Public ignorant about key messages concerning diet and cancer
September 27, 2011
New research on public perceptions about cancer reveals that 50-year-old ideas still hold sway while many current lifestyle messages are not getting through.
On the positive side, however, the vast majority of people now believe cancer is curable.
Experts at the University of Leicester and Leicester’s Hospitals carried out the research to assess patients’ beliefs about the causes of cancer, which was funded by the Leicestershire-based charity Hope Against Cancer.
The study, published online in the journal Clinical Oncology, aimed to compare knowledge about the outcome of cancer treatment and beliefs about the causes of cancer among British South Asian cancer patients and beliefs held by British White cancer patients and the impact of these beliefs upon the patients’ mental health.
Between September 2007 and January 2010, 279 patients, who were aware they had cancer, entered the study, funded by Leicestershire-based charity Hope Against Cancer, at the Leicestershire Cancer Centre. Researchers found that:
- Across both groups there was an over emphasis on pollution, stress and injury as causes of cancer
- Almost one quarter of the group believed cancer was caused by injury, reflecting research carried out over half a century ago
- 20% believed that surgery could cause cancer to spread
- Both cohorts believed religion/fate played a part in cancer
- 30% of the group gave credence to alternative medicine being as effective as current clinical procedures
- It was generally accepted that smoking can cause cancer
- There was widespread lack of awareness about the roles diet, obesity and lack of exercise play in the development of the disease.
The vast majority believed cancer to be curable, with only 10.6% of the British South Asian group and 2.7% of the British White group thinking it was incurable. Out of the total sample, 93% understood the advantages of early screening.
Many of the two groups’ assumptions about cancer were held in common. There was widespread over-emphasis on environmental pollution, stress and injury as triggers for cancer. Environmental pollution is a relatively minor cause of cancer, while there is no evidence that stress or injury can cause cancer.
Twenty per cent of the sample believed wrongly that treatment, in particular surgery, caused the cancer to spread and this was a cause of significant depression among British South Asians and anxiety across both groups.
The perceived role of religion in the cause of and recovery from cancer was more prevalent among the British South Asians, though a small cohort of the British White patients had some belief in Fate.
Nearly 30% of the total sample thought alternative treatments could be as effective as surgery, radiotherapy and chemotherapy. This view was held by almost twice as many British South Asian patients as British White patients.
The way patients understand cancer can have a major impact on how they cope with it psychologically. This study is part of a wider investigation with the long-term aim of improving psychological support of cancer patients.
Professor Paul Symonds, of the Department for Cancer Studies and Molecular Medicine at the University of Leicester, commented: “It is clear that there is a continual need for education into the causes of cancer. The good news is that the majority of the sample believed that cancer was curable and screening effective, while 84% appreciated that smoking could cause cancer.
“This shows that some messages are getting through, but we clearly have more work to do in educating the public on the effect of diet and obesity.”
Karen Lord, PhD research student working on the project, said: “It is vital that those diagnosed with cancer have accurate information about treatment options so that they can make informed decisions about their care.
“Myths such as the belief that surgery causes cancer to spread and that alternative treatment is as effective as conventional treatments should be challenged.”
Wendi Stevens, Hope Against Cancer Co-ordinator, added: “This research has highlighted some interesting views relating to cancer. Hope Against Cancer funds a wide range of research looking into treatment, but we believe it is also important to look at cause and education as well in the hope that this knowledge can be used to cut the incidence of cancer in the future.”
Notes to Editors: Further details are available from Paul Symonds, Professor of Clinical Oncology, Department of Cancer Studies and Molecular Medicine, University of Leicester, tel 0116 258 6294, email paul.symonds@uhl-tr.nhs.uk
Gaile Lloyd-Jones, Hope Against Cancer Press Officer – gaile.lloyd_jones@btopenworld.com 07799491555
Hope Against Cancer – 0116 270 0101, enquiries@hfcr.org
Hope Against Cancer was launched in 2003 and to date have raised over £2.2 million, enabling the charity to fund 28 research fellowships in the Hospitals and Universities of Leicester including DMU & Loughborough Into many cancers including bladder, ovarian, prostate, melanoma, liver, bowel, leukaemia, colorectal and breast cancer. They have also funded nursing fellowships, relating to patient care.
Contact: Paul Symonds
paul.symonds@uhl-tr.nhs.uk
44-011-625-86294
University of Leicester
Potatoes are the largest and most affordable source of potassium of any vegetable or fruit
September 27, 2011
A frequently expressed concern in the ongoing public health debate is that fresh fruits and vegetables, particularly those that are nutrient dense, are not affordable to the average consumer. Research presented today at the American Dietetic Association’s (ADA) Food and Nutrition Conference and Expo (FNCE) demonstrates that potatoes are one of the best nutritional values in the produce department, providing significantly better nutritional value per dollar than most other raw vegetables. Per serving, white potatoes were the largest and most affordable source of potassium of any vegetable or fruit.
Dr. Adam Drewnowski and colleagues from the University of Washington merged nutrient composition data from the USDA Food and Nutrition Database for Dietary Studies (FNDDS 2.0) with the USDA Center for Nutrition Policy and Promotion (CNPP) national food prices database. Frequency of consumption data was obtained from the National Health and Nutrition Examination Survey (NHANES 2003-4). The Affordable Nutrition Index (ANI) was the metric used to assess nutritional value per dollar for potatoes and for other vegetables.
Potatoes were the lowest cost source of dietary potassium, a nutrient identified by the 2010 Dietary Guidelines as lacking in the American diet. The high cost of meeting federal dietary guidelines for potassium, 4,700 mg per person per day, presents a challenge for consumers and health professionals, alike. However, the cost of potassium-rich white potatoes was half that of most other vegetables.
“Potatoes deserve credit for contributing to higher diet quality and increasing vegetable consumption,” said lead researcher Adam Drewnowski, PhD. “Potatoes also play an important role in providing affordable nutrition to Americans. You CAN afford to meet key dietary guidelines IF you include potatoes in your diet.”
Further analyses of NHANES dietary intake showed that putting potatoes on the plate did improve overall diet quality. Individuals who consumed potatoes (baked, boiled and roasted) had higher intakes of potassium and vitamin C and consumed more total vegetables in a day compared to those who did not consume potatoes.
The study was funded by the United States Potato Board and adds to the growing database of nutrition science that supports potatoes in a healthful diet. In addition, one medium-size (5.3 ounce) skin-on potato contains just 110 calories per serving, boasts more potassium (620g) than a banana, provides almost half the daily value of vitamin C (45 percent), and contains no fat, sodium or cholesterol.
For a copy of the research abstract, contact Meredith Myers at 303-873-2333 or meredithm@uspotatoes.com.
Visit www.potatogoodness.com for healthy potato recipes, videos and nutrition information.
About the United States Potato Board
The United States Potato Board was established in 1971 by a group of potato growers to promote the benefits of eating potatoes. Recognized as an innovator in the produce marketing industry, the USPB adopted a new campaign in 2007. “Potatoes Goodness Unearthed®” showcases the appeal of naturally nutrient-rich potatoes, also known as America’s favorite vegetable. Based in Denver, Colo., the USPB represents more than 4,000 potato growers and handlers across the country. To unearth more goodness about the USPB and its programs, visit www.potatogoodness.com.
Marijuana administration after a traumatic experience prevents post-traumatic stress symptoms
September 21, 2011
Cannabinoids (marijuana) administration after experiencing a traumatic event blocks the development of post-traumatic stress disorder (PTSD)-like symptoms in rats, according to a new study conducted at the University of Haifa and published in the journal Neuropsychopharmacology.
“We found that there is a ‘window of opportunity’ during which administering synthetic marijuana helps deal with symptoms simulating PTSD in rats,” said Dr. Irit Akirav of the University of Haifa’s Department of Psychology, who led the study.
In the study, which Dr. Akirav conducted with research student Eti Ganon-Elazar, the researchers set out to examine how administering cannabinoids (synthetic marijuana) affects the development of PTSD-like symptoms in rats, whose physiological reactions to traumatic and stressful events is similar to human reactions.
In the first part of the study, the researchers exposed a group of rats to extreme stress, and observed that the rats did indeed display symptoms resembling PTSD in humans, such as an enhanced startle reflex, impaired extinction learning, and disruption of the negative feedback cycle of the stress-influenced HPA axis.
The rats were then divided into four groups. One was given no marijuana at all; the second was given a marijuana injection two hours after being exposed to a traumatic event; the third group after 24 hours and the fourth group after 48 hours.
A week later, the researchers examined the rats and found that the group that had not been administered marijuana and the group that got the injection 48 hours after experiencing trauma continued to display PTSD symptoms as well as a high level of anxiety.
By contrast, the PTSD symptoms disappeared in the rats that were given marijuana 2 or 24 hours after experiencing trauma, even though these rats had also developed a high level of anxiety.
“This indicates that the marijuana did not erase the experience of the trauma, but that it specifically prevented the development of post-trauma symptoms in the rat model,” said Dr. Akirav, who added that the results suggest there is a particular window of time during which administering marijuana is effective. Because the human life span is significantly longer than that of rats, Dr. Akirav explained, one could assume that this window of time would be longer for humans.
The second stage of the study sought to understand the brain mechanism that is put into operation during the administering of marijuana. To do this, they repeated stage one of the experiment, but after the trauma they injected the synthetic marijuana directly into the amygdala area of the brain, the area known to be responsible for response to trauma. The researchers found that the marijuana blocked development of PTSD symptoms in these cases as well. From this the researchers were able to conclude that the effect of the marijuana is mediated by a CB1 receptor in the amygdala.
For more information:
Rachel Feldman
Division of Marketing and Media
University of Haifa
press@univ.haifa.ac.il
+972-54-5352435
Number of children poisoned by medication rising dramatically, study says
September 16, 2011
The number of young children admitted to hospitals or seen in emergency departments because they unintentionally took a potentially toxic dose of medication has risen dramatically in recent years, according to a new Cincinnati Children’s Hospital Medical Center study.
The rise in exposure to prescription products has been so striking that the Centers for Disease Control and Prevention has established the PROTECT Initiative, intended to prevent unintended medication overdoses in children.
Randall Bond, MD, an emergency medicine physician at Cincinnati Children’s, will present his study on children and pharmaceutical poisonings Sept. 20 at a PROTECT Initiative meeting in Atlanta. The study will be published online Sept. 16 in the Journal of Pediatrics.
“The problem of pediatric medication poisoning is getting worse, not better,” says Dr. Bond, who also is medical director of the Drug and Poison Information Center at Cincinnati Children’s. “More children are exposed, more are seen in emergency departments, more are admitted to hospitals, and more are harmed each year.”
Dr. Bond found that exposure to prescription products accounted for most of the emergency visits (55 percent), admissions (76 percent) and significant harm (71 percent). Levels of ingestion of opioids, most often prescribed to treat pain; sedatives-hypnotics, frequently prescribed as sleep aids; and cardiovascular medications were particularly high.
“Prevention efforts at home have been insufficient,” says Dr. Bond. “We need to improve storage devices and child-resistant closures and perhaps require mechanical barriers, such as blister packs. Our efforts can’t ignore society’s problem with opioid and sedative abuse or misuse.”
Dr. Bond studied patient records from 2001 to 2008 in the National Poison Data system – an electronic database of all calls to members of the American Association of Poison Control Centers. Dr. Bond studied children 5 years old and younger exposed to a potentially toxic dose of a single pharmaceutical agent, either prescription or over-the-counter. A total of 453,559 children were included in the study.
The largest part of increasing admissions, injuries and death was due to children finding and ingesting medication on their own. Therapeutic errors at home were uncommon and increased only minimally.
The most likely explanation for these trends is a rise in the number of medications around small children, he says. A 1998-99 survey found that half of adults had taken at least one prescription medication in the preceding week and 7 percent had taken five or more. In 2006, the same surveyors found that 55 percent had taken at least one prescription medication in the preceding week and 11 percent had taken five or more.
There are 57 poison control centers in the United States. Together they provide free, 24-hour poison expertise and treatment advice by phone. All poison centers can be reached by calling the same telephone number 1-800-222-1222. Poison centers are staffed by pharmacists, physicians, nurses and poison information providers who are toxicology specialists.
The PROTECT Initiative is a collaboration among public health agencies, private sector companies, professional organizations, consumer/patient advocates and academic experts to keep children safe from unintentional medication overdoses. According to the Centers for Disease Control, more than 70,000 emergency visits each year result from unintentional overdoses among children under the age of 18.
Contact: Jim Feuer
jim.feuer@cchmc.org
513-636-4656
Cincinnati Children’s Hospital Medical Center
Healthy lifestyle habits lower heart failure risk
September 14, 2011
If you don’t smoke, aren’t overweight, get regular physical activity and eat vegetables, you can significantly reduce your risk for heart failure, according to research reported in Circulation: Heart Failure, an American Heart Association journal.
In a new study, people who had one healthy lifestyle behavior decreased their heart failure risk, and each additional healthy behavior further decreased their risk.
Heart failure affects about 5.7 million Americans. At age 40, a person’s lifetime risk of developing heart failure is one in five.
“Any steps you take to stay healthy can reduce your risk of heart failure,” said Gang Hu, M.D., Ph.D., lead author of the study and director of the Chronic Disease Epidemiology Laboratory at the Pennington Biomedical Research Center in Baton Rouge, La. “Hypothetically, about half of new heart failure cases occurring in this population could have been prevented if everyone engaged in at least three healthy lifestyle behaviors.”
Previous research has shown an association between healthy lifestyle behaviors and lower risk of heart failure in men. The new study is the first to find a similar connection in women.
Researchers followed 18,346 men and 19,729 women from Finland who were 25 to 74 years old. During a median follow-up of 14.1 years, 638 men and 445 women developed heart failure. Participants were classified by BMI: normal weight (less than 25 kg/m2); overweight (25-29.9 kg/m2); and obese (greater than 30 kg/m2).
After adjusting for heart failure risk factors, such as high blood pressure, diabetes and a past heart attack, researchers found:
- Male smokers had an 86 percent higher risk for heart failure compared to never-smokers. Women smokers’ risk increased to 109 percent.
- Being overweight increased heart failure risk by 15 percent in men and 21 percent in women compared to normal-weight people. The risk increased to 75 percent for obese men and 106 percent for obese women.
- Moderate physical activity reduced the risk of heart failure by 21 percent in men and 13 percent in women compared to a light physical activity level. High levels of physical activity lowered the risk even further: 33 percent in men and 36 percent in women.
- Eating vegetables three to six times per week decreased heart failure risk by 26 percent in men and 27 percent in women compared to those who ate vegetables less than once per week.
Furthermore, the more healthy lifestyle behaviors a person engaged in, the greater the decline in risk.
Engaging in all four healthy lifestyle behaviors decreased the risk for heart failure by 70 percent in men and 81 percent in women, compared to 32 percent in men and 47 percent in women who engaged in only one healthy behavior.
Many people remain unaware of the link between unhealthy lifestyle behaviors and heart failure risk, researchers said.
Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body’s needs for blood and oxygen.
Basically, the heart can’t keep up with its workload.
“Healthcare workers should discuss healthy lifestyle habits with their patients and stress that they can do more,” Hu said.
The Finnish Academy and Special Research Funds of the Social Welfare and Health Board, City of Oulu funded the study.
Co-authors are Yujie Wang, M.Sc.; Jaakko Tuomilehto, M.D., Ph.D.; Pekka Jousilahti, M.D., Ph.D.; Riitta Antikainen, M.D., Ph.D.; Markku Mähönen, M.D., Ph.D. and Peter T. Katzmarzyk, Ph.D. Author disclosures are on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
Contact: Karen Astle
Karen.Astle@heart.org
214-706-1392
American Heart Association
Confronting meaninglessness
September 12, 2011
You’ve just finished an amazing dinner at your favorite restaurant and you are ready to put on your comfy pajamas and slip into sweet slumber. You arrive at your doorstep and find the front door ajar. Your heart beats wildly in your chest and you peer in, only to discover that your house has been ransacked.
According to author Alexa Tullett, “There’s more than one way to interpret this event. You could see it as an indication that there’s a bad apple in your neighborhood, and in this case you would only feel comforted if that person was arrested. On the other hand, you could see it as an indication that your neighborhood is less safe than you thought, and in this case there would be many things that could ease your concern: getting better locks, starting a community watch program, or having a greater police presence.”
How do you look at this situation? Would you feel relieved if you got safer locks, or would you remain fearful until the robber was taken to jail?
Tullett and her co-authors Rimma Teper, and Michael Inzlicht from the University of Toronto explore the possibility that different threat-reduction approaches can be adaptive in different situations in an article in Perspectives on Psychological Science, a journal of the Association for Psychological Science.
The authors suggest that the way a threat is construed will determine the types of threat-reduction strategies that will be effective for an individual.
In the case of the robbery, Tullett says “the general idea is that if you interpret a threat in a very narrow way, as in a dangerous person is out there, there are limited ways that you can resolve the threat. If, on the other hand, you interpret it broadly, there is a broader range of ways that you can resolve the threat.”
Imagine another scenario – Your friend has overheard his co-workers at work conversing about how he is a nice guy, but not very attractive. You console him, reminding him of his intelligence and accomplishments and are surprised to find that this doesn’t help. This misunderstanding is because you saw this as a threat to your friend’s identity as a desirable person, but your friend saw this as a narrower threat to his identity as an attractive person.
According to the authors, social psychologists have collected a large amount of evidence demonstrating the versatility in how we respond to unexpected and unsettling events.
Author Tullett says there is debate on how we respond to unsettling events. Some believe that when people are unsettled by something that happens in one area of life they wont feel better until they experience a boost in that area. Others disagree, and think that the area doesn’t matter – feeling better in one area makes people feel better in all areas.
This research helps us understand how both of these can be correct depending on how people interpret certain situations – narrowly or broadly.
For more information about this study, please contact: Alexa Tullett at alexa.tullett@utoronto.ca.
Perspectives on Psychological Science is ranked among the top 10 general psychology journals for impact by the Institute for Scientific Information. It publishes an eclectic mix of thought-provoking articles on the latest important advances in psychology. For a copy of the article “Confronting Threats to Meaning: A New Framework for Understanding Responses to Unsettling Events” and access to other Perspectives on Psychological Science research findings, please contact Lucy Hyde at 202-293-9300 or lhyde@psychologicalscience.org.
Contact: Lucy Hyde
lhyde@psychologicalscience.org
202-293-9300
Association for Psychological Science
Discovery of blood pressure genes could help prevent cardiovascular disease
September 11, 2011
Findings, published today in Nature and Nature Genetics (11/9/2011) by the International Consortium for Blood Pressure Genome-Wide Association Studies represent a major advance in our understanding of the inherited influences on blood pressure and offer new potential therapeutic targets for prevention of heart disease and stroke – the biggest cause of death worldwide.
Research published in Nature and co-led by scientists from Queen Mary, University of London has discovered 16 new gene regions that influence blood pressure.
Toby Johnson, Patricia Munroe and Mark Caulfield from Barts and The London Medical School co-led with US and European colleagues an international collaborative study involving 351 scientists from 234 institutions based in 24 countries around the world. This study analysed data on over 270,000 people to find genetic variations in the DNA of each person that were associated with higher or lower blood pressure. This enabled them to identify 16 new gene regions influencing blood pressure and provided confirmation of 12 other gene regions that had previously been discovered by the Barts and The London team.
The researchers then combined the effects of genetic variation in all 28 gene regions and showed that these impact upon the risk of developing hypertension, stroke, coronary heart disease, and structural changes in the heart. The combined effect of these variations on blood pressure is similar to the effect of a standard blood pressure lowering medicine. Importantly, they showed that genetic effects on blood pressure are broadly similar in people of European, East Asian, South Asian, and African ancestries.
Blood pressure is influenced by a combination of lifestyle factors and genes which until now have proved challenging to identify. Even small changes in blood pressure can increase risk of stroke and heart attack and over one billion people worldwide have high blood pressure – hypertension.
Professor Mark Caulfield, who is also President of the British Hypertension Society, said: “High blood pressure affects a quarter of the adult population in the UK. These new gene regions we report today offer a major leap forward in our understanding of the inherited influences on blood pressure and offer new potential avenues for treatment which is particularly welcome for those who do not achieve optimal blood pressure control.”
Professor Patricia Munroe said: “This large multicentre collaboration has yielded many new genes for blood pressure, determining which gene and their function will improve our understanding of the basic architecture of hypertension, and should facilitate new therapeutic drug development.”
Dr Toby Johnson said: “There were enormous challenges to overcome in collecting and analysing the amount of data we needed for this study. Our discoveries illustrate the power of international collaborative research.”
A related study published today, in Nature Genetics and co- led by Louise Wain and Martin Tobin from the University of Leicester, and Paul Elliott from Imperial College London, reports on the identification of gene regions for two further types of blood pressure measurement; pulse pressure (PP) and mean arterial pressure (MAP). Both measurements can predict hypertension and cardiovascular disease. The research uncovered four new gene regions for pulse pressure and two for mean arterial pressure indicating novel genetic mechanisms underlying blood pressure variation.
Louise Wain (University of Leicester) said: “Our study shows the importance of looking at different measures of blood pressure in order to identify new genetic variants that affect levels of blood pressure in the population.”
Paul Elliott (Imperial College London) said: “Pulse pressure is a marker of the stiffness of the arteries that carry blood from the heart round the body. Our results could help understanding about the genetic mechanisms underlying relationships of pulse pressure with risk of heart disease and stroke.”
These important findings published in Nature and Nature Genetics were made possible by funding from the Wellcome Trust, the Medical Research Council, the British Heart Foundation, and the National Institute for Health Research, and provide greater understanding of the genetic architecture of blood pressure, a key determinant of cardiovascular health.
Contact: Alex Fernandes
press@qmul.ac.uk
44-207-882-7910
Queen Mary, University of London
US investment in health research remains stagnant
September 8, 2011
Aggressive medical therapy could help prevent stroke
September 8, 2011
To prevent a common type of stroke, intensive medical therapy could be better by itself than in combination with surgery that props open affected arteries. But it remains to be seen whether the apparent advantage will prove true over the long term.
The findings, from a national clinical trial conducted by University of Florida researchers and colleagues, will be published online in The New England Journal of Medicine online on Wednesday, Sept. 7.
Against expectations, the short-term risk of stroke and related death was twice as high in some cases for patients whose diseased arteries were widened via balloon angioplasty and stent insertion, compared with patients who received medical therapy alone. Although the 30-day risk of stroke for the stenting patients is concerning, long-term results could be more favorable, the researchers said.
“Five years from now, who will be doing better – the patients who are being medically managed, or those who received a stent?” said study co-author Michael F. Waters, M.D., Ph.D., director of the Shands at UF Stroke Program, who along with Brian L. Hoh, M.D., the William Merz associate professor of neurological surgery in the College of Medicine, led the UF portion of the trial.
The study will have a substantial impact on clinical practice and research, the researchers said, because it is the first randomized stroke trial to pit stenting against nonsurgical treatment for symptomatic intracranial atherosclerosis, a type of stroke caused by artery blockage in the brain. Early results clearly show that intensive medical management is key to improving health, the researchers said.
“This study provides an answer to a longstanding question by physicians – what to do to prevent a devastating second stroke in a high-risk population. Although technological advances have brought intracranial stenting into practice, we have now learned that when tested in a large group this particular device did not lead to a better health outcome,” said Walter Koroshetz, M.D., deputy director of the NIH National Institute of Neurological Disorders and Stroke, which funded the clinical trial.
Every 40 seconds, someone in the U.S. has a stroke. Stroke is the fourth leading cause of death and a leading cause of disability in the U.S. Almost 800,000 people a year have a new or recurring stroke, according to the American Heart Association. With higher than average rates of stroke and related deaths, parts of the southeastern U.S. are together termed the “Stroke Belt.”
Patients with the type of stroke known as symptomatic intracranial atherosclerosis do not respond well to existing treatments. One-quarter of those patients have another stroke within 12 months, and the risk of additional strokes continues in subsequent years. Doctors are unsure what the best course of treatment is.
To find out, the UF researchers and colleagues launched a clinical trial, nicknamed SAMMPRIS, at 50 sites around the country, including at the Medical University of South Carolina, the lead site. The study recruited 451 participants age 30 to 80 who had at least 70 percent narrowing in the arteries in the brain, and had experienced symptoms within the previous 30 days. UF recruited the second-highest number of patients among all sites, through its stroke program, which has been designated a Comprehensive Stroke Center by the Agency for Health Care Administration.
Patients in one group were randomly assigned to receive intensive management involving smoking cessation and medications for blood pressure, cholesterol, diabetes and blood-clot prevention. A second group of patients had that same medical treatment but also had balloon angioplasty and stent implantation into the affected brain artery to improve blood flow.
Almost 15 percent of patients who received stents had a stroke or died within 30 days of enrolling in the study, compared with just under 6 percent of patients in the medical therapy group. The stark difference between the groups persisted almost a year, by which time about 21 percent of patients who had received stents had had negative effects, compared with 12 percent in the medical group.
The researchers initially thought that patients who received stents would have fared better, given the successful use of similar procedures in clinical practice at the Shands at UF Stroke Program and other medical centers.
But the striking difference between the two patient groups prompted the study’s independent safety monitoring body to call off new recruitment. The researchers will, however, continue to monitor previously enrolled patients for the next two years.
It’s not unusual for surgical patients to have more complications at first, the researchers said. That’s because the invasiveness of surgery poses an inherent risk regardless of the illness being treated.
“The real question is, is there a benefit to patients over the long term,” said study co-author and co-principal investigator Hoh, who is an associate professor of radiology and neuroscience in the UF College of Medicine. “If you think about it, when people are concerned about stroke, it’s not just their first month that matters, so we’re waiting to see what the longer-term results will be.”
Over time, improvement of stent design and honing of surgical techniques could help improve outcomes for patients.
“This is certainly not the final say on managing this disease,” Waters said. “This is another piece of the puzzle that helps to guide our hand.”
Contact: Czerne M. Reid
czerne@ufl.edu
352-273-5814
University of Florida
New half-match bone marrow transplant procedure yields promising outcomes for cancer patients
September 2, 2011
Half-matched bone marrow or stem cell transplants for blood cancer patients have typically been associated with disappointing clinical outcomes. However, a clinical trial conducted at the Kimmel Cancer Center at Jefferson testing its unique, two-step half-match procedure has produced some promising results: the probability of overall survival was 45 percent in all patients after three years and 75 percent in patients who were in remission at the time of the transplant.
Reporting in the journal Blood in a published-ahead-of-print article dated August 25, Neal Flomenberg, M.D., Chair of the Department of Medical Oncology at Thomas Jefferson University Hospital, Dolores Grosso, DNP, Co-Principal Investigator and lead author of the article, and colleagues discuss the results of 27 patients treated on this phase I/II trial who had diagnoses that included leukemia, lymphoma and myelodysplasia.
The patients received their transplant in two steps. First, after receiving radiation therapy to further treat their disease, the patients were given a specified dose of T cells (a type of immune cell that fights infection) from their half-matched family donor. The donors were parents, siblings or children of the patient. The patients next received the drug cyclophosphamide to help the newly infused donor T cells to be more tolerant to the patient’s body. The second step of the transplant occurred when the patients received a dose of their donors’ stem cells to help their blood counts return to normal and further strengthen their new immune system.
Dr. Flomenberg and his team found that after a follow-up of 28-56 months, overall survival for the patients after one year was 54 percent and 48 percent at three years. Patients in remission at the time of the transplant fared better with an overall survival of 75 percent. Seventeen of the 27 patients—with a median age of 52 years old—were alive six months after their transplant, which was the official end point of the trial.
While more recent studies have shown promising increases in overall survival for patients undergoing half-match transplants, historically, clinical outcomes for these types of transplants have been poor, which has limited the use of this type of procedure.
The results of the Jefferson trial represent a very promising improvement in this area.
Bone marrow or stem cell transplants are performed in order to replace a patient’s diseased immune system with that of a healthy donor. Traditionally, the use of a genetically fully matched donor has been associated with the best results in bone marrow transplant, but many patients lack a fully-matched related or unrelated donor. Almost every patient will have a half-matched donor (also known as a haploidentical donor) in their family, however.
The successful use of haploidentical donors would greatly expand the number of donors available to a patient, extending this therapy to almost everyone who would benefit from receiving a transplant. This would include minority patients, including patients with sickle cell anemia, who do not have as many fully-matched unrelated donors available to them.
“Our half-match bone marrow transplant results open up many doors for different types of patients who can’t find an exact match,” said Dr. Flomenberg. “It also justifies recommending that patients at high risk for relapse should consider having a half-match transplant early in the treatment of their disease.”
“Jefferson’s two-step procedure provides promising results that could serve as the basis for further exploration and optimization of the technique,” he added.
Jefferson medical oncologists’ approach is unique in that the dosage, timing and treatment of donor T cells was carefully controlled and optimized. No other transplant regimen controls the exact amount of donor T cells given. The investigators believe that dosing the T cells in this way helped avoid many of the life-threatening side effects of this type of transplant.
“We believe the dosage and timing of T cells from the donor into the patient is essential for success. In fact, it’s equally as important as prescribing specific doses of radiation and chemotherapy to initially treat the disease,” said Dr. Grosso. “The goal of this two-step regimen was to develop a better technique for half-matched patients with relapsed blood cancers initially, but we also showed that it can be appropriate for high risk patients earlier in their disease who lacked fully matched donor options.”
Contact: Steve Graff
stephen.graff@jefferson.edu
215-955-6300
Thomas Jefferson University