Cancer patients want more information about medical imaging risk

A substantial gap exists between patient expectations and current practices for providing information about medical imaging tests that use radiation, according to a new study published online in the journal Radiology. Researchers said the findings highlight a need for better communication as medicine enters an era of patient-centered care.In recent years, there have been numerous reports in the media about potential risks of tests that use ionizing radiation. However, benefit-risk discussions about ionizing radiation from medical imaging are rare and seldom initiated by clinicians.For the new study, researchers from Memorial Sloan Kettering Cancer Center (MSKCC) in New York City analyzed over nine hours of transcribed conversations with 30 people who had undergone medical imaging exams to determine their understanding of the benefits and risks associated with various medical imaging procedures and their expectations regarding communication of those benefits and risks.

Read the rest of the article at http://www.medicalnewstoday.com/releases/291385.php.

Cherenkov Effect improves radiation therapy for patients with cancer

The characteristic blue glow from a nuclear reactor is present in radiation therapy, too. Investigators from Dartmouth’s Norris Cotton Cancer Center, led by Brian W. Pogue, PhD, and PhD candidates Adam K. Glaser and Rongxiao Zhang, published in Physics in Medicine and Biology how the complex parts of the blue light known as the Cherenkov Effect can be measured and used in dosimetry to make therapies safer and more effective.”The beauty of using the light from the Cherenkov Effect for dosimetry is that it’s the only current method that can reveal dosimetric information completely non-invasively in water or tissue,” said Glaser.

Read the rest of the article at http://www.medicalnewstoday.com/releases/290027.php.

Sunlight continues to damage skin in the dark

Much of the damage that ultraviolet radiation (UV) does to skin occurs hours after sun exposure, a team of Yale-led researchers concluded in a study that was published online by the journal Science.Exposure to UV light from the sun or from tanning beds can damage the DNA in melanocytes, the cells that make the melanin that gives skin its color. This damage is a major cause of skin cancer, the most common form of cancer in the United States. In the past, experts believed that melanin protected the skin by blocking harmful UV light. But there was also evidence from studies suggesting that melanin was associated with skin cell damage.In the current study, Douglas E. Brash, clinical professor of therapeutic radiology and dermatology at Yale School of Medical, and his co-authors first exposed mouse and human melanocyte cells to radiation from a UV lamp. The radiation caused a type of DNA damage known as a cyclobutane dimer (CPD), in which two DNA “letters” attach and bend the DNA, preventing the information it contains from being read correctly. To the researchers’ surprise, the melanocytes not only generated CPDs immediately but continued to do so hours after UV exposure ended. Cells without melanin generated CPDs only during the UV exposure.

Read the rest of the article at  http://www.medicalnewstoday.com/releases/289728.php.

Human stem cells repair damage caused by radiation therapy for brain cancer in rats

For patients with brain cancer, radiation is a powerful and potentially life-saving treatment, but it can also cause considerable and even permanent injury to the brain. Now, through preclinical experiments conducted in rats, Memorial Sloan Kettering Cancer Center researchers have developed a method to turn human stem cells into cells that are instructed to repair damage in the brain. Rats treated with the human cells regained cognitive and motor functions that were lost after brain irradiation. The findings are reported in the February 5 issue of the journal Cell Stem Cell.During radiation therapy for brain cancer, progenitor cells that later mature to produce the protective myelin coating around neurons are lost or significantly depleted, and there is no treatment available to restore them. These myelinating cells–called oligodendrocytes–are critical for shielding and repairing the brain’s neurons throughout life.A team led by neurosurgeon Viviane Tabar, MD, and research associate Jinghua Piao, PhD, of the Memorial Sloan Kettering Cancer Center in New York City, wondered whether stem cells could be coaxed to replace these lost oligodendrocyte progenitor cells. They found that this could be achieved by growing stem cells–either human embryonic stem cells or induced pluripotent stem cells derived from skin biopsies–in the presence of certain growth factors and other molecules.Next, the investigators used the lab-grown oligodentrocyte progenitor cells to treat rats that had been exposed to brain irradiation. When the cells were injected into certain regions of the brain, brain repair was evident, and rats regained the cognitive and motor skills that they had lost due to radiation exposure. The treatment also appeared to be safe: none of the animals developed tumors or inappropriate cell types in the brain.

Read the rest of the article at  http://www.medicalnewstoday.com/releases/289083.php.

Majority of primary care physicians find that medical imaging improves patient care

According to a study published online in the Journal of the American College of Radiology (JACR), large majorities of primary care physicians believe that advanced medical imaging, such as computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET), provides considerable value to patient care.A national survey of 500 primary care physicians was conducted using an online self-administered questionnaire. Study results showed that primary care physicians overwhelmingly indicated that advanced imaging:For more information read here http://www.medicalnewstoday.com/releases/288560.php

 

Patient-centred approach to recording side effects of radiotherapy

For lung cancer that cannot be removed with surgery, radiotherapy is the primary treatment option. However, it is associated with a range of side effects, including fatigue and inflammation of the oesophagus and lungs.

Current methods to record treatment-related toxicities rely on assessment by health care professionals. Now a team from The University of Manchester and The Christie NHS Foundation Trust – both part of the Manchester Cancer Research Centre – has explored the use of patient-reported outcomes to improve the recording of side effects for lung cancer patients.

Dr Corinne Faivre-Finn, a researcher in The University of Manchester’s Institute of Cancer Sciences and a consultant based at The Christie NHS Foundation Trust, who led the research, said: “Such patient-reported outcome tools have been mainly evaluated for use with chemotherapy treatments. We wanted to assess their feasibility and relevance in lung cancer patients undergoing radiotherapy.”

The group looked at the agreement between side effects as reported by doctors and the patients themselves. They also evaluated the relationship between reported toxicities and quality-of-life measures, relating to aspects such as tiredness, anxiety and shortness of breath.

Patients were asked to fill in questionnaires covering both side effects and quality of life at three time points: before treatment, at the end of radiotherapy and at later follow up. The consultants answered questions at identical time points covering the same common radiotherapy-related toxicities for each patient.

The study found that there was strongest agreement between the patient’s scoring of side effects and measures relating to their quality of life. Toxicities as recorded by the clinicians appeared to underestimate their severity.

“This was the first study in Europe to explore such a patient-centred approach to recording side effects. Incorporating this method into cancer care could allow us to detect and manage serious effects earlier. It could also improve patient-doctor relationships and help doctors better understand the full impact of treatment on patients,” added Dr Faivre-Finn.

Adapted by MNT from original media release

 

http://www.medicalnewstoday.com/releases/287751.php

Interstitial lung disease is a significant risk factor for lung inflammation following stereotactic body radiation therapy for lung cancer

Pretreatment interstitial lung disease (ILD) is a significant risk factor for developing symptomatic and severe radiation pneumonitis in stage I non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT) alone.

ILD is a group of diseases that cause scarring and stiffing of the tissue and space around the air sacs in the lungs, which results in diminished gas exchange. The incidence of ILD among lung cancer patients is higher than in the general population as tobacco smoking is a common risk factor for both. Some lung cancer patients with ILD may not be considered good candidates for surgical therapy. SBRT uses sophisticated techniques to deliver a targeted and focused radiation dose to a tumor in order to stop the growth locally with limited damage to surrounding healthy tissue. SBRT is considered an acceptable therapy choice for early-stage NSCLC patients who are not good candidates for or decline surgery.

In order to determine the optimal treatment for early-stage lung cancer patients with ILD, researchers at Kyoto University in Japan examined the incidence of radiation pneumonitis and the clinical outcomes in 157 patients who underwent SBRT alone for stage I NSCLC.

Results published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC), show that of the 157 patients who received SBRT for lung cancer therapy, 20 were identified as having pretreatment ILD. The presence of ILD was a significant risk factor for both symptomatic and severe radiation pneumonitis and the cumulative incidence of radiation pneumonitis increased significantly with worse ILD. Overall survival trended to be shorter in the ILD positive population but this was not statistically significant and may be accountable to the ILD itself. There were no differences in disease progression or local progression rates in patients with ILD versus those patients without.

“Our results suggest that the impact of ILD on radiation pneumonitis depends on the preexisting severity of the ILD findings and clinicians should be cautious when considering SBRT for those with significant ILD findings”, say the authors. “However, other than radiation pneumonitis, life-threatening complications after SBRT are rare. Thus, if the severity of ILD and the risk of radiation pneumonitis are carefully evaluated, SBRT is a curative-intent treatment option for those with early-stage NSCLC and pretreatment ILD.”

http://www.medicalnewstoday.com/releases/285268.php

 

Picture courtesy of www.nature.com

 

Health costs could be reduced by more appropriate use of cardiac stress testing with imaging

In a new study recently published in the Annals of Internal Medicine, researchers at NYU Langone Medical Center concluded that overuse of cardiac stress testing with imaging has led to rising healthcare costs and unnecessary radiation exposure to patients.

In what is believed to be the first comprehensive examination of trends in cardiac stress testing utilizing imaging, researchers also showed that there are no significant racial or ethnic health disparities in its use. They also made national estimates of the cost of unnecessary cardiac stress testing with imaging and the health burden of this testing, in terms of cancer risk due to radiation exposure.

Cardiac stress testing, particularly with imaging, has been the focus of debate about rising health care costs, inappropriate use, and patient safety in the context of radiation exposure. Joseph Ladapo, MD, PhD, assistant professor in the Departments of Medicine and Population Health at NYU Langone, and the lead author of the study, and colleagues wanted to determine whether U.S. trends in cardiac stress testing with imaging may be attributable to population shifts in demographics, risk factors, and provider characteristics, and to evaluate whether racial/ethnic disparities exist in physician decision making.

They designed their study utilizing data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1993 to 2010. Patients chosen for the study were adults without coronary heart disease who were referred for cardiac stress tests.

Between 1993 to 1995 and 2008 to 2010, the annual number of ambulatory visits in the U.S. in which a cardiac stresstest was ordered or performed increased by more than 50%. Cardiac stress tests with imaging comprised a growing portion of all of these tests – increasing from 59% in 1993 to 1995 to 87% in 2008 to 2010. At least 34.6% – or one million tests – were probably inappropriate, the researchers concluded, with associated annual costs and harms of $501 million and 491 future cases of cancer.

The authors also concluded that there was no evidence of a lower likelihood of black patients receiving a cardiac stresstest with imaging (odds ratio, 0.91 [95% CI, 0.69 to 1.21]) than their white counterparts – although some modest evidence of disparity in Hispanic patients was found (odds ratio, 0.75 [CI, 0.55 to 1.02]).

The investigators concluded that the national growth in cardiac stress testing can be attributed largely to population and provider characteristics – but the use of imaging cannot. Physician decision making about cardiac stress testing also does not result in racial/ethnic disparities in cardiovascular disease.

“Cardiac stress testing is an important clinical tool,” says Dr. Ladapo, “but we are over using imaging for reasons unrelated to clinical need. This is causing preventable harm and increasing healthcare costs.

“Reducing unnecessary testing also will concomitantly reduce the incidence of radiation related cancer,” he adds. “We estimate that about 500 people get cancer each year in the US from radiation received during a cardiac stress test when, in fact, they most probably didn’t need any radiological imaging in the first place. While this number might seem relatively small, we must remember that ‘first, do no harm’ is one of the guiding principles in medicine.”

So what can be done to reduce unnecessary cardiac stress testing with imaging? “More efforts, such as clinical decision support, are needed to reduce unnecessary cardiac stress testing,” Dr. Ladapo concludes, suggesting greater use ofstress testing without radiological imaging, such as regular exercise treadmill tests or stress testing with ultrasoundimaging as opposed to CT imaging.

As to the reason why certain racial and ethnic minorities have poorer rates of treatment for cardiovascular disease and generally have poorer cardiovascular health outcomes compared to white patients, Dr. Ladapo concludes that no one has really explored whether there could be disparities in cardiac stress testing, which is a mainstay of diagnosing patients with heart disease in this country. “If we know that one minority group has a higher incidence of poorer outcomes from heart disease, perhaps we need to examine if they would benefit from more appropriate use of cardiac stress testing,” he offers. “Perhaps one contributing reason they have poorer outcomes is because we are not testing them appropriately.”

http://www.medicalnewstoday.com/releases/283694.php

 

Exercise can enhance tumor-shrinking effects of chemotherapy

New research published in the American Journal of Physiology, suggests exercise may boost the tumor-shrinking effects of chemotherapy.

In a study of mice with melanoma, scientists from the University of Pennsylvania (Penn) in Philadelphia, found that chemotherapy shrank more tumors when combined with exercise.

Senior author Joseph Libonati, an associate professor in Penn’s School of Nursing, and colleagues were originally trying to find out if exercise could protectcancer patients against the heart damage that can result from use of the common cancer drug doxorubicin.

Although the drug is effective against a variety of cancers, one of its side effects is the potential damage it can do to heart cells. In the long term, this can causeheart failure.

Prof. Libonati says at first, all cancer patients are concerned about is the cancer, “and they’ll do whatever it takes to get rid of it.”

“But then when you get over that hump you have to deal with the long-term elevated risk of cardiovascular disease,” he adds.

There is evidence that taking up regular exercise before undergoing chemotherapy can protect heart cells from the damaging effects of doxorubicin. But not many have investigated whether there is any benefit from exercising during chemotherapy.

For their study, the team picked four groups of mice and induced them with melanoma. Over the next 2 weeks, two of the groups received two injections of doxorubicin, and two received placebo injections.

At the same time, mice in one of the chemotherapy groups and one of the placebo groups were placed on exercise regimens. The other mice did not exercise during the treatment period. The exercising mice walked on treadmills for 45 minutes a day on 5 days of each week.

Exercise helped chemotherapy shrink tumors but did not change effect on heart

After the 2-week period, the team found the mice that received chemotherapy – regardless of whether they had exercised or not – showed signs of heart damage. The damage consisted of reduced heart function and increased fibrosis or tissue thickening.

As Prof. Libonati says, “exercise didn’t do anything to the heart – it didn’t worsen it, it didn’t help it.”

But he and his team were amazed when they looked at the tumors. They found the mice that had received chemotherapy and exercised had much smaller tumors after 2 weeks than the sedentary mice on chemotherapy.

They conclude that in mice with melanoma, exercise appears to boost the tumor-shrinking effects of doxorubicin, without having an effect on the damage the drug can do to the heart.

They suggest further studies should now look into exactly how exercise boosts the effects of chemotherapy. Perhaps a reason is because exercise improves blood flow, which allows more of the drug to reach the cancer cells.

Prof. Libonati adds, “If exercise helps in this way, you could potentially use a smaller dose of the drug and get fewer side effects.”

He explains that we are only just beginning to understand the effect exercise can have on drug- taking:

“People don’t take a drug and then sit down all day. Something as simple as moving affects how drugs are metabolized.”

Finding out more about how exercise affects the body could lead to drugs that mimic the effects of exercise.

Funds for the study came from the National Cancer Institute, the National Heart Lung and Blood Institute, the National Center for Research Resources, the National Center for Advancing Translational Sciences, and the Biobehavioral Research Center at Penn.

Meanwhile, Medical News Today recently learned of a study published in Science Translational Medicine that showed how tumors shrank following a bacteria injection. The researchers shrank cancer tumors in rats, dogs and also one human patient, by directly injecting the tumors with a modified version of Clostridium novyi to trigger targeted anti-cancer responses.

Written by Catharine Paddock PhD

Copyright: Medical News Today

http://www.medicalnewstoday.com/articles/282767.php

 

 

UCLA scientists unlock protein that can accelerate recovery in cancer patients following radiation and chemotherapy

Scientists from UCLA’s Jonsson Comprehensive Cancer Center (JCCC) have shown for the first time how a unique protein found in human bone marrow can drive stem cells to repair our blood system after an injury. These groundbreaking findings provide a roadmap to make existing radiation and chemotherapy treatments more effective for patients with cancer and other blood-related diseases.

Led by Dr. John Chute, UCLA professor of hematology and radiation oncology and JCCC member, the nearly two-year study was published online ahead of print in the Journal of Clinical Investigation.

Millions of cancer patients worldwide currently receive some form of radiation therapy or chemotherapy in hopes of curing the disease, and most will suffer damage to the blood system as a result. Current therapeutic regimens are also cyclical (generally requiring a 30-day wait period between treatments) to allow the blood system time to heal and repair.

Hematopoietic stem cells (HSCs) are cells in our body that can change and become any other type of blood cell (such as red or white blood cells). Scientists have long used HSCs in the laboratory to study how the bone marrow in our body can regulate and instruct these blood stem cells to regenerate and repair themselves, and thus help our bodies to recover after an injury or stress (such as following radiation or chemotherapy).

In his prior research, Dr. Chute discovered that specific cells that make up the lining of blood vessels in our bone marrow (called endothelial cells) play a key role in telling HSCs how to renew and repair themselves. He further theorized that following an injury or stress to our body, the blood system as a whole will benefit as the activities and functions happening in our bone marrow directly drive HSCs to promote and accelerate recovery.

In this new study, Dr. Chute and colleagues built upon their research to specifically identify a new protein called pleiotrophin. They discovered that the protein binds to HSCs, and that it is this process that activates recovery of blood stem cells and our entire blood system.

Dr. Chute’s team conducted experiments in mouse models to administer pleiotrophin after a normally lethal dose of radiation. Results showed that HSCs and the blood system recovered faster, and in two thirds of the cases the animal survived.

Additionally, Dr. Chute’s team found in further testing that by doing the opposite and actually blocking pleiotrophin (thereby preventing it from functioning), the blood stem cells saw no advantage in recovery. This highly suggests that the protein is key in accelerating recovery of the blood system.

“We have now discovered the mechanism by which pleiotrophin can instruct blood stem cells to regenerate,” said Dr. Chute. “By modeling it for potential use in human patients, this opens the door for tremendous therapeutic possibilities.”

Dr. Chute and his team are currently pursuing a Phase I clinical trial, with the goal of accelerated recovery for patients undergoing all types of radiation and chemotherapy as well as lessened delays between treatments.

“With this discovery, we hope to provide the basis for improving outcomes for patients with cancer or other blood-related diseases and who are undergoing highly toxic treatments,” said Dr. Chute.

This research was supported by funding from the National Institute of Allergy and Infectious Diseases and National Heart, Lung, and Blood Institute. Additional funding was provided by the UCLA Broad Stem Cell Research Center.

http://www.medicalnewstoday.com/releases/283036.php