Day: 02/18/2012

Polymorphisms in immune function genes and non-Hodgkin lymphoma survival.

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Cytokines play a critical role in regulating the immune system. In the tumor microenvironment, they influence survival, proliferation, differentiation, and movement of both tumor and stromal cells, and regulate tumor interactions with the extracellular matrix. Given these biologic properties, there is reason to hypothesize that cytokine activity influences the pathogenesis of non-Hodgkin lymphoma (NHL).

Methods

We investigated the effect of genetic variation in cytokine genes on NHL prognosis and survival by evaluating genetic variation in individual SNPs as well as the combined effect of multiple deleterious genotypes. Survival information from 496 female incident NHL cases diagnosed during 1996–2000 in Connecticut were abstracted from Connecticut Tumor Registry in 2008. Survival analyses were conducted by comparing Kaplan-Meier curves and hazard ratios (HR) were computed using Cox proportional hazard models adjusting for demographic and tumor characteristics for genes that were suggested by previous studies to be associated with NHL survival.

Results

We found that the variant IL6 genotype is significantly associated (HR = 0.42; 95%CI: 0.23–0.77) with a decreased risk of death, as well as relapse and secondary cancer occurrence, among those with NHL. We also found that risk of death, relapse, and secondary cancers varied by specific SNPs for the follicular, DLBCL, and CLL/SLL histologic types. We identified combinations of polymorphisms whose combined deleterious effect significantly alter overall NHL survival and disease-free survival.

Conclusion

Our study provides evidence that the identification of genetic polymorphisms in cytokine genes may help improve the prediction of NHL survival and prognosis.

Source: Journal of Cancer Survivorship

 

 

 

Late cardiotoxicity after low dose of anthracycline therapy for acute lymphoblastic leukemia in childhood .

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Late cardiotoxicity is a known complication of anthracycline therapy but the long-term effects of low cumulative doses are not well documented. We studied late cardiotoxicity in survivors of childhood acute lymphoblastic leukemia (ALL) treated with low anthracycline doses 10 to 20 years earlier.

Methods

Seventy-seven ALL survivors who received a cumulative anthracycline dose <250 mg/m² and were at least 10 years after treatment were evaluated for signs of clinical heart failure. Cardiac function was assessed by echocardiography including tissue Doppler measurements of the septal mitral annulus in 37 ALL survivors 10.6–18.3 years (median 13.3 years) after anthracycline treatment with cumulative doses of 180 (n = 19) or 240 mg/m² (n = 18). The control group consisted of 30 healthy volunteers matched for age, sex, BSA, and BMI.

Results

No clinical relevant cardiotoxicity was found. Left ventricular shortening fraction (SF) was significantly reduced in male ALL survivors. Three of the 19 male ALL survivors had an SF below 30%. Male ALL survivors showed a significantly lower early filling velocity to atrial contraction velocity ratio but myocardial velocity during early filling was comparable between patients and controls. ALL survivors had a significantly longer isovolumetric relaxation time (IVRT). Thirty percent of the ALL survivors have an abnormal IVRT compared to the normal range of the controls.

Conclusion and implications for cancer survivors

At a median of 13.3 years after exposure to cumulative doses of anthracyclines of 180 or 240 mg/m², no clinical relevant cardiotoxicity was found but subclinical cardiac abnormalities were present in 30% of the patients.

Source: Journal of Cancer Survivorship

 

 

 

Twenty-five years later—what do we know about religion/spirituality and psychological well-being among breast cancer survivors? A systematic review.

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A diagnosis of cancer is a life-changing event for most people. The trauma and uncertainties of a breast cancer diagnosis can affect survivors’ psychological well-being. Religion and/or spirituality can provide a means of support for many women as they live with the realities of a diagnosis of cancer. The purpose of this focused review is to critically analyze and synthesize relationships among psychological well-being, religion, and spirituality among women with breast cancer.

Methods

MEDLINE, CINAHL, Web of Science, Cambridge Scientific Abstracts, Cochrane CENTRAL, and PsycINFO databases were searched: January 1985–March 2010. The search terms religi*(religious/religion), spiritu*(spiritual/spirituality), breast cancer, psychological adjustment, psychological outcomes, psychological distress, psychological well-being, and outcomes were searched for separately and in combination.

Results

Eighteen quantitative studies were analyzed in order to examine associations among religion, spirituality, and psychological well-being for women diagnosed with breast cancer. These three variables were operationally defined as follows: (a) religious practice, religious coping, and perception of God; (b) spiritual distress, spiritual reframing, spiritual well-being, and spiritual integration; and (c) combined measure of both the religion and spirituality constructs.

Discussion/conclusions

Results of this review suggest that within this population, limited relationships exist among religion, spirituality, and psychological well-being. Given the various definitions used for the three variables, the strength and clarity of relationships are not clear. In addition, the time of assessment along the course of the disease varies greatly and in some instances is not reported. Diagnosis and/or prognosis, factors that could influence psychological well-being, are frequently not factored into results. There does, however, appear to be sufficient evidence to include a brief, clinically focused assessment of women diagnosed with breast cancer regarding the importance of a given belief system as they face the diagnosis and treatment of their disease.

Implications for cancer survivors

The implications for cancer survivors are as follows: (a) Psychological well-being of women diagnosed with breast cancer may depend to some extent on their belief system. (b) Coping through “turning to God” for women without a significant prior relationship with God, or minimal spiritual behaviors, may experience diminished well-being. (c) Longitudinal studies suggest that struggling with, or questioning, one’s belief system in early survivorship may also be associated with lower levels of well-being. This diminished well-being often resolves over time.

Source: Journal of Cancer Survivorship

 

 

 

Work ability of survivors of breast, prostate, and testicular cancer in Nordic countries: a NOCWO study .

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Cancer can cause adverse effects on survivors’ work ability. We compared the self-assessed work ability of breast, testicular, and prostate cancer survivors to that of people without cancer. We also investigated the association of disease-related and socio-demographic factors and job-related resources (organizational climate, social support, and avoidance behavior) with work ability and looked at whether these associations were different for the survivors and reference subjects.

Methods

Working aged cancer patients diagnosed between 1997 and 2002 were identified from hospital or cancer registries in Denmark, Finland, Iceland, and Norway (Nordic Study on Cancer and Work). A cancer-free reference group was selected from population registries. We collected information on work ability and other factors from 1,490 employed survivors and 2,796 reference subjects via a questionnaire.

Results

The adjusted mean value of work ability was slightly lower among the breast and prostate cancer survivors compared to the cancer-free population. Co-morbidity, chemotherapy, low workplace support, and low organizational commitment were associated with reduced work ability. Avoidance behavior from supervisors or colleagues was only related to work ability among the cancer survivors.

Conclusions and implications

More attention should be paid to assisting cancer survivors in work life, particularly those who have chronic diseases or have undergone chemotherapy. Although most factors affecting the work ability of the survivors and reference subjects were the same, survivors’ work ability seemed to be particularly sensitive to avoidance behavior. The results suggest that there is a need to improve communication at the workplace and develop supportive leadership practices in order to avoid isolating behavior towards cancer survivors.

Source: Journal of Cancer Survivorship

 

 

 

 

Sun exposure in young adult cancer survivors on and off the beach: results from Project REACH

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Although cancer survivors are at risk for future skin cancers, many do not practice recommended sun protection. Studies have demonstrated poor adherence to specific behaviors (e.g., sunscreen, artificial tanning) during sunbathing, but less is known about survivors’ typical amount of sun exposure during activities other than sunbathing.

Methods

We conducted a mailed survey of 153 adults (median age = 26.1) diagnosed with a non-skin cancer before age 30. Information on recent sunbathing and incidental sun exposures, protective behaviors, and perceived vulnerability was collected. Analyses focused on characterizing survivors with the lowest levels of recommended sun protection.

Results

Twenty-nine percent of participants exhibited low sun protection adherence during sunbathing and 31% during incidental exposure. Younger age was associated with low adherence, but this difference was significant only for sunbathing (OR=0.4; 95% CI, 0.2–0.9). Women were more likely than men to have low adherence during sunbathing (34.0% vs. 20.3%; OR = 2.44; 95% CI, 1.1–5.5). Survivors treated with radiation did not differ on exposures, adherence, or perceived vulnerability to the sun, despite feeling more susceptible to skin cancers (p = 0.03).

Conclusions

Despite known skin cancer risks, many young cancer survivors receive significant sun exposure. Assessment of sunbathing alone fails to capture sun exposure behaviors, particularly in men. Survivors treated with radiation may recognize their increased risk of skin cancer, but not the role of sun protection in modifying that risk.

Source: Journal of Cancer Survivorship

 

 

 

 

Comparison of physical activity levels between cancer survivors and non-cancer participants in the 2009 BRFSS.

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The purpose of this study is to compare physical activity (PA) levels between cancer survivors and those without cancer diagnosis (non-cancer participants).

Methods

Using data from the 2009 Behavioral Risk Factor Surveillance System, we conducted secondary data analysis to compare PA between 31,078 cancer survivors with history of single-site cancer diagnosis at least 2 years prior to the survey, including cancer survivors of prostate [n = 2,951], female breast [n = 5,695], colon [n = 1,436], cervix [n = 2,211], endometrium [n = 1,080], and ovary [n  = 732], and 235,351 non-cancer participants between 40 and 79 years of age. Self-reported PA and cancer history data were collected through telephone interviews. Weekly moderate- to vigorous-intensity PA levels were calculated in moderate-to-intensity physical activity equivalent (MIE). Least-squares means of MIE were obtained from sex, age groups (40–64 years [middle-aged] and 65–79 years [older]), and cancer site-specific multivariable linear regression models, adjusting for age, age2, race/ethnicity, household income, and education.

Results

Prostate cancer survivors reported participating in approximately 20 min/week more MIE, compared to their non-cancer counterparts (P < 0.10 for the middle-aged group; P < 0.01 for the older group). Middle-aged cervical and endometrial cancer survivors reported approximately 10 min/week less MIE (P < 0.05 and P < 0.15, respectively). Adjusted means of MIE were not different between cancer survivors of colon, female breast, or ovary and non-cancer participants.

Conclusions

This study demonstrates higher PA levels among prostate cancer survivors and lower PA levels among middle-aged cervical and endometrial cancer survivors, compared to sex- and age group-matched general populations.

Source: Journal of Cancer Survivorship

 

 

 

Physical activity among adult survivors of childhood lower-extremity sarcoma.

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Adult survivors of childhood lower-extremity sarcoma are largely physically inactive, a behavior which potentially compounds their health burden. Altering this behavior requires understanding those factors that contribute to their physical inactivity. Therefore, this investigation sought to identify factors associated with inactivity in this subpopulation of cancer survivors.

Methods

Demographic, personal, treatment, and physical activity information from adult survivors of childhood lower-extremity sarcomas was obtained from the Childhood Cancer Survivor Study (CCSS) cohort. Generalized linear models were used to identify variables that best identified those individuals who were physically inactive.

Results

Only 41% of survivors met Center for Disease Control (CDC) activity guidelines. Survivors were 1.20 (95% confidence intervals (CI) 1.11–1.30) more likely compared to CCSS sibling cohort and 1.12 (95% CI 1.10–1.15) times more likely than the general population to fail to meet CDC guidelines. Significant predictors of physical inactivity included female sex, hemipelvectomy surgery, and platinum and vinca alkaloid chemotherapy.

Conclusions

The primary findings of this study are that survivors of childhood onset lower-extremity sarcoma are (1) highly likely to be physically inactive and (2) less likely than their siblings or the general population to regularly exercise. This study has identified treatment-related risk factors associated with inactivity that will help health and wellness practitioners develop successful exercise interventions to help these survivors achieve recommended levels of physical activity for health.

Implications for cancer survivors

These results suggest that physical activity interventions for adult survivors of childhood lower-extremity sarcomas should be sex specific and responsive to unique physical late effects experienced by these survivors.

Source: Journal of Cancer Survivorship

 

 

 

Defining cancer survivorship: a more transparent approach is needed .

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There is a lack of a consistent, operational definition of what it means to be a cancer survivor despite widespread use of the term. The term carries positive connotations of ‘beating’ cancer, but some people living past cancer do not identify with this portrayal.

Methods

The term ‘cancer survivor’ was first developed and used in the USA for advocacy reasons and to promote research and care of this growing population. Some organizations define a cancer survivor from the time of cancer diagnosis. Researcher and policy makers may use different definitions based on their research or funding priorities.

Results

The use of the term ‘cancer survivor’, its acceptability and its interpretation amongst people living past a cancer diagnosis and primary treatment is relatively understudied. There may be numerous interpretations of cancer survivorship amongst people living past cancer, and some individuals may not relate to the term.

Discussion and implications for cancer survivors

Instead of working towards a universal definition of cancer survivorship, we suggest that researchers and policy makers use operational descriptions when discussing the diverse population of people living past a cancer diagnosis.

Source: Journal of Cancer Survivorship

 

Breast and colorectal cancer survivors’ knowledge about their diagnosis and treatment .

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Aspects of a personal cancer history can have implications for future decisions regarding screening, diagnosis, and treatment. Clinicians must sometimes rely on patients’ self-report of their medical history. This study assessed knowledge of details of cancer diagnosis and treatment among breast and colorectal cancer survivors.

Methods

Written surveys were completed by 480 breast cancer survivors and 366 colorectal cancer survivors diagnosed between 1999 and 2008 at a large cancer center in the Minneapolis, MN, area (81% response rate). Responses were compared with cancer registry and medical records.

Results

Forty percent of breast cancer survivors and 65% of colorectal cancer survivors were unable to identify their stage of disease. Seven percent of breast cancer survivors and 21% of colorectal cancer survivors in whom regional nodes were examined did not know whether they had positive nodes. Accuracy of knowledge of estrogen and progesterone status among breast cancer survivors was 58% and 39%, respectively. Of breast cancer survivors treated with doxorubicin, 43% correctly identified it as a drug they had received. Their accuracy of identification of receipt of tamoxifen or specific aromatase inhibitors was >90%. Of colorectal cancer survivors treated with oxaliplatin, 52% correctly identified it as a drug they had received. Accuracy on many items decreased with patient age.

Conclusions

This study identifies several gaps in adult cancer survivors’ knowledge of details of their diagnosis and treatment that have implications for follow-up care.

Implications for cancer survivors

Provision of written treatment summaries to cancer survivors could help them obtain appropriate patient-centered long-term follow-up care.

Source: Journal of Cancer Survivorship

 

 

 

 

 

A Possible New Treatment for Alcoholism.

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An active ingredient in a Chinese herbal remedy for hangovers shows many promising effects in a series of animal experiments.

Medications approved for the treatment of alcoholism — disulfiram, naltrexone, and acamprosate — have had less than inspiring results. In this series of experiments, researchers gave rats alcohol, the novel herbal flavonoid dihydromyricetin (DHM), or both in combination, and the results suggest a novel approach to treating multiple aspects of alcohol dependence.

DHM reversed alcohol intoxication, as measured by the animals’ ability to right themselves after receiving alcohol; this effect was blocked by the benzodiazepine receptor antagonist flumazenil. DHM prevented alcohol tolerance and reduced alcohol intake in animals trained to prefer alcohol. During alcohol withdrawal, DHM ameliorated anxiety-like behavior (measured by time in the open arms of an elevated maze) and reduced susceptibility to pentylenetetrazol-induced seizures. In neuronal cultures, DHM antagonized potentiation of –aminobutyric acid (GABA) type A receptor currents by alcohol (flumazenil again blocked DHM’s effect), but DHM itself potentiated those currents, prevented up-regulation of GABAA receptors during alcohol withdrawal, and inhibited binding of a benzodiazepine to the benzodiazepine receptor.

Comment: Doses of dihydromyricetin, which is derived from Hovenia dulcis, were equivalent to human doses used to treat hangovers. Apparently, DHM has a complex agonist effect on the benzodiazepine receptor, which is a component of the GABAA receptor complex that facilitates hyperpolarizing chloride currents through the GABA-benzodiazepine receptor complex. Thus, DHM can block multiple effects of alcohol without causing impairment or dependence itself. DHM’s agonistic effect may also decrease up-regulation of the receptor complex and inhibit the action of picrotoxin, which reduces GABAA currents, an inverse agonistic mechanism that contributes to the neuronal excitability associated with alcohol withdrawal. Previous human experience with Hovenia suggests that DHM may be ready for human testing.

Source: Journal Watch Psychiatry