Day: 06/19/2013

A vaccine that prevents cervical cancer becomes more widely available to millions of women around the world.

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When a major global vaccine alliance announced today that it had struck an agreement with two pharmaceutical companies to drastically reduce the price of human papillomavirus (HPV) vaccines in poor countries, there was plenty to celebrate at Fred Hutch.

Fred Hutch, via Dr. Denise Galloway and colleagues, made major breakthrough contributions to the vaccine that prevents HPV.

Their work showed that HPV is associated with nearly all genital-tract cancers and with many head and neck cancers. Her team also played a pivotal role in identifying how HPV causes cancer.

Cervical cancer used to be one of the most common causes of cancer death among American women, but thanks to widespread use of the Pap test, early detection and the introduction of the HPV vaccine, it’s no longer one of the biggest cancer threats.

“In just 25 years, we went from not having any idea what viruses were involved in these cancers to having a vaccine,” Galloway said in a previous interview about her work. “That’s amazingly fast.”

 

However, Galloway has often said it is imperative to take the vaccine into low-income countries, where HPV is a major killer of women, and where a vaccine would do the most good.

The price of the vaccine, which is about $300 for the three needed doses in the U.S. and other developed nations, is out of reach for poor women in Africa, Asia, Latin America and other parts of the world.

And yet, according to the World Health Organization, cervical cancer remains the second most common cancer in the world, with more than 500,000 new cases and 275,000 deaths each year—virtually all linked to HPV. More than 85 percent of cervical cancer deaths occur in developing countries.

This is why the agreement reached by the Global Alliance for Vaccines and Immunization with Merck, the maker of Gardasil vaccine, and GlaxoSmithKline, the maker of Cervarix, is so important.

Both companies have agreed to sell their vaccines in poor countries for under $5 per dose.

It’s certainly a transformational moment—a cause for celebration here and around the globe as research continues to move forward against cancer.

Source: questmagazine

 

 

 

 

 

 

Effects of Patient-Directed Music Intervention on Anxiety and Sedative Exposure in Critically Ill Patients Receiving Mechanical Ventilatory SupportA Randomized Clinical Trial.

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ABSTRACT

Importance  Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support.

Objective  To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients.

Design, Setting, and Patients  Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis–St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days.

Interventions  Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125).

Main Outcomes and Measures  Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency).

Results  Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity.

Conclusions and Relevance  Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH.

Source: JAMA

 

 

‘MAN OF STEEL’ BURNING QUESTIONS: SUPERMAN KILLS? JIMMY OLSEN’S AWOL? AND MORE SPOILERS!

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Man of Steel, the Zack Snyder-directed reimagining of Superman, certainly didn’t encounter kryptonite at the box office. But we’d venture to say that many of the people who helped propel it to a $116 million weekend haul left the theater scratching their heads. Was that dragon creature upon which Russell Crowe‘s Jor-El rode over Krypton from the same genus as the flying beasts in Avatar? Why did Harry Lennix and Chris Meloni’s military men have more screentime than Laurence Fishburne‘s Perry White? Is everyone else as disappointed as I am thatMichael Shannon didn’t scream “Kneel before Zod“?  So many questions. Here are eight which we feel we can more or less answer. But beware!Major SPOILERS ahead.

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1. Is Man of Steel pretty much just the story of Jesus?
Unbelievably, even more so than Superman Returns. Sure, the 2006 picture had Brandon Routh’s Son of Krypton endure a kryptonite scourging that would have fit if the movie had been called The Passion of Kal-El. But Man of Steel goes further. It makes it very clear that Superman is 33 years old when he first chooses to don the cape and become a symbol of hope for humanity. His arms are outstretched, crucifix-style, when floating through space. He turns himself in, preparing to sacrifice himself to “save” humankind. And you could sub in God as easily as Jor-El when Kevin Costner’s Jonathan Kent talks about the “other father” who sent Clark to Earth.

2. Has it ever been established before that one Kryptonian can kill another Kryptonian just by snapping his neck? And wait, I thought Superman had a code never to kill?
In any of the main DC Comics universes, Superman has never killed a sentient being. However, in the 1988 comic Superman #22, with art by John Byrne, Superman does kill a General Zod from a “pocket universe” using Gold Kryptonite. The experience does leave him shattered, and he begins to question whether he himself is a dangerous being — moral uncertainty that Henry Cavill’s self-righteous Zod-killing Superman inMan of Steel does not seem to possess. Moreover, it hasn’t ever been established that a Kryptonian fighting a Kryptonian while on Earth could kill the other just by breaking his neck. You would need Kryptonite to do that or a molecular chamber like in Superman II — where it isn’t clear if Zod and his companions actually are killed when they’re rendered human. If just snapping Zod’s neck could kill him, it makes sense Superman would kill him before he could kill those huddled people with his X-ray vision. But why didn’t he kill Zod before the general destroyed much of Metropolis?

3. Have Kryptonians ever had difficulty adapting to Earth’s atmosphere in previous Superman storytelling?
Not really. This seems to be an invention of screenwriters Christopher Nolan and David S. Goyer to make them seem less godlike. Zod and Faora can still fly and repel bullets, but they need to wear breathing masks so as not to be overwhelmed by the low-density atmosphere of Earth.

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4. What does Zod’s symbol stand for?
As we learn during his incarcerated conversation with reporter Lois Lane, Clark Kent‘s “S” is actually a Kryptonian symbol that signifies the idea of hope. On the chest of the nefarious General Zod, there lives another symbol (albeit a slightly S-like one in its own right). But if Clark’s is hope, then what is Zod’s swirly insignia meant to stand for?

5. Where’s Jimmy Olsen? And who the hell is this Steve a**hole?
Although we might better remember bumbling photographer Jimmy Olsen from small screen Superman, Daily Planet reporter Steve Lombard (portrayed here by Michael Kelly) is also a character from DC Comics history, first appearing in a 1973 issue.

6. Krypton is a planet with rhino dragons and embryoceans, but people can still give birth vaginally?
Essentially, the Kryptonian appears to be built exactly like the standard Earth human, right down to the reproductive organs. Sure, they generally create offspring via some weird kind of undersea embryo system, but there’s at least the option of the old fashioned way.

7. Who Did Superman Vote For?
Man Of Steel takes place in the present day, making an adult American citizen Clark Kent eligible to vote in 2012. So who did he vote for? As a bona fide proud Kansan, we might assume he has Red State leanings. Then again, his “S” does stand for “hope,” and that is Barack Obama’s go-to branding device.

8. Is Jonathan Kent’s death exactly the same as that of Helen Hunt’s father at the beginning of Twister?
Yes.

Source: http://www.hollywood.com

 

 

Hans-Peter Kiem genetically manipulates stem cells to treat HIV, genetic diseases and cancers.

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Fred Hutch oncologist, stem cell and gene therapy researcher

Imagine if we could treat deadly diseases by generating healthier versions of the very building blocks of our bodies—blood stem cells. That’s the vision of Dr. Hans-Peter Kiem, whose Hutchinson Center laboratory is working to make such therapies a reality.

“Not long ago, this was science fiction,” he said.

Kiem’s cutting edge research reflects his longstanding interest in blood stem cell transplantation, now one of the standard treatments for many blood cancers, in which the patient receives an infusion of blood stem cells, either from a donor or from the patient’s own multiplied cells. The idea is that the new stem cells will grow into disease-free blood cells—a concept that Kiem’s research takes a step further.

“Stem cells can do everything,” said Kiem, who first came to the Hutchinson Center as a fellow in 1992 and joined the faculty five years later. “If we can correct defective stem cells, we can cure diseases.”

Kiem and his colleagues investigate how stem cells can be extracted from sick patients, manipulated at a genetic level and then delivered back to them to treat a range of diseases, from infections like HIV to genetic diseases to aggressive cancers.

One ongoing research effort confronts a major challenge in cancer treatment: Patients can receive only so much chemotherapy at a time, or else their blood cell counts may drop to a level that invites infections, anemia, excessive bleeding and other serious health complications. In such a scenario, the patient must stop receiving chemotherapy until the cell counts recover to healthy levels—but meanwhile, the cancer can worsen.

Kiem’s lab has developed a way to extract a patient’s blood stem cells and insert a special “resistance” gene that is designed to protect the cells from damage by common chemotherapy drugs such as temozolomide and BCNU. An infusion of these enhanced cells could give new hope to patients with the most aggressive form of brain cancer—glioblastoma—which is very difficult to treat. A small study for glioblastoma patients that Kiem started in fall 2009 is showing promising initial results and continuing to expand.

Kiem is also planning a study of patients with AIDS and lymphoma, who would receive blood stem cells with two inserted genes: one that counteracts the HIV infection and one that protects the patient from chemotherapy’s effects.

More recently Kiem has extended his work to derive blood stem cells from a new class of stem cells called induced pluripotent stem cells. What makes pluripotent stem cells promising for new treatments is that they can be derived from readily accessible adult tissues, such as skin cells, and can mature into many other types of tissues and cells, including blood stem cells. These blood stem cells could in turn be expanded and used for blood stem cell transplantations, offering a new treatment option for patients with defective marrow or immune function.

Kiem’s groundbreaking work led to his selection in 2009 as the recipient of the first José Carreras/E. Donnall Thomas Endowed Chair for Cancer Research. The award is named for internationally known tenor and leukemia survivor Carreras and Thomas, who developed bone marrow transplantation.

“Don Thomas was pursuing something that was at that time viewed as very difficult,” Kiem said. “It’s a bit of the same thing right now for gene therapy in stem cells. I hope that in 10 or 20 years it will be like what Don has achieved.”

Source: Fred Hutchinson Cancer Research Center

 

 

 

Immune cells that suppress genital herpes infections identified.

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Discovery has implications for development of a vaccine to prevent and treat HSV-2 and similar infections

Fred Hutchinson Cancer Research Center and University of Washington scientists have identified a class of immune cells that reside long-term in the genital skin and mucosa and are believed to be responsible for suppressing recurring outbreaks of genital herpes. These immune cells also play a role in suppressing symptoms of genital herpes, which is why most sufferers of the disease are asymptomatic when viral reactivations occur.

The discovery of this subtype of immune cells, called CD8αα+ T cells, opens a new avenue of research to develop a vaccine to prevent and treat herpes simplex virus type 2, or HSV-2. Identifying these T cells’ specific molecular targets, called epitopes, is the next step in developing a vaccine.

The findings are described in the May 8 advance online edition of Nature.

Better understanding of these newly identified CD8αα+ T cells may also play a critical role in developing effective vaccines against other types of skin and mucosal infections, according to senior author Larry Corey, M.D., an internationally renowned virologist and president and director of Fred Hutch.

“The discovery of this special class of cells that sit right at the nerve endings where HSV-2 is released into skin is changing how we think about HSV-2 and possible vaccines,” said Corey. “For the first time, we know the type of immune cells that the body uses to prevent outbreaks. We also know these cells are quite effective in containing most reactivations of HSV-2. If we can boost the effectiveness of these immune cells we are likely to be able to contain this infection at the point of attack and stop the virus from spreading in the first place. We’re excited about our discoveries because these cells might also prevent other types of viral infections, including HIV infection.”

There is currently no effective vaccine for genital herpes. “While antiviral treatment is available, the virus often breaks through this barrier and patients still can transmit the infection to others,” Corey said.  “In addition, newborn herpes is one of the leading infections transmitted from mothers to children at the time of delivery. An effective genital herpes vaccine is needed to eliminate this complication of HSV-2 infection.”

The long-term persistence of CD8αα+ T cells where initial infection occurs may explain why patients have asymptomatic recurrences of genital herpes because these cells constantly recognize and eliminate the virus, according to Jia Zhu, Ph.D., corresponding author, research assistant professor in Laboratory Medicine at the University of Washington and an affiliate investigator in the Fred Hutch Vaccine and Infectious Disease Division.

“The cells we found perform immune surveillance and contain the virus in the key battlefield where infection occurs, which is the dermal-epidermal junction,” said Zhu. “These cells are persistent in the skin and represent a newly discovered phenotype distinguished from those of CD8+ T cells circulating in the blood.”

The dermal-epidermal junction (DEJ) is where the dermis (the tissue layers just beneath the skin) connects to the epidermis (outer skin layer). This junction is important because of the roles it plays in cellular communication, nutrient exchange and absorption, and other skin functions.

Scientists examined the DEJ for T cell activity because this is where the genital herpes virus multiplies after reactivating and traveling from its hiding place in the body’s sensory neurons. Previous research by the same research group showed that the nerve endings reach the dermal-epidermal junction and release the virus that infects the skin and can cause lesions.

Prior to this research, CD8αα+ T cells were known to exist in the gut mucosa. Much of the research on CD8+ T cells has focused on studying them in the circulating blood, which has a dominant phenotype of CD8αβ+. Fred Hutch and UW scientists compared the two types of CD8+ T cells and found that only the CD8αα+ T cells persist in the skin while CD8αβ+ T cells diminished from the tissue after healing of a herpes lesion.

“We did not expect to find CD8αα+ T cells in the skin,” Zhu said. “This was a surprise.”

The research involved using novel technologies to examine the T cells in human tissues. In all, the work provides a roadmap that can be applied to other human diseases, according to Zhu.

Zhu said the studies the research group performed in humans are unique. “To our knowledge, we are the only research group to use sequential human biopsies to study CD8+ T cell function in situ, in their natural spatial distribution and at their original physiological state,” she said.

According to the federal Centers for Disease Control and Prevention, 776,000 people in the United States are newly infected with herpes annually. Nationwide, 16.2 percent, or about one out of six people aged 14 to 49 years have genital HSV-2 infection.  Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

Most individuals infected with HSV-2 or the related HSV-1, which causes genital herpes and cold sores, experience either no symptoms or have very mild symptoms that go unnoticed or are mistaken for another skin condition. Because of this, most people infected with HSV-2 are not aware of their infection.

Grants from the National Institutes of Health and the James B. Pendleton Charitable Trust funded the study. Researchers from the University of Washington and the Benaroya Research Institute also contributed to the study.

Source: Fred Hutchinson Cancer Research Center

 

 

Fred Hutchinson transplant program pioneers treatment options for minority patients struggling to find a donor match.

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Patients from ethnic minority and mixed-racial backgrounds are less likely to receive a lifesaving bone marrow transplant than Caucasian patients with the same disease due to lack of matching donors, according to the National Marrow Donor Program (NMDP).

The likelihood of a patient finding a bone marrow donor match is highly dependent on genetic similarities between the patient and donor. Seventy percent of patients in need of a transplant do not have a matching donor in their family, according to Be The Match, operated by the NMDP. These patients must instead turn to a donor registry or alternative methods for treatment. Unfortunately, few minority patients have either a matched family member or an identified matched unrelated donor. This is due to complex genetic factors and low donor-registration numbers.

Seattle Cancer Care Alliance (SCCA) is working with Fred Hutchinson Cancer Research Center to pioneer new lifesaving transplant procedures to reduce the need for matching bone marrow donors by providing bone marrow or blood stem cell transplants to patients who would not typically be candidates due to lack of a matching donor.

“The striking difference in donation levels echoes the need to raise awareness of the bone marrow and umbilical cord blood donation registries, while continuing the development of transplant programs that expand the availability of these life-saving treatment to more people,” said SCCA’s Colleen Delaney, M.D., MSc, director of the Cord Blood Transplant Program and associate member of the Clinical Research Division at Fred Hutch. “Thanks to innovative treatments developed at Fred Hutch and available today through the SCCA Transplant Program, nearly all patients in need of a bone marrow or blood stem cell transplant will be able to identify a donor. Our goal is to make sure every patient who needs a blood stem cell transplant will get one with survival rates that are equivalent to conventional unrelated donors.”

Delaney is a renowned expert in the development of novel methods to grow cord blood stem cells in the laboratory and has pioneered steps toward reducing the risk of life-threatening infections in patients who receive a cord blood transplant.

Cord blood is unique from other sources of stem cells for bone marrow transplants. This leftover blood in the umbilical cord, which is collected immediately after birth without harm to the infant or mother, contains immune cells that are protected from foreign invaders such as bacteria and viruses. Due to this protection, these “naive” immune cells do not perceive a patient’s unmatched stem cells as a threat. This means cord blood transplants do not require a near identical genetic match between donor and patient for successful treatment. Most cord blood transplants involve a genetically mismatched donor and patient.

While cord blood transplant recipients have been at high risk for early post-transplant complications due to the low number of cells available in a single cord blood unit, Delaney’s innovative methods for expanding the number of cord blood cells per unit prior to transplant have been able to reduce such risks.

Jessie Quinn, a patient of half-Caucasian and half-African American ancestry, knows first-hand the lifesaving promise of expanded cord blood cells method. A survivor of acute myelogenous leukemia (AML), Quinn was the first patient to participate in an SCCA clinical study led by Delaney using her novel approach with expanded cord blood cells. Quinn credits her survival to the Fred Hutchinson Transplant Program at SCCA and her doctors’ dedication to developing innovative options for patients unable to find a donor match.

The Fred Hutchinson Transplant Program at SCCA also provides successful haploidentical transplants for patients unable to find a relative who is a perfect match. Led by Paul O’Donnell, M.D., Ph.D., medical director of SCCA’s Adult Transplant Service and researcher in the Clinical Research Division at Fred Hutch, haploidentical transplants are performed when a patient’s relative offers a partial donor match. Through advances in drug therapies, physicians are able to control the adverse immune system responses that previously prevented these partially matched relatives from serving as donors. Haploidentical transplants are especially beneficial for pediatric patients using their parents or siblings as donors.

“Patients should not give up hope if they run into difficulties finding a donor,” O’Donnell said. “At SCCA, we are committed to turning cancer patients into cancer survivors. Sometimes that means exploring alternative options and looking into clinical trials to help our patients conquer cancer. The Fred Hutchinson Transplant Program at SCCA offers patients additional treatment plans when they often believe they are out of options.”

O’Donnell is currently leading a multi-center, randomized clinical trial to determine the effectiveness of double unrelated umbilical cord blood transplants versus haploidentical related bone marrow transplants in people with leukemia or lymphoma. He is actively recruiting patients. A multi-center randomized Phase II study led by Delaney is also currently recruiting patients to evaluate the clinical efficacy of giving study participants umbilical cord blood cells that have been expanded in the laboratory to increase the number of cells available for the transplant.

SCCA has been at the forefront of revolutionizing transplant treatment options since the clinical use of bone marrow and stem cell transplantation was first developed at the Fred Hutch more than 40 years ago. One of its founders, E. Donnall Thomas, M.D., won the 1990 Nobel Prize in physiology or medicine for this groundbreaking work. As a result of Thomas’ innovation, the world’s millionth blood stem cell transplant procedure took place in January of this year. To date, SCCA’s doctors have performed more than 14,000 bone marrow transplants and the clinic consistently ranks among the country’s top transplant centers in one-year patient survival rates.

Fred Hutch continues to lead transplant research and has pioneered the use of transplants to treat autoimmune disorders and other, non-cancerous diseases. By developing “mini-transplants” that use minimal doses of radiation resulting in reduce side effects, older patients who were not previously eligible for transplants now have an additional treatment option.

For more information about the Fred Hutchinson Transplant Program at SCCA, please visit:http://www.seattlecca.org/diseases/bone-marrow-transplant-overview.cfm.

Source: Fred Hutchinson Cancer Research Center

 

 

Cancer diagnosis puts people at greater risk for bankruptcy.

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Study also shows younger cancer patients are most vulnerable to financial stress

People diagnosed with cancer are more than two-and-a-half times more likely to declare bankruptcy than those without cancer, according to a new study from Fred Hutchinson Cancer Research Center. Researchers also found that younger cancer patients had two- to five-fold higher bankruptcy rates compared to older patients, and that overall bankruptcy filings increased as time passed following diagnosis.

The study, led by corresponding author Scott Ramsey, M.D., Ph.D., an internist and health economist at Fred Hutch, was published online on May 15 as a Web First in the journal Health Affairs. The article will also appear in the journal’s June edition.

Ramsey and colleagues, including a chief judge for a U.S. Bankruptcy Court, undertook the research because the relationship between receiving a cancer diagnosis and bankruptcy is less well understood than the much-studied link between high medical expenses and likelihood of bankruptcy filing.

“This study found strong evidence of a link between cancer diagnosis and increased risk of bankruptcy,” the authors wrote. “Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients. Our study thus raises important questions about the factors underlying the relationship between cancer and financial hardship.”

For this study, researchers analyzed data from a population-wide registry of individuals over age 21 who lived in western Washington and who were diagnosed with cancer between Jan. 1, 1995 and Dec. 31, 2009. They were compared to a randomly sampled age-, sex-, and ZIP code-matched population of people without cancer. Cancer cases were identified using the Cancer Surveillance System of Western Washington, a population-based cancer registry based at Fred Hutch that is part of the National Cancer Institute’s Surveillance Epidemiology and End Results Program (SEER).

The cancer and control cohorts were both linked with the records of the U.S. Bankruptcy Court for the Western District of Washington. The court serves 19 counties in western Washington, including all 13 counties represented in the Cancer Surveillance System of Western Washington. Researchers included Chapter 7 or Chapter 13 bankruptcy filings only.

“This is the strongest evidence we have between a disease and risk for severe financial distress,” Ramsey said. “I’ve not seen other studies that linked databases of this quality.”

Ramsey directs the Hutchinson Institute for Cancer Outcomes Research (HICOR), which is dedicated to health economics and cancer outcomes research. Its mission is to improve the efficiency and effectiveness of cancer prevention, early detection and treatment to reduce the economic and human burdens of cancer. HICOR is believed to be the first of its kind among comprehensive cancer centers nationwide.

Among the study’s key findings:

  • Between 1995 and 2009 there were 197,840 people in western Washington who were diagnosed with cancer and met the inclusion criteria for the study. Of those, 4,408 (2.2 percent) filed for bankruptcy protection after diagnosis. Of the matched controls who were not diagnosed with cancer, 2,291 (1.1 percent) filed for bankruptcy.
  • Compared to cancer patients who did not file for bankruptcy, those who did were more likely to be younger, female and nonwhite. The youngest age groups had up to 10 times the bankruptcy rate as compared to the older age groups. The authors noted that because cancer is generally a sudden and unexpected event, the risk of bankruptcy is influenced by factors such as debt load before diagnosis, assets, presence and terms of health and disability insurance, number of dependent children, and incomes of others in the household at the time of the cancer diagnosis.

“The youngest groups in the study were diagnosed at a time when their debt-to-income ratios are typically highest — often unavoidably, because they are paying off student loans, purchasing a home, or starting a business,” the authors wrote. “All working-age people who develop cancer face loss of income and, in many cases, loss of employer-sponsored insurance, both of which can be devastating for households in which the patient is the primary wage earner.”

In contrast, people age 65 or older generally have Medicare insurance and Social Security benefits. These older people are likely to have more assets and possibly more income than working-age people. “However, it is likely that having stable insurance (specifically, coverage not tied to employment) plays a major role in mitigating the risk of bankruptcy for those over age sixty-five,” the authors wrote.

  • The proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, compared to 0.16 percent within one year for the control group. For bankruptcy filings within five years of diagnosis, the proportion of cancer patients was about 1.7 percent, compared to 0.7 percent for the control group.
  • The incidence rates for bankruptcy at one year after diagnosis for the cancers with the highest overall incidence rates, stated as rates per 1,000 person years from diagnosis, were as follows: thyroid, 9.3; lung, 9.1; uterine, 6.8; leukemia/lymphoma, 6.2; colorectal, 5.9; melanoma, 5.7; breast, 5.7; and prostate. 3.7. The incidence rate for all cancers combined was 6.1. (Person-years takes into account the number of people in the study and the amount of time each person spent in the study.)

The high bankruptcy incidence rate for those with thyroid cancer may be because thyroid cancer affects younger women more often than other cancers do according to the researchers. “Compared to men, younger women are more likely to live in single-income households and to have lower wages and lower rates of employment, and therefore less access to high-quality health insurance – leaving them more financially vulnerable,” the authors wrote.

Source: Fred Hutchinson Cancer Research Center

 

 

Taking cholesterol-lowering drugs may also reduce the risk of dying from prostate cancer, study finds.

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Men who take statins are less likely to die from prostate cancer than those who don’t

 

– Men with prostate cancer who take cholesterol-lowering drugs called statins are significantly less likely to die from their cancer than men who don’t take such medication, according to study led by researchers at Fred Hutchinson Cancer Research Center. The findings are published online today in The Prostate.

The study, led by Janet L. Stanford, Ph.D., co-director of the Prostate Cancer Research Program and a member of the Hutchinson Center’s Public Health Sciences Division, followed about 1,000 Seattle-area prostate cancer patients. Approximately 30 percent of the study participants reported using statin drugs to control their cholesterol. After a mean follow-up of almost eight years, the researchers found that the risk of death from prostate cancer among statin users was 1 percent as compared to 5 percent for nonusers.

“If the results of our study are validated in other patient cohorts with extended follow-up for cause-specific death, an intervention trial of statin drugs in prostate cancer patients may be justified,” Stanford said.

“While statin drugs are relatively well tolerated with a low frequency of serious side effects, they cannot be recommended for the prevention of prostate cancer-related death until a preventive effect on mortality from prostate cancer has been demonstrated in a large, randomized, placebo-controlled clinical trial,” said first author Milan S. Geybels, M.Sc., formerly a researcher in Stanford’s group who is now based at Maastricht University in The Netherlands.

The study is unique in that most prior research of the impact of statin use on prostate cancer outcomes has focused on biochemical recurrence – a rising PSA level – and not prostate cancer-specific mortality. “Very few studies of statin use in relation to death from prostate cancer have been conducted, possibly because such analyses require much longer follow-up for the assessment of this prostate cancer outcome,” Geybels said.

The potential biological explanation behind the association between statin use and decreased mortality from prostate cancer may be related to cholesterol- and non-cholesterol-mediated mechanisms.

  • An example of the former: When cholesterol is incorporated into cell membranes, these “cholesterol-rich domains” play a key role in controlling pathways associated with survival of prostate cancer cells.
  • An example of the latter: Statin drugs inhibit an essential precursor to cholesterol production called mevalonate. Lower levels of mevalonate may reduce the risk of fatal prostate cancer.

“Prostate cancer is an interesting disease for which secondary prevention, or preventing poor long-term patient outcomes, should be considered because it is the most common cancer among men in developed countries and the second leading cause of cancer-related deaths,” Geybels said. “While many prostate cancer patients have indolent, slow-growing tumors, others have aggressive tumors that may recur or progress to a life-threatening disease despite initial therapy with radiation or surgery. Therefore, any compound that could stop or slow the progression of prostate cancer would be beneficial,” he said.

Source: Fred Hutchinson Cancer Research Center

 

 

Alcohol consumption has no impact on breast cancer survival, according to new research.

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However, breast cancer survivors who consume alcohol in moderation may have a reduced risk of dying from heart disease

Although previous research has linked alcohol consumption to an increased risk of developing breast cancer, a new study has found that drinking before and after diagnosis does not impact survival from the disease. In fact, a modest survival benefit was found in women who were moderate drinkers before and after diagnosis due to a reduced risk of dying from cardiovascular disease, a major cause of mortality among breast cancer survivors.

The study results will be published in the April 8 edition of the Journal of Clinical Oncology. Polly Newcomb, Ph.D., a member of the Public Health Sciences Division and head of the Cancer Prevention Program at Fred Hutchinson Cancer Research Center, led the study.

“Our findings should be reassuring to women who have breast cancer because their past experience consuming alcohol is unlikely to impact their survival after diagnosis,” said Newcomb. “This study also provides additional support for the beneficial effect of moderate alcohol consumption with respect to cardiovascular disease.”

The study was based on data from almost 23,000 women with breast cancer who participated in theCollaborative Breast Cancer Study, a National Cancer Institute-sponsored, multi-site, population-based study of risk factors for breast cancer, and the largest such study of its kind. The study began in 1988 and was conducted in New Hampshire, Massachusetts and Wisconsin. In a smaller follow-up study between 1998 and 2001, about 5,000 study participants with breast cancer were also sent a follow-up questionnaire about their alcohol consumption habits after diagnosis.

Among study participants with a history of breast cancer, the authors found that the amount and type of alcohol a woman reported consuming in the years before her diagnosis was not associated with her likelihood from dying from breast cancer. However, the authors also found that those who consumed a moderate level of alcohol (three to six drinks per week) in the years before their cancer diagnosis were 15 percent less likely to die from cardiovascular disease than non-drinkers. Moderate wine consumption in particular was associated with a lower risk of cardiovascular disease mortality, while no such benefit was evident for consumption of beer or spirits, or for heavier levels of alcohol consumption.

Similar patterns were evident when considering reported alcohol consumption after breast cancer diagnosis. The amount and type of alcohol a woman consumed after diagnosis did not appear to be associated with survival of breast cancer, but those who consumed alcohol in moderation experienced a 40- to 50-percent lower mortality rate from cardiovascular disease.

What could account for the difference in alcohol’s impact on developing breast cancer risk and on survival from the disease? “It could be that the kind of breast cancer that is more likely to be diagnosed among women who drink may be more responsive to hormone-modifying therapies,” Newcomb said. Alcohol consumption is believed to influence breast cancer risk through increases in estrogen production in both pre- and post-menopausal women.

Funding for the study was provided by grants from the National Cancer Institute and Komen for the Cure. Co-authors included researchers from the University of Wisconsin Paul B. Carbone Comprehensive Cancer Center, Wageningen University in the Netherlands, H. Lee Moffitt Cancer Center, Norris Cotton Cancer Center, the University of North Carolina Lineberger Cancer Center and Research Institute, and Harvard Medical School and Brigham and Women’s Hospital.

 

Source: Fred Hutchinson Cancer Research Center

 

Antiretroviral PrEP for Injection-Drug Users?

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In a randomized, controlled trial involving injection-drug users in Thailand, tenofovir reduced the risk for HIV infection.

 

Antiretroviral pre-exposure prophylaxis (PrEP) is effective in preventing sexually acquired HIV infection among men who have sex with men as well as heterosexual men and women. Might it also help to prevent HIV infection among injection-drug users? To find out, investigators from the CDC and the Thailand Ministry of Health conducted a study involving HIV-uninfected injection-drug users recruited at drug-treatment clinics in Bangkok.

A total of 2413 individuals were randomized to oral tenofovir or placebo, either administered daily via directly observed therapy (DOT) or provided at monthly visits. The decision to use DOT was up to the participants, who could switch at monthly visits. Each month during follow-up (mean duration, 4 years), participants received HIV testing and risk-reduction and adherence counseling. Drug levels were also measured at some of the clinics, and at the time of the first positive HIV test in all individuals who seroconverted.

The median age of participants was 31; 80% were men, and 48% had 

≤6 years of education. Twenty-two percent were enrolled in a methadone program. Baseline characteristics were similar between groups, except that sexual intercourse with casual partners and having sex with men during the 12 weeks preceding enrollment were more common in the placebo group.

HIV infection was confirmed in 50 participants — 17 in the tenofovir group and 33 in the placebo group — for an overall 48.9% reduction in HIV incidence with tenofovir in intent-to-treat analysis. Efficacy was higher — 73.5% — among individuals with detectable tenofovir levels in their plasma.

Comment: This study is the first to demonstrate the efficacy of tenofovir in preventing HIV infection among injection-drug users. Almost concomitantly, the CDC published interim guidance for pre-exposure prophylaxis in this population. Interestingly, the CDC recommended using tenofovir/FTC (not tenofovir alone, as studied in Thailand), arguing that tenofovir/FTC and not tenofovir alone is approved by the FDA for prophylaxis. The CDC also suggested that prevention services targeting injection and sexual risk behaviors be provided for injection-drug users.

I must emphasize that this study used directly observed therapy as one strategy, and that efficacy of antiretrovirals for prevention depends on adherence. Thus, any PrEP program should incorporate strong adherence counseling.

 

Source: Journal Watch HIV/AIDS Clinical Care