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New cross-Canada study in Journal of Clinical Oncology outlines risks

A new cross-Canada study has found that breast and prostate cancer treatment can foster bone loss. In the online edition of the Journal of Clinical Oncology, the scientists explain how loss of bone mass might affect 46,000 people diagnosed with breast and prostate cancer each year* and place them at increased risk for osteoporosis and fractures.

“Our study also looked at possible medications that can reverse or halt bone loss,” says Dr. Fred Saad, lead author and director of urologic oncology at the Université de Montréal’s Faculty of Medicine and the Centre Hospitalier de l’Université de Montréal (CHUM), who completed the exhaustive study with colleagues from McMaster University, the Université Laval, the University of Toronto and the University of British Columbia.

“Bone is a dynamic tissue which undergoes a cyclic process of breaking down and rebuilding,” adds Dr. Saad. “Medications called bisphosphonates help with the rebuilding process and have been successfully used to combat osteoporosis, which is good news for cancer patients.”

Evaluating the studies

Dr. Saad and colleagues evaluated data from more than 3,500 breast and prostate cancer studies. They concluded that breast cancer patients treated with aromatase inhibitors were more likely to have bone loss and fractures compared to patients who didn’t receive the therapy. Similarly, men who received androgen deprivation therapy to treat their prostate cancer had an increased risk of bone disorders. Although the numbers vary from one study to the next (from five to 45 percent), an elevated risk is consistently observed.

“Awareness of the incidence of cancer-associated bone loss raises issues for clinicians who should identify those patients who are most at risk for fractures and prescribe treatment strategies,” says Dr. Saad. “This information is not only a concern for the specialists, but also for the general practitioners who frequently encounter these patients.”

Bisphosphonate treatment reduces bone loss

Dr. Saad’s group also evaluated data that included bisphosphonate treatment for cancer patients receiving chemotherapy. Prostate cancer patients who received bisphosphonate treatment and androgen deprivation therapy did show an increase in bone loss. In the same vane, there was a protective effect on bone loss for breast cancer patients who were treated with bisphosphonates.

“It is clear that the use of bisphosphonates attenuates bone loss,” concludes Dr. Saad. “However, the optimal dosing and long-term impact is unclear and needs to be determined. Other measures to combat the bone loss, such as exercise, vitamin D intake, avoidance of cigarettes, may also be beneficial

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Article adapted by Medical News Today from original press release.
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*(Re: Canadian Cancer Society)

This press release is available in French.

About the study:

The article “Cancer Treatment-Induced Bone Loss in Breast and Prostate Cancer” (http://www.jco.ascopubs.org/cgi/reprint/JCO.2008.18.4184v1), published in the Journal of Clinical Oncology, was authored by Fred Saad from the Université de Montréal and the Centre hospitalier de l’Université de Montréal; Jonathan D. Adachi of McMaster University; Jacques P. Brown of the Université Laval; Leah A. Canning and Karen A. Gelmon of the University of British Columbia; Robert G. Josse and Kathleen I. Pritchard of the University of Toronto.

Partners in research:

This study was funded through grants from Sanofi-Aventis.

On the Web:

About the Journal of Clinical Oncology: http://www.jco.ascopubs.org
About the Université de Montréal: http://www.umontreal.ca/english/index.htm
About the Centre Hospitalier de l’Université de Montréal http://www.chumtl.qc.ca/accueil.fr.html
About McMaster University: http://www.mcmaster.ca
About the Université Laval: www.ulavhttp://www.ulaval.caal.ca
About the University of Toronto: http://www.utoronto.com
About the University of British Columbia: http://www.ubc.ca

Source: Sylvain-Jacques Desjardins
University of Montreal

Not knowing which way is up can have deadly consequences for pilots. This confusion of the senses, called spatial disorientation, is responsible for up to 10 percent of general aviation accidents in the United States, with 90 percent of these being fatal, according to the Federal Aviation Administration.

Although there have been no spatial disorientation accidents in space, it is a major concern for astronaut pilots. A National Space Biomedical Research Institute (NSBRI) study is tackling the issue by developing a tool that will assist pilots in real-time to overcome spatial disorientation.

Project leader Ron Small said the first step is to understand the factors leading to spatial disorientation, which tends to occur in poor visibility conditions. The root cause, though, is physiology.

“Humans are notoriously bad at figuring out their orientation when flying because we did not evolve in a flight environment, in contrast with birds,” said Small, a member of NSBRI’s Sensorimotor Adaptation Team. “It is worse in a spacecraft because the vehicle can move side to side, up and down, and rotate in all directions.”

The project involves specially designed software that monitors the flight of the vehicle - speed, heading, pitch and altitude - and the actions of the pilot. The system will use audio and visual cues to alert pilots of problems before things get out of hand. The group is also looking at the option of testing a vest with pager-like vibrators distributed throughout that vibrate in a sequence to alert the pilot when an orientation correction is needed.

“It is really important that the system alert pilots in real-time,” said Small, a principal system engineer at Alion Science and Technology Corp., in Boulder, Colo. “We’re not doing the pilot any good if we can only give advice after the fact.”

Small is working closely with co-investigator Dr. Charles Oman, who is NSBRI’s Sensorimotor Adaptation Team Leader and director of the Man Vehicle Laboratory at Massachusetts Institute of Technology. To better understand the problems facing astronauts, the group is building on information from Small’s previous studies of spatial disorientation for the U.S. military and analyzing data from aircraft accidents and space missions. The group has consulted with experts such as former astronaut Dr. Thomas Jones.

“As we go forward with deep space exploration and return to the moon, it’s important to provide the latest tools in the cockpit to help pilots from being misled by spatial disorientation,” said Jones, a former U.S. Air Force pilot and veteran of four space shuttle flights. “Spatial disorientation mistakes in space are very rare, but because of mission costs and the potential for loss of life, you want to do everything possible to preclude them.”

The group has tested the software’s ability to detect spatial disorientation incidents. They are now working to better understand the differences in craft movement in the atmosphere and in space and how the human inner ear functions in both environments. The inner ear helps control the sense of orientation.

The researchers are putting emphasis on lunar landings due to the challenges of reduced gravity and the unfamiliar, dusty terrain. Data collected from helicopters will play a large role in the research since the rotary-propelled aircrafts’ movements are most like a spacecraft touching down on the moon. Low-gravity flight experiments and lunar lander simulations are slated to begin next year.

The project team members believe the onboard aids developed for spaceflight will be an essential tool for pilots of medical emergency helicopters, who often respond to auto accidents on dark, rainy nights when it is easy to become disoriented. Military and civilian pilots are also likely to benefit from the research.

“Pilots of small planes often have less training in spatial disorientation and how to respond to an incident,” Jones said. “Their lives can be saved by having this extra help in the cockpit.”

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Article adapted by Medical News Today from original press release.
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The NSBRI Sensorimotor Adaptation Team is developing pre-flight and in-flight training countermeasures so that astronauts can adjust more rapidly to weightlessness, to other gravitational environments, and upon return to Earth’s gravity. The team is also developing training tools for telerobotic arm operation.

Source: Brad Thomas
National Space Biomedical Research Institute

An editorial published in this week’s Lancet is highly optimistic regarding President-elect Obama’s ability to influence real change in health care policy - one of the United States’ most divisive political issues.

“Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care,” say the writers of the editorial. “Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported.”

They add that, “It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality.”

According to the editorial, Obama’s plan for global health must consider climate change, two ongoing wars, and trade relations. The writers propose six steps with which Obama can effect meaningful change:

1. “Health equity and human security should be a stated objective of foreign policy.”
2. “The DHHS Director of Global Health Affairs, Bill Steiger - who has badly hurt America’s reputation in global health - should be replaced with a more experienced and appropriate politician.”
3. “Mark Dybul, the head of PEPFAR - the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies - will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies - for example, its preference for abstinence-until-marriage programmes.”
4. “Just as George W Bush reinstated the global gag rule - a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning - in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke.”
5. “A public commitment to agree to spend the internationally agreed target of 0.7% of gross national income on aid by 2015 would set a good example to the international community.”
6. “As a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights.”

The writers also hope that Obama will not be as antagonistic towards the UN system as the Bush administration was.

“The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains,” concludes the editorial. “An increase in support - including financial support - for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, ‘change can happen’. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans - and those affected by American foreign policy.”

Obama and health: change can happen
The Lancet (2008). 372[9651]: p. 1708.
Click Here to View Journal Website

Written by: Peter M Crosta

According to an editorial published in this week’s Lancet, the National Health Service (NHS) in the UK has made an ‘undignified’ and ‘divisive’ move by allowing patients to ‘top-up’ their free NHS treatment with treatments that are not currently approved by the NHS.

“The existing system allows patients to pay for extra treatment (top-ups) but then they lose all NHS care.” explain the authors. “The new proposal, which is out for consultation until January, will allow top ups, with the rider that the extra treatment cannot be given on an NHS ward but will need to be administered in a private ward or hospital. The UK Government is clearly embarrassed, not wanting patients in adjacent NHS beds to be receiving different care.”

The editorial writers believe that NHS funding must be based on dignity and solidarity, and they label the new two-tier NHS as ‘undignified’ and ‘divisive’.

“The National Institute for Health and Clinical Excellence, battered this year for its decisions about high-profile drugs for renal and lung cancer, and dementia, is to review how it calculates whether a treatment is cost effective. But the funding of a national health service reaches higher, to the heart of government. This summer saw the UK Government use £400 billion of taxpayers’ money to rescue ailing financial institutions. Vast sums of money can be made available when needed,” conclude the writers.

The editorial adds that if the government does not re-align its priorities, there will be accusations of ‘moral bankruptcy’.

A morally bankrupt government divides the NHS
The Lancet (2008). 372[9651]: p. 1708.
Click Here to View Journal Website

Written by: Peter M Crosta

A study published on bmj.com finds that the electrocardiograms (ECGs) usually given to people with suspected angina have limited accuracy in their ability to predict the future likelihood of heart disease. Researchers from the London Chest Hospital emphasize that in order to improve the chances of detecting individuals at high risk of heart disease and heart attack, physicians must also use alternative tests that add predictive value to what is gathered from the clinical histories of patients.

About 2% of people in the UK experience angina - a common chest-pain symptom of coronary artery disease. To make sure that people with angina symptoms can be checked by a specialist within two weeks of referral, there are rapid-access chest pain clinics available for patients. Assessments usually consist of non-invasive ECGs during rest and exercise, but there is little data on the ability of these tests to predict future heart disease.

Further investigating this issue, the researchers studied 8,176 patients who had no earlier diagnosis of heart disease but had suspected angina. Doctors referred each patient to one of six chest pain clinics. A clinical assessment provided researchers with information on age, sex, ethnicity, duration of symptoms, description of chest pain, smoking status, history of hypertension, and medications. In addition, patients received an ECG while at rest.

Of the total sample, about 60% (4,848) of the patients had an exercise ECG performed and 1,422 of these also provided more “detailed” exercise ECG data. Patients were followed up for a median of 2.46 years.

The results demonstrated that patients who had a negative exercise ECG - indicating no heart problems - had some 47% of the coronary events that occurred in the follow-up period. The authors believe that this points to the limited accuracy in predicting the risk of future heart disease when using exercise ECGs. In addition, the researchers argue that a routine clinical assessment was able to provide almost the same amount of predictive information as an ECG when predicting future heart problems. Similarly, no additional benefit was provided by the resting ECG.

“Our study emphasises the importance of the clinical assessment for prognosis in patients with suspected angina,” conclude the authors. “The data show that the need to improve risk stratification cannot be met by the resting ECG whereas the incremental value of the exercise ECG is small. Alternative tests are needed but must be developed within cohorts from chest pain clinic because prognostic value depends on the population in which the test is applied.”

They add: “The limited incremental value of these widely applied tests emphasises the need for more effective methods of risk stratification in this group of patients.”

In an accompanying editorial, Beth Abramson (Director of St Michael’s Hospital in Toronto) writes that these findings point to “the importance of taking a detailed history and making a thorough physical examination, and that additional information from the ECG is helpful in some patients but does not predict risk in everyone.”

Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study
Neha Sekhri, Gene S Feder, Cornelia Junghans, Sandra Eldridge, Athavan Umaipalan, Rashmi Madhu, Harry Hemingway, Adam D Timmis
BMJ (2008). 337:a2240
doi:10.1136/bmj.a2240
Click Here to View Journal Website

Written by: Peter M Crosta
Copyright: Medical News Today