Alternative Medicine for Cancer Ups Death Risk

Researchers from the Yale Cancer Center (USA) found that reject conventional medicine (for a potentially curable cancer) in favor of alternative treatments have a 2.5-fold higher risk for death.

 

Complementary versus alternative: If a non-mainstream practice is used together with conventional medicine, it is considered “Complementary.” If a non-mainstream practice is used inlace of conventional medicine, it is considered “alternative.” Today, we are addressing the latter. In my practice, we often bring conventional and complementary approaches in a coordinated way, an approach known as integrative medicine.

The Study: Researchers examined records (2004-2013) in National Cancer Database (USA) to find 280 patients with early-stage cancer (breast, prostate, lung, or colorectal) whose treatment was coded as “other-unproven: cancer treatment administered by non-medical personnel.” They then matched the alternative medicine group to 560 patients with the same types of cancer who received conventional treatments.

The Findings: Alternative medicine use was associated with a nearly 6-fold increased risk of death among patients with breast cancer. For those with colorectal cancer, the risk increased by a factor of 4.5, and among patients with lung cancer, the risk of death doubled. The risk among prostate cancers did not differ between the conventional and alternative treatment groups. The last is not a surprise, given the long natural history of prostate cancer and the short median follow-up of this study.

I’m Dr. Michael Hunter.

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The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

And, one more thing: NEW free apps for Android and iOS (Apple): In apps, search My Breast Cancer by Michael Hunter.


Reference: This new study was published online in the Journal of the National Cancer Institute.

Immunotherapy for Cancer

The latest approval of a cancer drug by the US Food and Drug Administration (FDA) changes the paradigm of cancer treatment — the new indication specifies a genetic defect without any mention of tumor types. It allows the drug to be used in any cancer that harbors the specified genetic defect, wherever the tumor appears in the body.

What: Historically, the US Food and Drug Administration (FDA) has approved cancer treatments based on where in the body the cancer started — for example, prostate or breast cancers. For the first time, the FDA approved a drug based on a tumor’s biomarker without regard to the tumor’s original location.

Details: The new approval is for the immunotherapy pembrolizumab (Keytruda, Merck & Co), which is already approved for use in several different tumor types, including melanoma and lung cancer. But this latest approval covers the use of pembrolizumab in tumors that have microsatellite instability-high (MSI-H) or are mismatch repair deficient (dMMR). These defects are found most commonly in colorectal, endometrial, and gastrointestinal cancers but also less commonly appear in cancers arising in the breast, prostate, bladder, thyroid gland, and other places, the agency notes.

Microsatellite instability & immunotherapy: It’s not just colorectal cancer: The results from that trial showed that patients with colorectal cancer with normal DNA repair (microsatellite stable) had zero response to pembrolizumab, whereas those with MSI and deficient DNA repair had a 50% response rate, she said. In addition, about 20% had stable disease. This is much higher than has been seen with immunotherapy in other tumor types, where fewer than 20% patients respond. But the trial also included patients with any solid tumor and MSI, and these patients also showed the 50% response rate and 20% stable disease results.

Downsides: Common side effects of pembrolizumab include fatigue, itchiness, diarrhea, decreased appetite, rash, fever, cough, dyspnea, musculoskeletal pain, constipation, and nausea. The drugs can also cause serious immune-mediated side effects, including lung, liver, kidney, or colon inflammation, endocrine problems.

Action point: All patients with advanced cancer who have had at least one standard therapy should be tested to see if their tumor harbors these genetic defects.

I’m Dr. Michael Hunter.

http://www.medscape.com/viewarticle/880537

Colorectal Cancer Disparities in USA: “We Should Be Embarrassed”

What You Need to Know: Lack of education, regardless of race or ethnicity, is the most important factor linked to disparities in mortality rates from colorectal cancer in the United States.

Background: It has long been known that there are disparities in mortality rates from colorectal cancer (CRC) between educated white and uneducated black populations in the United States. The study, led by Ahmedin Jemal, PhD, from the American Cancer Society in Atlanta, looked at the rate of death from CRC in people younger than 65 years (i.e., premature death) in each of the 50 states from 2008 to 2010. The researchers classified CRC patients 25 to 64 years of age by level of education (12 years or fewer, 13 to 15 years, and 16 years or more), race/ethnicity, and state.

Results:

They found there were significantly more premature CRC deaths in states with the lowest education levels than in those with higher levels. In fact, rates of premature death decreased with increased years of education, regardless of race or ethnicity.

  • In the white population, Delaware had the fewest premature CRC deaths, but even in that state, the rate was 15% higher in the least-educated than in the most-educated people (rate ratio [RR], 1.15; 95% confidence interval [CI], 0.66 – 2.01). New Mexico had the most premature CRC deaths; the rate was 3-fold higher in the least-educated than in the most educated people (RR, 3.18; 95% CI, 2.01 – 5.05).
  • In the black population, rate ratios ranged from 0.84 (95% CI, 0.54 – 1.30) in Mississippi to 2.41 (95% CI, 1.62 – 3.59) in Virginia. New York had the lowest death rate (12.9%) among those with the lowest level of education.
  • Blaise Polite, MD, MPP of the University of Chicago expressed this view in an editorial: “The major finding from this study…remains unaltered: If you are black or have low educational attainment, where you live in the United States determines how likely you are to die as a result of colorectal cancer. That is an experiment that has to end in the 21st-century United States.”

My Take: We should be embarrassed. Between 2008 and 2010, more than 23,000 deaths from colon cancer, 50% of the total, could have been prevented if all states had colon cancer equal to the five states with the lowest rates for the most educated whites. An equally important point is the variation among the states; 69% of deaths could have been prevented in Mississippi, compared with only 29% in Utah. While lifestyle factors no doubt contribute to disparities, access to colonoscopy is a key component to reducing your chance of dying from colorectal cancer.

An author of the study adds: “Screening is recommended for people 50 to 75 years. In those with 12 years or less of education, only 40% get screened, compared with 70% of those with a college-level education,” he explained. Even worse, “in the uninsured population, it is only 19%. That is ridiculously low, and highlights the importance of access to care.”

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minuteable now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: 

 

Do Apples and Berry Fruits Reduce Colon Cancer Risk?

Background: Colon cancer arises due to the conversion of precancerous polyps (benign) found in the inner lining of the colon.

  • Prevention is better than cure, and this is very true with respect to colon cancer.
  • Various epidemiologic studies have linked colorectal cancer with food intake.
  • Apple and berry juices are widely consumed among various ethnicities because of their nutritious values.

My Take: This thorough literature review suggests that various phenolic phytochemicals present in these fruit juices have the potential to inhibit colon cancer cell lines. We need more research on the use of diet to reduce cancer risk. In the meantime, eat those fruits and vegetables! I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: World Journal of Gastroenterology, 12/26/2014  Review Article

Would A Lottery Ticket Tempt You to Get Colon Cancer Screening?

What You Need to Know: Convincing patients to do an often dreaded colon cancer screening test could just take a little extra nudge – like a chance to win $50. Patients who were told they had a 1-in-10 chance of winning $50 were more likely to complete home stool blood tests that help screen for colon cancer, according to a new study.

“Our study is another example of how modest financial incentives may go a long way in improving health behaviors and health care quality,” says author Jeffrey Kullgren, M.D., M.S. M.P.H. “Integrating a small lottery incentive into usual care is a low cost tool with potential to promote patients’ use of a service proven to saves lives by catching cancer early.”

Background: Officially called a fetal occult blood test, the home kit requires patients to take a sample of their bowel movement and mail it to a lab. The test helps detect hidden, microscopic blood in stool that may be an early sign of abnormal growths (polyps) or cancer in the colon. It is the least expensive way to screen for colon cancer and is recommended annually for people over the age of 50, but only about one-third of patients who are prescribed the home kit actually complete it.

The Study: Researchers wanted to see what price might help reverse the trend, looking at whether flat dollar amounts of up to $20, a chance to win $50 or raffle for $500 could be an effective incentive. The $50 lottery approach had the greatest impact, increasing the test completion rate by 20 percent. The study was done at the Philadelphia (USA) Veterans Affairs Medical Center among 1,549 patients who were prescribed the blood stool test.

“Fecal occult blood tests are inexpensive and an effective way to find colon cancer early and save lives. It’s up to the patient, however, to do this test at home and unfortunately completion rates are low,” says Kullgren, who is also a member of U-M’s Institute for Healthcare Policy and Innovation.

My Take: Low cost incentives may help us to improve our ability to prevent chronic diseases. This approach is worthy of more exploration in a number of health areas. I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: University of Michigan Health System. “Need to encourage patients to screen for colon cancer? Try a lottery.” ScienceDaily. ScienceDaily, 17 November 2014. <www.sciencedaily.com/releases/2014/11/141117174330.htm>.

Colon Cancer: Why Pattern of Spread is Predictable

liver_metastases_extensive

What You Need to Know: The genes that favor staggered colon cancer metastasis have been discovered by researchers. Of the colon cancer patients that develop metastases, 40% develop metastasis first to the liver and later to the lung, always in this clinical order of appearance. The study reveals that the metastatic lesion in the liver is necessary for later metastasis to lung to occur, the former thus becoming a platform from which the cells prepare the subsequent lung metastatic niche to be colonized.

Without a previous lesion in the liver there is no lesion in the lung: Of colon cancer patients that develop metastases, 40% present metastasis first to the liver and later to the lung, always in this clinical order of appearance. Although this staggered behavioral pattern was known, it was not understood at the molecular level.

So What’s New? This study reveals that the metastatic lesion in the liver is necessary for later metastasis to lung to occur, the former thus becoming a platform from which the cells prepare the subsequent lung metastatic niche to be colonized. The researchers observed that established metastatic cells in the liver release a molecule called PTHLH. This molecule affects the cells of pulmonary blood vessels, which respond to PTHLH by triggering remodelling processes. When a tumor cells escapes from the liver to travel towards the lung, it releases more PTHLH, thus further stimulating the process. This causes the previously impermeable blood vessel walls to form gaps, which the metastatic cell exploits to cross into and colonize the lung.

“Without the signal from the liver, the tumour cells could hardly enter the lung. With PTHLH, the cells that have colonized the liver are armed with a system that facilitate their activity at a distant site and they are able to prepare a niche in which to generate a new lung lesion. The tumour cells gain capacity to form PTHLH when the levels of p38 MAPKinase are decreased,” explains Roger Gomis.

Of note, most patients that develop metastasis to the liver do not do so to the lung, thanks to maintenance — among other factors — of appropriate p38 MAPKinase levels. The experiments have been validated in 284 clinical samples from patients with stage II and III colon tumours. These are the most relevant cases clinically because they are patients that have not developed metastases but could have acquired this capacity. The results have also been confirmed in cell lines and mouse models.

I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

References: Jelena Urosevic, Xabier Garcia-Albéniz, Evarist Planet, Sebastián Real, María Virtudes Céspedes, Marc Guiu, Esther Fernandez, Anna Bellmunt, Sylwia Gawrzak, Milica Pavlovic, Ramon Mangues, Ignacio Dolado, Francisco M. Barriga, Cristina Nadal, Nancy Kemeny, Eduard Batlle, Angel R. Nebreda, Roger R. Gomis. Colon cancer cells colonize the lung from established liver metastases through p38 MAPK signalling and PTHLH. Nature Cell Biology, 2014; DOI: 10.1038/ncb2977; Institute for Research in Biomedicine-IRB. “Why colon cancer metastasis always follows the same invasive pattern.” ScienceDaily. ScienceDaily, 2 June 2014. <www.sciencedaily.com/releases/2014/06/140602101407.htm>.

 

 

 

Sitting Too Long? You May Increase Your Risk of Cancer

African American young woman

What You Need to Know: If you’re spending a lot of time sitting every day, either in front of the TV or at work, you may be at higher risk for developing certain types of cancer, according to new research published this week in the Journal of the National Cancer Institute.

The Evidence: The study found an additional two hours a day of sedentary behavior was linked to an 8% increase in colon cancer risk, a 10% increase in endometrial cancer risk and a 6% increase in risk for lung cancer. It did not find the same connection for breast, rectum, ovary and prostate cancers or for non-Hodgkin lymphoma.

  • Researchers came to these conclusions by analyzing 43 existing studies – that included more than 4 million study participants and 68,936 cancer cases – to measure the relationship between hours spent sitting and certain types of cancers.
  • It’s important to note that while the study identifies a link between sedentary behavior and an increased risk for certain cancers, the research doesn’t prove cause and effect.

“Does sitting in front of the TV cause colon cancer? No,” said Dr. Martin Heslin, chief of surgical oncology at the University of Alabama at Birmingham. “But the recommendations (of the study) are awesome.” Heslin, who was not involved in the research, says that in addition to sedentary behavior, several factors can increase your risk of cancer, including drinking or smoking too much, being obese and having a genetic predisposition.

 

It’s nearly impossible to say that any one of these factors causes someone to get a specific cancer, he says, but these are the behaviors we can control to help reduce our risk.

“You can affect TV time by turning it off,” said Heslin, though he acknowledges it’s not so easy to turn off work if you’re stuck in an office all day.

In that case, Heslin suggests looking for opportunities to leave your desk, such as standing up while working or taking a walk, to reduce the number of hours you spend sitting down.

“If I ever have the opportunity to design (a meeting room), I’m putting a waist-high table in the room, and no chairs,” Heslin said.

According to an editorial accompanying the study, organizations such as the American Cancer Society and the UK Department of Public Health address the need to reduce hours spent sitting, but do not offer any quantitative recommendations or strategies to help people improve. Daniela Schmid, one of the study’s co-authors and a faculty member in the University of Regensburg’s department of epidemiology and preventive medicine, hopes to change that.

“The findings of our study may encourage public health efforts to expand physical activity recommendations to reduce time spent in sedentary behavior,” Schmid said.

Previous studies support the findings in Schmid’s study. A 2012 study conducted by the National Institutes of Health concluded that sitting for several hours a day is bad for you, even if you are physically active. Researchers found even exercising at least 150 minutes each week – the generally accepted public health guideline for physical activity – can’t reverse the negative effects of sitting down for hours. In that study, sitting increased an individual’s risk for major chronic diseases such as Type 2 diabetes, cardiovascular disease, and breast and colon cancers.

My Take: If you sit regularly, get up periodically (even if that means every 20-30 minutes for a few minutes). In addition, aim for a minimum of 150 minutes per week of the equivalent of a brisk walk (for example, 30 minutes daily for five times per week). I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

Available now: Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Both can be found at the Apple Ibooks store. Coming Soon for iPad: Understand Breast Cancer in 60 Minutes; Understand Colon Cancer in 60 Minute; Understand Colon Cancer in 60 Minutes; Understand Brain Glioma in 60 Minutes. Thank you.

Reference: CNN Health, 16 June 2014