Health News, Wellness, and Medical Information

January 31, 2010

Shorter, More Intense Radiation OK for Some Breast Cancers

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A shorter, more intense course of whole-breast radiation works as well as the traditional six-week course, at least for some early-stage breast cancers, a new study shows.

“This concept of a shorter length of treatment is gaining acceptance,” said Dr. Manjeet Chadha, associate chair of radiation oncology at Beth Israel Medical Center and associate professor of radiation oncology at Albert Einstein College of Medicine, both in New York City. Chadha led the study and is scheduled to present the results Wednesday at the American Society for Radiation Oncology annual meeting, in Chicago.

Researchers previously have tried to investigate whether they can alter the duration of radiation therapy or the volume, Chadha said. “My study focuses on the duration of it,” she said.

In her three-week treatment — called accelerated hypofractionated whole breast irradiation — a woman gets the entire affected breast irradiated and receives a ”boost,” or extra dose, at the site where the tumor was removed. Other approaches include giving a boost dose after the entire radiation treatment to the whole breast is completed.

Chadha’s study is ongoing, but she planned to report on 122 patients with early-stage breast cancers who underwent lumpectomies followed by the accelerated treatment. They were then tracked for a median of two and a half years (half followed longer, half less). The patients’ median age was 66.

No relapses were noted, and the three-year survival rate was nearly 95 percent, Chadha said.

”It sounds encouraging,” she said of her results. To further evaluate the accelerated treatment, she compared the first 50 patients on the briefer approach to a matched group of 70 patients who got the more traditional six-week radiation treatment.

Side effects, such as skin irritation and redness, were similar, she found. ”There was no difference in fatigue or breast edema [swelling],” she said. The cosmetic results were satisfactory, too.

The new study adds some valuable information for doctors trying to decide for individual women which radiation treatment approach might be best, said Dr. Nayana Vora, a professor of radiation oncology and associate member of the developmental cancer therapeutics program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

”It’s a short follow-up,” she said, noting that some side effects may surface later. But, she noted that a study outside the United States that looked at the briefer treatments has followed patients for up to 12 years with results similar to Chadha’s study.

”Very few studies have been documented in the U.S. with external whole beam [to the whole breast] and a concomitant boost,” Vora said. ”It tell us that, yes, patients can be treated with a short course of radiation treatment. Will it become the standard of care? I don’t know.”

While Vora typically offers her patients the six-week treatment unless they can’t commit to that time period because of transportation problem or other obstacles, she said she now may consider the shorter treatment.

In another study to be presented at the oncology meeting, researchers reported that breast cancer patients who have a mastectomy and then receive radiation to the lymph nodes behind the breast bone (the internal mammary lymph nodes) do not live longer than those who don’t get those nodes treated.

The study evaluated 1,334 women with stage 1 or 2 breast cancers that had spread to the axillary lymph nodes under the arms or whose original tumor was in a central, internal location. All got radiation to the chest wall and nodes above the collar bone. But half got the internal mammary radiation and half did not.

After a decade, survival differences between the groups were small, with 60 percent of those who didn’t get the extra radiation still alive, and 63 percent of those who got it surviving.

Most radiation oncologists are reluctant to radiate the internal mammary nodes, Vora explained, because of their proximity to the heart.

January 24, 2010

Waiting, Wondering About Radiology Results Irks Patients

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Many patients don’t like how long it takes to receive the results of radiology tests and aren’t happy with the lack of information when they do get the results, a U.S. study has found.

Radiology imaging tests include MRI, CT, ultrasound, mammography and X-ray.

“Most of the patients in our study were decidedly dissatisfied with how they find out about their radiology test results. Specifically, they were unhappy with the delay before getting results and the lack of detail when they do find out what the tests showed,” lead investigator Dr. Annette J. Johnson, an associate professor of radiology at Wake Forest University School of Medicine, said in a university news release.

“The classic, most common story we heard was that the patient went to her doctor for a symptom such as pain, was sent for an MRI and then heard nothing until their next regular doctor’s appointment,” Johnson said. “Then, when the patient asked what the MRI showed, her doctor gave a generic answer — ‘Everything was fine.’ The patients in our study said that they don’t want to hear ‘fine’ weeks after the test. They want to know details and they want to know them as soon as the results are in.”

The patients in the study were asked about their experiences with radiology imaging tests, what they want to know from the tests, and how they would like to learn about the results.

Johnson and colleagues found that patients “want their results quickly, in writing, and they want detailed information about the test results in language they can understand.”

Many patients said they’d like a secure way to see their results online as soon as they’re available. That would give them time before the next doctor’s appointment to prepare questions, learn more about their condition or disease, and get a jump on setting up referrals if needed. Being able to see their test results would help them play an active role in their care.

January 17, 2010

What Can Prevent Walking Disability in Older People?

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The National Institute on Aging (NIA), part of the National Institutes of Health, today announced the award of $29.5 million in grant support over the next two years to determine whether a specific physical activity program can stave off disability in older people. The funding will begin the Lifestyle Interventions and Independence for Elders — LIFE — trial, the largest ever undertaken to prevent mobility disability among older people who are at risk of losing their ability to walk and to live independently in the community. The grant is being awarded to the University of Florida’s Institute on Aging in Gainesville.

The first two years of the six-year, eight-site LIFE trial are being funded through the American Recovery and Reinvestment Act. The grants are part of the $5 billion that President Obama announced Sept. 30 on the NIH campus.

“There is a lot of evidence indicating that exercise can help in preventing diseases, such as diabetes, among older people. But we do not know whether and how a specific regimen might prevent walking disability in older people who are at risk of losing mobility,” said NIA Director Richard J. Hodes, M.D. “This research is critically important at a time when the population is aging and new interventions should be sought to keep people healthy and functioning in the community longer.”

At eight sites around the country, LIFE will involve 1,600 people aged 70 to 89, who at the start of the study meet its criteria for risk of walking disability, defined as the inability to walk a quarter of a mile or four blocks. About 200 participants will be enrolled at each of the study sites, which include the University of Florida; the University of Pittsburgh; Northwestern University School of Medicine in Chicago; Stanford University in Palo Alto, Calif.; Pennington Biomedical Research Center in Baton Rouge, La.; Yale University in New Haven, Conn.; Tufts University in Boston and Wake Forest University School of Medicine in Winston-Salem, N.C. Wake Forest will also coordinate the data management and analysis.

“Limitations in walking ability compromise independence and contribute to the need for assistive care,” said Evan C. Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology, whose program is overseeing the trial. “Older people with impaired walking are less likely to remain in the community, have higher rates of certain diseases and death, and experience a poorer quality of life. A successful intervention might help prevent these bad outcomes.”

“We know that many older people have chronic health problems that affect their ability to walk,” said Jack Guralnik, M.D., Ph.D., chief of the NIA’s Laboratory of Epidemiology, Demography and Biometry and co-principal investigator of the study. “Arthritis, muscle weakness and poor balance can all affect how well and how far a person can walk. And, some older people have all of these problems. We will test the LIFE intervention in this population to see how it works in a real-world setting.”

Study participants will be randomly assigned to one of two groups. One group will follow a structured intervention consisting of walking at moderate intensity, stretching, balance and lower extremity strength training; the control group will participate in a health education program. The participants will be followed for about three years. Researchers will evaluate whether, compared to health education, the physical activity intervention reduces the risk of major walking disability, serious fall injuries and disability in activities of daily living, and whether it improves cognitive function. They will also assess the cost-effectiveness of the intervention.

“This will be the largest randomized controlled trial to prevent major mobility disability ever conducted in older persons who are at high risk of losing their physical independence,” said Marco Pahor, M.D., director of the University of Florida’s Institute on Aging and study principal investigator. “Typically, this population is excluded from large trials, and from this perspective the LIFE study is unique.”

January 11, 2010

CDC Study Links 2 Antibiotics to Birth Defects

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Taking antibiotics during pregnancy does not raise the risk for most birth defects, though there are some exceptions, new research has found.

Penicillin, which is the most commonly used antibiotic during pregnancy, as well as erythromycin, cephalosporins and quinolones, other widely prescribed antibiotics, were not associated with increased risk for about 30 different birth defects.

However, the study found that two types of antibiotics were linked with a higher risk for several birth defects: nitrofurantoins and sulfonamides, sometimes called “sulfa drugs,” which are prescribed for urinary tract and other infections.

Women whose children had anencephaly, a fatal malformation of the skull and brain, were three times more likely to have taken sulfonamides, the study found. Sulfonamides were also tied to an increased risk for such heart defects as hypoplastic left heart syndrome and coarctation of the aorta, choanal atresia (a blockage of the nasal passage), transverse limb deficiency and diaphragmatic hernia, an abnormal opening in the diaphragm that results in severe breathing difficulties.

Nitrofurantoins were also associated with multiple birth defects, including anophthalmia and microphthalmos (eye defects) and several congenital heart defects. Mothers whose children were born with a cleft lip or cleft palate were twice as likely to have taken nitrofurantoins, the study found.

But pregnant women should not be overly worried if they need an antibiotic to treat an infection during pregnancy, stressed the study’s lead author, Krista Crider, a geneticist with the National Center on Birth Defects and Developmental Disabilities, part of the U.S. Centers for Disease Control and Prevention.

“The most important message is that most commonly used antibiotics do not seem to be associated with the birth defects we studied,” Crider said.

The findings are published in the November issue of Archives of Pediatrics & Adolescent Medicine.

Crider and her colleagues analyzed data on more than 13,000 women whose babies had one of more than 30 birth defects, including cleft palate, heart or limb defects and anencephaly. They compared the women’s rates of antibiotic usage, from the month leading up to pregnancy through the end of the first trimester, with that of almost 5,000 women whose children did not have a birth defect. The data was culled from the National Birth Defects Prevention Study, which began in 1997 and includes about 30,000 women from 10 states.

Information on the impact of many prescription drugs on developing fetuses is sorely lacking, Crider pointed out. Much of that stems from the fact that ethical considerations preclude conducting drugs trials in pregnant women, she said.

Though many antibiotics have been used safely for decades, resistant strains of bacteria are forcing doctors to use a wider array of antibiotics. For some, little data exist.

The researchers found that about 30 percent of women took an antibiotic between the three months prior to conception and the end of the pregnancy.

Even antibiotics that generally were safe were found to be associated with a few specific birth defects. Women whose babies were born with a certain type of limb malformation were three times more likely to have taken penicillin. Erythromycin, cephalosporins and quinolones were also associated with an increased risk for one or two specific birth defects.

However, the researchers said they did not know if the birth defects were caused by the antibiotics or the underlying infection.

One expert said women need to remember the good antibiotics can do mom and baby, as well. Though many pregnant women want to avoid taking any drugs during pregnancy, infections pose a risk to mother and baby and often need to be treated, said Dr. Jennifer Wu, an obstetrician-gynecologist at Lenox Hill Hospital in New York City.

“Untreated infections during pregnancy can lead to severe consequences, such as maternal sepsis [blood infection] and preterm labor,” Wu said. “Yet many patients are afraid to take medications such as antibiotics during pregnancy.”

The study “supports the evidence that antibiotics are safe for pregnant women,” she said. “It is reassuring for doctors and patients to have more data on necessary drugs for pregnancy.”

Crider also stressed that the chances of having a baby with a birth defect remain small, even if an antibiotic has been linked to an elevated risk. For example, the risk of having a child with hypoplastic left heart syndrome is about one in 4,200. Sulfonamides were associated with a three-fold increase, making the likelihood about one in 1,400, she said.

Brand names for nitrofurantoins include Furadantin, Macrobid and Macrodantin. Bactrim and Septra are among the brand names of sulfonamides.

Given the data, Crider said, women should be cautious about taking either of those types of drugs during pregnancy and should discuss other options with their physicians,.

According to the study, the overall risk for having a child with a birth defect is about three percent.

The study did not look at chromosomal defects, including Down syndrome.

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