancer, and of black ethnic origin.

There isn’t a single test for prostate cancer, but men can undergo prostate-specific antigen (PSA) test to help detect early prostate cancer. Normally, men do not have an elevated PSA level. In some cases, doctors may request other tests such as a cystoscopy or prostate biopsy.

A biopsy can determine if the tumor is cancerous or not, and how far has the tumor spread. Most of the time, doctors may recommend other imaging techniques to determine the extent and severity of the illness, including bone scan, ultrasound, MRI scan, CT scan, and PET scan.

Prostate cancer is one of the cancers that has a good prognosis, with a 5-year survival rate for most men to be nearly 100 percent. For those whose cancer has spread to other parts of the body, the 5-year survival rate is 30 percent.

Common treatments for the illness include radiation therapy and chemotherapy. In some cases, doctors need to surgically remove the prostate gland.

Source:

National Statistics Cancer registration statistics, England: first release, 2018 – Updated 27 January 2020 – https://www.gov.uk/government/publications/cancer-registration-statistics-england-2018/cancer-registration-statistics-england-first-release-2018

Visit the Source Site

Powered by WPeMatico

Study evaluates the impact of prostate cancer treatment decisions

A five-year follow-up study of more than 2,000 U.S. men who received prostate cancer treatment is creating a road map for future patients regarding long-term bowel, bladder and sexual function in order to clarify expectations and enable men to make informed choices about care.

The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation for Localized Prostate Cancer) study, coordinated by Vanderbilt University Medical Center, is a multi-site research study conducting long-term followup on men who were diagnosed with localized prostate cancer between 2011 and 2012.

The five-year results published in JAMA, with lead author Karen Hoffman, MD, MPH, from MD Anderson, provide evidence on outcomes with radiation, surgery or active surveillance in patients of all ages and ethnicities.

We are providing information about the side effects of different treatments for prostate cancer that men and their providers can use to make treatment decisions

However, we have only illuminated one facet of a complex decision. There is more to a treatment decision than just the side effects, the most obvious being the effectiveness of the treatment, and that is something we hope to be able to demonstrate as we are now funded to look at 10-year cancer outcomes.”

Daniel Barocas, MD, MPH, senior author, associate professor and vice chair of Urology at VUMC

Researchers studied 1,386 men who had favorable-risk prostate cancer and another 619 men with unfavorable-risk prostate cancer to evaluate the impact of their treatment decisions on urinary, sexual and bowel function over a five-year period.

The favorable-risk group chose either:

  • Active surveillance, an observation strategy in which treatment is only used if the cancer gets worse over time.
  • Nerve-sparing prostatectomy, surgical removal of the prostate with attempt to protect nerves that run alongside the prostate in hopes of minimizing the impact of surgery on erectile function.
  • External beam radiation therapy (EBRT), a common therapy that uses daily doses of radiation to destroy cancer cells.
  • Low-dose-rate brachytherapy, a type of radiation therapy involving implantation of radioactive “seeds.”

The unfavorable-risk disease group chose either:

  • Prostatectomy, which is surgery to remove the prostate.
  • External beam radiation therapy with androgen deprivation therapy (ADT), which is radiation in combination with an anti-hormone therapy used to reduce levels of androgen hormones to enhance the effectiveness of radiation.

Men undergoing surgery experienced an immediate, sharp decline in erectile function compared to other groups. However, on average, men treated with prostatectomy improve with time, while those undergoing radiation decline, so that sexual function differences between treatment groups attenuated by 5 years. While the difference in sexual function between surgery and radiation was still measurable in the unfavorable risk group, most men had such poor scores at five years that the difference between treatments may not be clinically significant.

“For sexual function, all of the treatment options, even surveillance, were associated with significant declines,” Barocas said. “Indeed, the magnitude of decline over time within each treatment group was larger than the magnitude of difference between treatment groups at five years.”

Related Stories

“Whether you get surgery or radiation there is a chance of reduced erectile function,” he said. “While the time course is different for surgery and radiation, our study shows that only about half of men undergoing these treatments who had erections good enough for intercourse before treatment will still have an erection good enough for intercourse five years later. I have started using this sobering statistic in patient counseling about treatment choice.”

In terms of urinary function, prostatectomy was associated with worse incontinence compared to other treatments through five years for both the favorable-risk and the unfavorable-risk groups. At five years, 10-16% of men who had surgery reported a moderate or big problem with leakage, compared to only 4-7% of men who had other treatments.

Men undergoing radiation reported worse urinary irritative and obstructive symptoms within the first six to 12 months, particularly those undergoing the low-dose rate brachytherapy. However, these urinary symptoms largely returned to baseline after one year.

In addition, study authors reported no clinically meaningful bowel function differences at the five-year mark, suggesting that contemporary radiation therapy is associated with less urinary and bowel toxicity than older forms of radiation.

“If you look at the side effect profile for external beam radiation, most of those men after a year have rebounded in terms of their urinary and bowel function, which is a novel finding of our study,” Barocas said. “The brachytherapy patients have a more difficult time with the urinary and bowel symptoms in that first year.”

For men with unfavorable risk disease, EBRT with ADT was associated with low hormonal function scores at six months and bowel function at one year, but these symptoms improved at later time points. The men who got EBRT with ADT also had better sexual function at five years and incontinence at each time point through five years than prostatectomy.

Study authors said, overall, the estimates of long-term bowel, bladder and sexual function after localized prostate cancer treatment may clarify expectations and enable men to make informed choices about care.

“This work provides critical and understandable information to patients and providers to help them make better decisions in localized prostate cancer,” said David Penson, MD, MPH, MMHC, chair of the Department of Urology at VUMC.

“The really exciting part is that Dr. Barocas has received funding from the NCI to explore longer-term outcomes in this population and is already working on developing a web-based interface to get this information to his patients,” he said.

Barocas said a separate publication in the Journal of Urology will help to translate the domain scores into more understandable results for patients to get a sense of their likelihood of leakage or erectile dysfunction, or bowel function problems.

The researchers have also developed a personalized prediction tool that tries to empower men by putting this information in their hands and allowing them to enter their own data and compute their chance of regaining function after treatment at http://www.ceasar-prostate.org.

Source:

Vanderbilt University Medical Center

Journal reference:

Hoffman, K.E., et al. (2020) Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA. doi.org/10.1001/jama.2019.20675.

Visit the Source Site

Powered by WPeMatico

Quitting smoking: Going it alone is not the best approach

We live in an era of self-empowerment. But when it comes to quitting smoking, going it alone isn’t the best approach.

That’s because smoking isn’t just a bad habit – it’s an addiction.

Smokers develop a physiological dependence on nicotine, and they need more than willpower to quit.”

Dr. Danish Ahmad, pulmonologist with Penn State Health Milton S. Hershey Medical Center

The American Cancer Society says it takes smokers eight to 10 quit attempts before they achieve success. But don’t get discouraged.

The more times people try to quit, the more successful they might be the next time.”

Diane Schmeck, certified tobacco treatment specialist at Penn State Health St. Joseph

Many smokers – seven in 10, according to the Centers for Disease Control and Prevention (CDC) – already know they want to quit. And while many know smoking increases the risk for lung cancer and cardiovascular disease, they don’t always know the other health risks, from cancers of the esophagus, pancreas and stomach to more subtle conditions. Smoking also negatively affects breathing and is the greatest risk factor for developing emphysema.

“Smoking affects your small blood vessels, which can mean poor circulation in the arms or legs, or a greater risk of erectile dysfunction in males,” Schmeck said.

Smokers will notice the health benefits of quitting almost immediately. “Within 20 minutes, a smoker’s heart rate and blood pressure improves, and within 12 hours, the carbon monoxide level drops,” Ahmad said. Within two weeks, quitters reduce their risk for a heart attack and breathing improves. Within one year, they cut their heart disease risk in half. And within 10 years, their risk of dying from lung cancer is half that of someone who is actively smoking.

While some people think e-cigarettes offer a bridge to quitting smoking, this is not recommended by the health care community. “There is no evidence that vaping is safer than smoking cigarettes,” Ahmad said. E-cigarettes don’t contain tobacco, but most contain nicotine, which makes vaping just as addictive as cigarette smoking.

Related Stories

Statistically, smokers have the best chance of quitting successfully through programs that combine one-on-one counseling, group support and medication. Counseling helps smokers identify their habits, patterns and triggers and shows them what behaviors they may need to change.

In addition to counseling, physicians recommend two different types of medication. One is nicotine replacement therapy-;patches, gums or lozenges. “These medicines replace the nicotine the body is seeking as a result of smoking cigarettes,” Ahmad said. The other types are oral medications, the most frequently recommended of which is varenicline (Chantix).

The good news: Many insurance plans cover smoking cessation programs.

Penn State Health Milton S. Hershey Medical Center offers one-on-one counseling through its Smoking Cessation Clinic. Participants meet with tobacco treatment specialists who help them develop personal quit plans and strategies.

In addition, the Milton S. Hershey Medical Center now offers group counseling at the University Fitness Center. People can self-refer by calling 717-531-6985.

At St. Joseph Medical Center, tobacco treatment specialists provide smoking cessation counseling to inpatients and on request. Outpatients receive counseling at Pulmonary Rehabilitation and the Pulmonary Diagnostics Laboratory. People can refer themselves to the program by calling 610-208-8811 or emailing [email protected]

People in Berks County can also take advantage of bilingual counseling offered through the Counsel on Chemical Abuse. And anyone can use resources from the Department of Health’s 1-800-QUIT-NOW phone and internet counseling line, or from the CDC’s Smokefree.gov app.

No matter which resource someone chooses, the fact remains that it’s never too late to quit. “The best thing you can do for your health is to keep working on it,” Ahmad said.

Source:

Penn State Health

Visit the Source Site

Powered by WPeMatico

Scientists urge further caution on use of Viagra for fetal therapy

University of Manchester scientists investigating a possible treatment for fetal growth restriction (FGR), a condition in which babies grow poorly in the womb, have urged further caution on the use of Viagra.

The drug, commonly used to treat erectile dysfunction, as it enhances blood flow – has been undergoing trials as a potential treatment for FGR. However, in a recent study in mice, Viagra showed no improvement in fetal growth but did result in high blood pressure in the pups as they reached maturity.

Babies with Fetal Growth Restriction (FGR) are at increased risk of stillbirth and are more likely to suffer from developmental problems and other conditions such as heart disease and diabetes in adulthood.

FGR affects around 3 in every 100 pregnancies and most cases are caused by poor function of the placenta, affecting blood flow and thus nutrient transfer from mother to the baby.

No treatments are available for FGR and often the only option for obstetricians is to deliver the baby early so they can be cared for outside the womb.

The Manchester team are the first to report the long-term effects of the drug, on both male and female offspring, when given to mice during pregnancy and publish their results in the American Journal of Physiology – Heart and Circulatory Physiology.

An international clinical trial of Viagra on severe cases of human FGR called STRIDER, and carried out at the same time as the Manchester study, also found the drug had no significant benefit on fetal growth or prolongation of pregnancy.

The Dutch arm of the STRIDER trial was halted after 11 babies of mothers using the medication died from lung complications, though this did not happen to babies in the New Zealand-Australia or the UK-Ireland trials.

Related Stories

In the Manchester study, over 90% of mice whose mothers were given Viagra during their pregnancy experienced a significant increase in their blood pressure. This increase was in the range of values equivalent to those used to diagnose high blood pressure in humans.

The effect was similar in both wild type (normally grown) and growth restricted mice and was consistent in both females and males.

Female mice also experienced a modest increased weight gain after birth and a minor reduction in glucose tolerance after 8 weeks.

The study was carried out by former PhD student Dr Lewis Renshall. He said:

This, and other studies have shown Sildenafil – otherwise known as Viagra – may not be a suitable treatment for FGR unless life-saving benefits can be demonstrated.

So there is still much work to do if we are to eventually find a treatment for this distressing condition.”

Dr Mark Dilworth, who led the study, added:

The evidence from this study and others suggest that caution should be used for the use of Viagra in fetal Growth Restriction. Our study suggests there may be long-term risks associated with its use in mice and importantly, there is a lack of beneficial effect in recent human clinical trials.

We do feel, however, that it is important to continue to conduct studies which look at longer term impacts of giving medication during pregnancy as there is surprisingly little research on this.”

Source:

University of Manchester

Journal reference:

Renshall, L. J., et al. (2020) Antenatal sildenafil citrate treatment increases offspring blood pressure in the placental-specific Igf2 knockout mouse model of FGR. American Journal of Physiology-Heart and Circulatory Physiology. doi.org/10.1152/ajpheart.00568.2019.

Visit the Source Site

Powered by WPeMatico

National veteran dataset will help dissect the relationship between mental illness and prostate cancer

There appears to be an unhealthy synergy between mental illness and prostate cancer, and researchers are working to dissect the relationship by first assembling the largest dataset ever of veterans with either condition or both.

Prostate cancer is the most common cancer diagnosed in the massive Veterans Health Administration network that sees about 9 million veterans annually who today are about 90% male.

It’s the largest and most connected health care system we have that can provide the sample size and follow up data to enable this large-scale assessment.”

Dr. Zachary Klaassen, urologic oncologist in the Department of Surgery at the Medical College of Georgia at Augusta University

Klaassen, director of clinical urological research at MCG and the Georgia Cancer Center, just received a $750,000 grant from the U.S. Department of Defense that is enabling investigators to scour the massive datasets of the VA since 2000 for men with mental health illness, those with prostate cancer and those with both so they can compare conditions and outcomes. He expects 20 or more separate research projects will ultimately come out of this new database over at least the next decade.

“We think there may be a correlation between mental health and aggressiveness of prostate cancer and we think patients who don’t get mental health care may not be getting the same treatment and follow up for their prostate cancer,” he says.

“So we want to see the impact of mental health on when you are diagnosed, how old you are, how aggressive the cancer is, compared to people who don’t have mental illness,” Klaassen says of the database he will develop over the next several years.

One working hypothesis is that if you have a mental illness like depression, which is pervasive in society and known to be even more common in patients with cancer, you may pay less attention to your body and overall health, and may be less likely to get screened for prostate cancer and/or seek help, says Klaassen.

“They may not have the capacity or social support to make or get to an appointment,” he says, which can mean diagnosis is delayed and the cancer is more advanced when it’s found.

There likely also are biological risks with factors like inflammation, which is increased in both cancer and depression, that might make the cancer more aggressive, says Klaassen, who also wants to look at inflammation markers in these patients.

One of their first explorations of the massive dataset will be to determine whether having a mental health illness diagnosed prior to their prostate cancer diagnosis impacts the treatment received, patient’s adherence to the planned prostate cancer treatment and follow up, and cancer outcomes.

They think that while having both conditions may worsen prostate cancer outcomes, getting treatment for mental illness at the VA may equalize cancer outcomes for patients with and without mental illness.

If they are correct that getting good mental health care, including things like therapy sessions and medication, means better cancer outcomes, it would definitely be a win for patients and the VA health system, which is known for excellent programs helping address the mental health problems of veterans, Klaassen says.

“If we find they are not the same then we have actionable items to figure out why not,” Klaassen says, possibly like better prostate cancer screening in men with mental health problems and mental health assessment in patients with prostate cancer.

Klaassen, a native of Canada, who completed his urologic oncology fellowship at the University of Toronto and Princess Margaret Cancer Centre after a urology residency at MCG and AU Health System, has extensively studied the intersection of mental illness and prostate and other cancers in Canada. He is among many investigators to see patterns of more mental health problems in patients with cancer and worse cancer outcomes in patients with mental illness.

Related Stories

“If you look hard enough, you likely will find a proportion of our patients are clinically depressed even before their prostate cancer diagnosis,” says Klaassen, the Ronald W. Lewis, MD Endowed Chair for Urologic Education, of the often successful but arduous task of battling prostate cancer.

Even with advanced disease, many men may live for several years while others may die of other causes rather than prostate cancer.

“Prostate cancer may not kill you but life with it can be very difficult,” Klaassen says. “Patients get all this treatment, they may get side effects like erectile dysfunction and urinary incontinence from their treatment, and advanced treatment like hormone therapy, is known to cause problems like depression, dementia, bone and muscle loss,” Klaassen says.

In 2017 in the journal Urologic Oncology, Klaassen and his colleagues reported that men with prostate cancer most at risk for suicide were white, unmarried males with metastatic disease and that about 60% of men with prostate cancer also have mental health distress– 10-40% with clinically significant depression. That depression risk increases with hormone therapy, a common treatment in the advanced stage of this male hormone-driven cancer. Investigators then recommended screening for erectile dysfunction, depression and suicidal thoughts in patients with prostate cancer as a standard part of treatment.

Klaassen and his colleagues reported earlier this year in the journal Cancer, after looking at 676,470 Canadians with cancer and 2.2 million without, that a cancer diagnosis is associated with an increased risk of death from suicide even if the patients with cancer had psychiatric care before their cancer diagnosis. Others including Klaassen have helped show that about 70% of suicides in people over age 60 are associated with a medical illness, and rates are even higher in those with cancer.

Also earlier this year, Klaassen and his colleagues reported in the British Journal of Cancer in that same large group of patients with cancers, including common malignancies like prostate, breast, lung and bladder cancers, that those with psychiatric problems before their cancer diagnosis had both worse cancer-specific mortality and all causes of mortality.

While factors underlying the association remain unclear, they theorized that those seeking psychiatric help before the diagnosis would be more “at risk” and have poorer survival. Those admitted to a psychiatric facility and later diagnosed with bladder or colorectal cancer were particularly at risk for cancer-related death compared to those without a psychiatric history.

While the whys of these associations are unclear, it may be, for example, cancers like breast and prostate cancer, which are associated with sexual well being, may be particularly difficult for patients who have already had to seek psychiatric help, they wrote. Other investigators have had similar findings and theories.

Last year, in European Urology, Klaassen and others reported an uptick in the use of antidepressants following surgery or radiation therapy for nonmetastatic prostate cancer but not in those who simply were kept under close watch, an option when the cancer is low grade and slow-growing. Their finding underscored the need for also providing psychological support to patients, they reported.

Major depression is one of the most common mental health disorders in the United States, according to the National Institute of Mental Health, with about 7% of all adults experiencing as least one major depressive episode.

The prostate is a walnut-sized gland between the bladder and penis that secretes supportive fluid for the sperm. Prostate cancer occurs in 1 out of 9 men over their lifetime, is the most common cancer in men in the United States, other than skin cancer, and the second leading cause of cancer death in men, behind lung cancer, according to the American Cancer Society. Risk factors include aging, obesity, smoking and chemical exposures like Agent Orange, as well as inflammation of the prostate.

Source:

Medical College of Georgia at Augusta University

Visit the Source Site

Powered by WPeMatico

NCCN Patient Advocacy Summit closes gaps in perspective of value in cancer care

The National Comprehensive Cancer Network® (NCCN®) hosted an annual NCCN Patient Advocacy Summit: Delivering Value for Patients across the Oncology Ecosystem in Washington, DC, today. The summit brought together patients, advocates, clinicians, policy-makers, and others to share diverse perspectives on the meaning of value in cancer care. The event also featured a keynote address on incorporating the patient voice into evidence-based care from Paul G. Kluetz, MD, Deputy Director, Oncology Center of Excellence, U.S. Food & Drug Administration (FDA).

We must always keep in mind that no two individuals will define value in exactly the same way. Therefore, patients must be included in any discussion of value at the beginning of their diagnosis and throughout each step of the process as that definition may change following treatment or if there’s a change in prognosis.”

Ilana Feuchter, MA, Senior Manager for National Advocacy, National Ovarian Cancer Coalition

Representatives from some of NCCN’s Member Institutions shared their experience from the clinical and institutional perspective with lessons learned from their high volume of cancer patients.

“Improving patient experience is an essential task for clinicians and hospitals,” said Justin E. Bekelman, MD, Associate Professor and Director of the Penn Center for Cancer Care Innovation, Abramson Cancer Center of the University of Pennsylvania, who delivered a keynote address titled ‘High-value cancer care: what’s in it for patients, clinicians, hospitals, industry, and payers?’ “It’s part of our mission, right up there with improving treatment outcomes and affordability, to ensure that each patient is approached with humanity and humility and feels the care they received was the best it could possibly be.”

“Personalized care for people with cancer is not only driven by clinical algorithms, but also includes a care design for each unique patient and their families, starting with access, finances, social service support, and one-on-one relationships with their clinical support team. Personal care design allows every patient’s voice to be heard so their goals for care can be achieved,” said Kimberly Bell, BSN, MBA, Administrator of Cancer Services, Cleveland Clinic Taussig Cancer Institute. “The value-based payment models being developed by payers and providers must consider the patient’s perspective on quality, care continuum, and finances. As we evolve in this area, this perspective needs to be integrated so patients feel the positive impact on care.”

Financial toxicity was a recurring topic throughout the summit, including issues like fee transparency, lost wages, and auxiliary costs of care.

“We know that behind the words ‘patient,’ ‘sick,’ and ‘cancer,’ there is a family,” said Carla Tardif, Chief Executive Officer, Family Reach. “That family’s only worry should be getting to the other side of cancer, but when financial barriers get in the way of treatment that is simply not the case.”

Shame and silence around a type of cancer, or as a member of a marginalized community, can pose additional barriers to high-quality care.

“LGBT people fear homophobia and hetero-normative values will crowd out inclusive consideration of the healthcare needs for our communities regarding value-based care,” said Darryl Mitteldorf, LCSW, Executive Director, The National LGBT Cancer Project. “LGBT people can have different configurations of what a family is, and our families are rarely considered by the healthcare system in the United States. The National LGBT Cancer Project, along with our partner, Malecare, facilitates the world’s largest anxiety support group, with over 43,000 active members, because LGBT people present with higher incidence rates of anxiety than most groups.”

Related Stories

“You have to be your own best advocate. If you believe something is wrong, press on, because you are probably right,” said Lillian Kreppel, Patient Ambassador, The Anal Cancer Foundation. “Don’t ignore symptoms like bleeding, lumps, bumps, or hemorrhoids. Don’t be so embarrassed that you won’t seek medical help. And don’t necessarily think that doctors have all the answers or know everything, especially when you are the one who lives in your body. Get a second and third opinion, and get educated on the HPV vaccine.”

Sexual health was also a key topic of conversation.

“One big issue for colorectal cancer patients regardless of age, but especially younger patients, is that physicians need to better address intimacy, fertility preservation, and overall sexuality,” said Ronit Yarden, PhD, MHSA, Senior Director of Medical Affairs, Colorectal Cancer Alliance. “Treatments for colorectal cancer often come with debilitating side effects that can reduce a patient’s quality of life. We not only want patients to survive, but we want them to thrive. They need open and honest conversations about their different options and the impact that their treatment will have on their everyday lives. Having these conversations before treatment-;not afterwards, when patients are often surprised and overwhelmed-;will help ensure that survivors can live their best lives.”

“Maintaining quality-of-life specific to sexual health and intimacy is important to prostate cancer patients post treatment,” agreed Chuck Strand, Chief Executive Officer, Us TOO Prostate Cancer Education & Support. “Erectile dysfunction and urinary incontinence can be temporary or ongoing treatment side effects from surgery or radiation. It’s important to patients and their partners to address this with their healthcare team during the process of making a shared decision on a treatment pathway, and be prepared to address management of these issues, if necessary, while recognizing the difference between intimacy and sex.”

Several panelists reiterated that new laws and policies can serve as an important motivation for improvement, as long as they are implemented with the end goal of improving the patient experience, and not simply a checklist to cross off. Increasing use of shared decision-making and patient-reported outcomes can result in care that better meets the needs of the people receiving it.

The panel discussions were moderated by Clifford Goodman, PhD, Senior Vice President, The Lewin Group, and included the following additional participants:

  • Alan Balch, PhD, CEO, National Patient Advocate Foundation
  • Kristin L. Carman, PhD, MA, Director of Public and Patient Engagement, Patient-Centered Outcomes Research Institute (PCORI)
  • Brian Connell, Executive Director, Federal Affairs, The Leukemia & Lymphoma Society (LLS)
  • Anjelica Davis, MPPA, President, Fight Colorectal Cancer
  • Andrea E. Ferris, MBA, President and Chief Executive Officer, Lungevity
  • Elizabeth Franklin, LGSW, ACSW, Executive Director, Cancer Policy Institute, Cancer Support Community
  • Miranda Goff, LICSW, Support Services Manager, GO2 Foundation for Lung Cancer
  • Edward Kim, MD, Chair, NCI Central Institutional Review Board, Adult CIRB – Early Phase Emphasis (EPE) Board

The NCCN Patient Advocacy Summit follows the recent NCCN Policy Summit on Defining, Measuring, and Applying Quality in an Evolving Health Policy Landscape and the Implications for Cancer Care. In 2020, NCCN Policy will host summits on how to accelerate advances in cancer care research, drive down healthcare costs, and improve patient access to quality cancer care across the lifespan. For dates and other information, visit NCCN.org/policy, and join the conversation online with the hashtag #NCCNPolicy.

Source:

National Comprehensive Cancer Network® (NCCN®)

Visit the Source Site

Powered by WPeMatico

Low libido in older women not just down to menopause

Menopause marks the end of a woman’s reproductive years. Along with it, comes various effects, including irregular to the complete cessation of periods, insomnia, mood swings, irritability, hot flushes, and decreased sexual drive.

Now, women older than 60 may experience a decrease in sexual drive and libido, and it’s not just because of menopause, a new study suggests.

A team of researchers at the University of Pittsburgh School of Medicine revealed that women in their 60s report many reasons behind a lack of libido. Published in the journal Menopause, the qualitative study explored on the possible reasons for their lack of desire for sex. They found that aside from going through menopause, there are a multitude of other factors affecting libido, including postmenopausal vaginal symptoms, fatigue or body pain, body image, life stressors, and erectile dysfunction in their partners.

Image Credit: SpeedKingz / Shutterstock

Image Credit: SpeedKingz / Shutterstock

“If a woman is having sexual problems, what’s going on with her partner may be contributing. Sex doesn’t occur in a vacuum,” Dr. Holly Thomas, assistant professor of medicine at Pittsburgh and lead author of the study, said.

Low libido and other factors

In the study, about 40 percent of women who are more than 60 years old experience low libido or desire to have sex, and about 10 percent report that they get bothered by it. The team of researchers want to know the factors that affect libido in men.

To land to their findings, the team performed three 12-woman focus groups. Through interviews, they gathered data from 15 other women privately, depending on the preferred setting of the participant.
One of the most surprising results is that many women said that sexual dysfunction or impotence in men is a key driver and contributor to their reduced sexual desire. In some women, they find temporary solutions to the problem, but others claimed that their partners were defensive.

Related Stories

“As women, we’re encouraged to be accommodating, so we learn to tamp down our own needs and desires, and prioritize those of others,” Thomas added.

Further, the researchers found that in some women, even if they are already retired and all their kids have lives of their own, they still feel stressed. The stress makes them worry less about sex and think of other things. Hence, they don’t view sex as a priority.

The researchers emphasized the need for more research and studies on the lack of libido in menopausal women since most body of knowledge focus on hormonal changes. Hearing what these women had to say develops new insights that may not be acquired through quantitative studies and large surveys.

Menopause and its health effects

Menopause is the period when the menstrual periods stop permanently, which means a women can’t get pregnant anymore. After menopause, the body produces less estrogen and progesterone, the female hormones. When there is a marked decrease in estrogen levels, it can affect health and cause various symptoms.

The common symptoms of menopause include a change in periods, hot flashes, dry vagina, loss of bladder control, trouble sleeping, less interest in sex or reduced sexual desire, mood changes, and body changes

Most women experience a change in their periods, with some periods closer together or having spotting. Some women may have periods that last for more than a week and heavy menstrual flow. Another common symptom is hot flashes, which can last a few years after menopause. This is due to reduced estrogen levels.

The vagina can also become drier, and some women may experience incontinence. Reduced vaginal lubrication can make sexual intercourse uncomfortable. They are also prone to having health problems, including vaginal and bladder infections. Women at this age may also lose bladder control, making them feel the sudden urge to urinate, or their urine may leak when laughing, exercising and sneezing.

Source:

https://www.upmc.com/media/news/111319-low-libido-older-women-thomas

Visit the Source Site

Powered by WPeMatico