by admin | Oct 17, 2013
Cardiovascular disease (CVD) and cancer are the most prevalent diseases in the current era, and the rates of these diseases continue to rise. More than 2 million breast cancer survivors in the United States are at risk for cardiotoxicity. Pediatric cancer survivors are two to five times more likely than the general population to develop heart disease. Treatment for cancer has become more effective, but cardiac disease in these patients has in turn become increasingly common. CVD can affect their quality of life as well as the course of cancer treatment. Preventing CVD in Cancer Patients Preventing CVD in cancer patients is important because aggressive cancer therapies are being used in older patients who may have cardiac problems or cardiovascular risk factors. Furthermore, researchers are identifying cardiac toxicities with new cancer therapies. Cardiotoxicity from cancer treatments include heart failure, hypertension, hypotension, arrhythmias, pericarditis, and myocardial ischemia. Radiation to the chest, leukemias, and chest tumors can lead to pericarditis, myocarditis, valve disease, and coronary artery disease. Diagnosing cardiotoxicity during cancer treatment can be challenging. Symptoms like fatigue, shortness of breath, and edema are common to cardiac problems but are also adverse effects of cancer therapy. When patients present with these symptoms, they should be referred to cardio-oncology programs for further evaluation. Collaborative Care Among Cardiologists & Oncologists At the University of Michigan, cardiologists are collaborating with oncologists to tailor cardiac and cancer therapy to minimize cardiotoxicity. We stratify risk in patients with cardiac disease or CVD risk factors in an effort to optimize these conditions prior to cancer treatment. Cardio-oncology programs: • Provide prevention and early detection of cardiac complications....
by admin | Sep 27, 2013
Cancer patients often experience a reduction in quality of life (QOL) during and after cancer treatment. Many experience pain, nausea, fatigue, sleep, and distress, among others. Family members caring for these patients often experience a lower QOL. Many studies have tested approaches to improve psychosocial functioning, but most have focused on only one aspect of psychosocial functioning. QOL is comprehensive and consists of five domains: cognitive, physical, emotional, social, and spiritual well-being. Testing a New Intervention for Patients Receiving Radiation In a study published in Cancer, my colleagues and I conducted a randomized trial in which we sought to help patients with advanced cancer receiving radiation therapy. Family members were also included in the study. While half of the participants stayed with their usual care during treatment, the other half participated in a multidisciplinary program of six, 90-minute sessions that formally addressed the five aforementioned domains of QOL. Each session included: • Physical therapy exercises to improve fatigue. • Discussions of topics like coping strategies or spiritual concerns. • Deep breathing or guided imagery to reduce stress. Our results demonstrated that the multidisciplinary intervention was effective in maintaining the QOL of patient participants. Conversely, patients who stayed with their standard routines showed a decline in QOL measures. Much of our program’s success was attributable to active engagement from patients. They also received support and encouragement to continue to practice the coping strategies, such as physical activity, spirituality—and relaxation—when cancer treatment was completed. More to Come: Maintaining Improved QOL Our study showed that our intervention can maintain QOL during cancer treatment, but unfortunately, our follow-up conducted 6 months after...
by admin | Aug 26, 2013
Studies have shown that patients with localized prostate cancer have favorable long-term overall survival rates and cancer-specific survival regardless of the treatment that is selected. Few prospective, randomized trials have looked at differences in survival outcomes between radical prostatectomy and external-beam radiation therapy. As a result, the decision-making process for clinicians and patients shifts. Treatment decisions become more about predicting functional outcome than about survival. Investigations with short-term and intermediate follow-up have identified incremental differences in functional outcome between patients undergoing prostatectomy and those receiving radiotherapy. While much is known about what happens the first several years after treatment, less is known about outcomes extending beyond 5 years. “Most patients live 10 to 20 years after treatment,” says David F. Penson, MD, MPH. “A careful evaluation of long-term functional outcomes can help us better understand the experience of men living with a diagnosis of prostate cancer.” Long-Term Function of Prostatectomy Vs Radiotherapy In a study published in the New England Journal of Medicine, Dr. Penson and colleagues prospectively compared urinary, sexual, and bowel function in 1,655 men with clinically localized prostate cancer, 1,164 of whom underwent prostatectomy, while 491 received radiotherapy. The study team also examined the extent to which men were bothered by declines in function at 15 years after prostatectomy or radiotherapy. Most of the men were in their 60s when they first received treatment. According to the results, men receiving prostatectomy were significantly more likely than those in the radiotherapy group to report urinary leakage and erectile dysfunction at 2 and 5 years after treatment. However, these problems increased in both groups over time, including 15...
by admin | Aug 2, 2013
Intra-abdominal injuries resulting from blunt torso trauma are a leading cause of morbidity in children and account for a significant number of ED admissions each year. Identifying these injuries early is critical to reducing morbidity and mortality from delayed or missed diagnoses. In recent years, CT has become standard for diagnosing many traumatic injuries, including those within the abdomen. At the same time, however, CT use in trauma and emergency care has expanded much faster than evidence for its use. “CT provides detailed and useful information about injuries and helps clinicians make informed management decisions,” explains James F. Holmes, MD, MPH, “but it also has its drawbacks. It exposes patients to relatively large radiation dosages, putting them at risk for radiation-induced malignancies.” Testing a Prediction Rule on Blunt Torso Trauma Recently, several smaller investigations have suggested that children with blunt torso trauma can be stratified by risk for intra-abdominal injury using a combination of readily accessible clinical factors. These studies, however, have been limited by their retrospective or single-center study designs and small samples. In an effort to overcome these limitations, Dr. Holmes and colleagues had a study published in Annals of Emergency Medicine that aimed to derive a prediction rule that identifies children with blunt torso trauma for whom CT would generally not be indicated. More than 12,000 children (average age, 11.1 years) from 20 EDs with blunt torso trauma were enrolled in the prospective analysis by Dr. Holmes’s study team. A prediction rule was created using a seven-item checklist that included patient history and physical examination variables readily available without the need for using laboratory or ultrasound...
by admin | May 28, 2013
Surgical resection of adenocarcinoma can significantly improve survival, but only 20% of patients are candidates to undergo this treatment. Typically, patients with unresectable pancreatic adenocarcinoma receive palliative, non-curative therapy. Recent research, however, suggests that accurate radiographic restaging, multimodality treatment, and advanced surgical technique can offer patients who have been previously deemed unresectable the possibility for curative salvage pancreatectomy. A New Approach for Pancreatic Cancer In the Journal of the American College of Surgeons, my colleagues and I at MD Anderson reported results from a study cohort of 88 high-risk patients who had been informed that their tumors were inoperable after an initial surgical attempt at removal. Of these patients, 66 completed a multidisciplinary treatment protocol with successful tumor removal. Risk for metastatic disease was stratified based on tumor involvement with local blood vessels, biopsy results and the nature of the tumor, and overall health status aside from pancreatic cancer. Patients who met these criteria underwent the MD Anderson protocol, which involved the following: A collaborative interpretation of pancreas-specific CT scans by surgeons and radiologists. Carefully administered preoperative chemotherapy and radiation treatment with multidisciplinary restaging prior to surgery. Use of advanced surgical techniques with planned removal and vascular reconstruction of involved blood vessels near the tumor. Using this protocol, we achieved survival numbers that are comparable to those of patients receiving surgery for clearly operable tumors. On average, patients undergoing the MD Anderson protocol lived about 30 months after tumor removal, which is almost three times longer than the average survival of 11 months for patients who do not undergo tumor resection. Key Considerations: Patient Selection & Imaging Our findings...
