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An advanced type of cancer radiation is more successful than traditional radiation in avoiding “dry mouth” when treating head and neck cancers, but it is unknown whether the treatment is better or worse at reducing the size of tumors, according to a new comparative effectiveness review funded by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).
The report finds that intensity-modulated radiation therapy (IMRT) leads to fewer cases of xerostomia, commonly known as dry mouth, than other types of radiation. Xerostomia, a potential side effect to radiation when salivary glands are damaged, can affect basic functions like chewing, swallowing and breathing; senses such as taste, smell and hearing; and can significantly alter a patient’s appearance and voice.
However, the report did not find evidence that IMRT is more successful than any other kind of radiation therapy in reducing tumors. Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissues, but more research is needed, the report said. The comparative effectiveness review, Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, was authored by the Blue Cross and Blue Shield (BC/BS) Association, Technology Evaluation Center in Chicago.
“The development of new technologies to treat cancer has been one of the true success stories of American medical research,” said AHRQ Director Carolyn M. Clancy, M.D. “This report provides patients and their doctors with more information about these advances, which they can use to make more informed choices about their own treatment.”
The report examines treatment for cancers to the head and neck, including the mouth, larynx and sinuses. (Tumors in the brain are considered a separate type of cancer and are not discussed in this report.) Non-brain head and neck cancers account for up to 5 percent of cancers that are diagnosed in the United States, with an estimated 47,560 new cases and 11,260 deaths in 2008.
As with other cancers, head and neck cancer often is treated by radiation, which can damage both cancerous and non-cancerous cells. To limit damage to non-cancerous cells, scientists have sought ways to target high doses of radiation to cancerous cells while sparing healthy ones. This is particularly important with head and neck cancers, because tumors can reside close to vital organs.
Standard radiation therapy has evolved over the past 20 years and now provides doctors with two-or three-dimensional images that simulate a patient’s treatment area on a computer screen. IMRT, which has been implemented over the past 10 years, also employs three-dimensional imaging and further technological and treatment enhancements that tightly control and target the amount of radiation delivered to the target area.
The AHRQ report found that IMRT leads to fewer cases of xerostomia than traditional two-dimensional or three-dimensional radiation therapies, probably because IMRT delivers radiation more precisely. It also found that IMRT improves some aspects of quality of life related to xerostomia. However, the evidence did not conclude that IMRT is better than traditional therapies at reducing the tumors themselves.
In this comparative effectiveness review, researchers also examined the evidence regarding proton beam radiation therapy, a technology that some clinicians believe targets radiation even more precisely than IMRT. However, researchers did not find enough evidence to draw any conclusions regarding the benefits or potential side effects of proton beam therapy, which is more commonly used to treat prostate cancer and pediatric tumors. In an AHRQ Technical Brief published last fall, researchers found limited evidence regarding whether proton beam radiation therapy is safer or more effective than other types of radiation to treat cancer.
Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer is the newest research review from the AHRQ’s Effective Health Care Program. The Effective Health Care Program represents the leading federal effort to compare alternative treatments for health conditions and make the findings public, to help doctors, nurses, pharmacists and others work together with patients to choose the most effective treatments.
In conjunction with the new report, AHRQ will soon publish in plain-language summary guides about radiation therapy for head and neck cancer treatment for patients, clinicians and policymakers. Summary guides on numerous clinical topics such as medicines to reduce the risk of breast cancer and choosing pain medicine for osteoarthritis, as well as other information and background on the Effective Health Care Program, can be found at http://www.effectivehealthcare.ahrq.gov.
Switching to electronic medical records can significantly boost how quickly patients with the sexually transmitted disease chlamydia are treated, a new study shows.
Researchers found that an electronic medical record system more than doubled the percentage of patients treated within two weeks of diagnosis.
The study examined the medical records of 100 patients at a sexual health clinic who were treated either before or after the clinic stopped using paper records.
Before the clinic converted to computerized records, it took an average of 11.5 days for a patient to be treated after being diagnosed with chlamydia. That rate fell to 3.5 days after the switch.
And the percentage of those who were treated within two weeks of getting a positive test result skyrocketed from 38 percent to 94 percent.
The longer a sexually transmitted infection goes untreated, “the more risk there is of onward transmission and of clinical complications,” the authors wrote. “Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods for the good of our patients and the betterment of public health.”
The findings were published online in the journal Sexually Transmitted Infections.
Hospitals across the United States are seeing a decrease of serious, often deadly infections from catheters placed in patients’ necks, called central line catheters, a new report finds.
“Health care-associated infections are a significant medical and public health problem in the United States,” Dr. Don Wright, the Deputy Assistant Secretary for Healthcare Quality in the U.S. Department of Health and Human Services (HHS), said during a noon teleconference Thursday.
Bloodstream infections occur when bacteria from the patient’s skin or from the environment get into the blood. “These are serious infections that can cause death,” said Dr. Arjun Srinivasan, the associate director for Healthcare-Associated Infection Prevention Programs in CDC’s Division of Healthcare Quality Promotion.
Central lines can be important conduits for these infections, he said. These lines are typically reserved for the sickest patients and are usually inserted into the large blood vessels of the neck. Once in place, they are used to provide medications and help monitor patients.
“It has been estimated that there are approximately 1.7 million health care-associated infections in hospitals alone each and every year, resulting in 100,000 lives lost and an additional $30 billion in health care costs,” Wright said.
In 2009, HHS started a program aimed at eliminating health care-related infections, the experts said. One goal: to cut central line infections by 50 percent by 2013.
To this end, the U.S Centers for Disease Control and Prevention (CDC) on Thursday released its latest update on the progress so far.
The report represents the first consistent tracking of blood infections caused by central venous lines across 17 states and “the results of the report are encouraging,” Wright said.
Srinivasan agreed. According to the study, there has been “an 18 percent national decrease in central line-associated bloodstream infections during the first six months of 2009, compared to the previous three years,” he said.
Srinivasan noted that most central line blood infections are preventable.
“We believe this decrease represents broader implementation of CDC guidelines and improved practices at the local level,” he said. “The bottom line of this reduction is that we believe care in hospitals is getting safer, but we know there is more work to be done.”
The report serves as a baseline to see how the country as a whole is faring in regard to these infections and also provides data so individual states can see where they stand, Srinivasan said.
On a state-by-state level, Vermont had the fewest infections, while Maryland had the most, according to the report.
“The real test will be comparing this data with future reports, which will be published every six months,” he said. “At that point we can judge progress over time and determine whether these efforts are driving infections down.”
Future reports will include all states, Srinivasan said. The states in the current dataset are those that currently have laws mandating the reporting of hospital infections to the CDC.
SOURCES: 2010, teleconference with: Don Wright, M.D., M.P.H, Deputy Assistant Secretary for Healthcare Quality, U.S. Department of Health and Human Services, Office of the Secretary, Office of Public Health and Science, and Arjun Srinivasan, M.D., associate director for Healthcare-Associated Infection Prevention Programs, Division of Healthcare Quality Promotion, U.S. Centers for Disease Control and Prevention;
Exercise during and after treatment improves quality of life and eases fatigue for patients battling either breast or prostate cancer, a new study finds.
“Using exercise as an approach to cancer care has the potential to benefit patients both physically and psychologically, as well as mitigate treatment side effects,” study lead author Dr. Eleanor M. Walker, division director of breast services in the department of radiation oncology at Henry Ford Hospital in Detroit, said in a statement.
Walker and colleagues created a program called ExCITE that encouraged 30 female breast cancer patients and 20 prostate cancer patients to collaborate on individualized exercise programs. The researchers followed the patients, aged 35 to 80, during their treatment and for a year afterward.
Before patients joined the exercise program, the hospital’s cardiology division evaluated their skeletal muscle strength, endurance and capacity for exercise. Staff also examined patients’ weight, overall health, and type of cancer treatment, as well as doing blood work, bone density screens, metabolic screenings and workups for inflammatory “markers.”
“Exercise is a great alternative to patients combating fatigue and nausea who are considering using supplements which may interfere with medications and chemotherapy they’re taking during cancer treatment,” Walker concluded.
Think you need to go to the doctor’s office to check your blood pressure? Think again: The best way to predict your risk of stroke or heart attack due to high blood pressure is through systematic monitoring at home rather than periodic checks in the doctor’s office, new research suggests.
“With home blood pressure monitoring you get a greater number of measurements and there is no white-coat effect,” lead author Dr. Teemu Niiranen told Reuters Health, speaking of the tendency for anxiety to drive up blood pressure. “At home the patient is more relaxed and this seems to provide blood pressure values that reflect the patient’s true blood pressure better.”
Writing in the American Heart Association’s journal Hypertension, Niiranen and colleagues at Finland’s National Institute of Health and Welfare concluded that home-measured blood pressure is a better predictor of heart disease-related problems than office-measured blood pressure.
High blood pressure is a major risk factor for heart disease, stroke, and kidney disease, and nearly one in three Americans have high blood pressure, according to the Centers for Disease Control. In 2006 it contributed to the deaths of 326,000 Americans.
The researchers used data on more than 2,000 Finns, 45 to 74 years old, gathered between 2000 and 2001. Participants agreed to be interviewed, undergo medical exams and monitor their blood pressure at home on well-calibrated monitoring devices.
At follow-up nearly 7 years later, 162 participants reported at least 1 non-fatal heart disease-related event such as a heart attack, stroke, or hospitalization due to heart failure. Among the 2,081 participants, 37 heart disease-related deaths were reported.
After analyzing the data, the Niiranen group concluded that the best predictor of heart attacks, strokes, and related deaths was home blood pressure monitoring.
The home blood pressure readings, because there were more of them and they weren’t affected by the “white coat effect,” were more accurate, the authors found.
The home blood pressure monitor used in the study - Omron’s HEM-722c, comparable to the HEM-712c in the U.S. — costs about $70. Niiranen said 60 percent of Finnish patients with high blood pressure have home monitors.
While the study was done in Finland, Niiranen said there’s no reason to believe these results would not also apply to the populations in other countries.
The study could not determine whether home monitoring could save lives, however, since it was only observational, Niiranen said.
The U.S. Food and Drug Administration today approved a second test to screen blood, tissue and organ donors for a blood-borne parasite, Trypanosoma cruzi (T. cruzi) that causes Chagas disease, a serious and potentially fatal parasitic infection.
The test, called Abbott Prism Chagas [Trypanosoma cruzi (E. coli, Recombinant) Antigen], detects antibodies to T. cruzi. It is a fully automated and highly sensitive and specific test for the detection of antibodies to T. cruzi.
The assay is intended as a screen to detect antibodies to T. cruzi in serum or plasma specimens obtained from donors of whole blood and blood components and other living donors.
It is also intended for use to screen organ donors when serum and plasma specimens are obtained while the donor’s heart is still beating and in testing blood specimens to screen cadaveric donors (those whose hearts are not beating).
“Screening for T. cruzi is an important safety measure to help protect our blood supply and help prevent the spread of Chagas disease,” said Karen Midthun, M.D., acting director of the FDA’s Center for Biologics Evaluation and Research.
An estimated 300,000 people in the United States are infected with Chagas disease.
Chagas disease is spread mainly by blood-sucking insects infected with T. cruzi. Chagas disease can also be spread through blood transfusion, organ transplants and from mother to unborn child. National screening of the blood supply was instituted in early 2007, and more than 1,000 donors with T. cruzi infection have been identified within the past three years of testing.
The Abbott Prism Chagas is manufactured by Abbott Laboratories, based in Abbott Park, Ill.
Men and women have differnet reasons for abusing prescription painkillers, a new study shows.
It included 662 non-cancer patients with chronic pain who took opioid painkillers, a group of narcotics that includes morphine, codeine, fentanyl and oxycodone. The researchers examined the rates and characteristics of opioid abuse among the patients, profiles of risk factors for potential abuse, and how strongly certain risk factors predict painkiller abuse.
Men and women had similar rates of opioid abuse but there were gender differences in risk factors for such abuse, the study found.
“Our analysis showed the drug misuse by women is motivated more by emotional issues and psychological distress while in men this behavior usually stems from problematic social and behavioral problems that lead to substance abuse,” study author Robert N. Jamison, a clinical psychologist at Harvard’s Brigham and Women’s Hospital, said in a news release.
“Further, women who misuse pain drugs are more likely to admit to being sexually or physically abused or have a history of psychiatric or psychological problems.”
Jamison and colleagues recommended that women who are taking opioids to treat non-cancer chronic pain and show signs of “significant affective stress” should receive treatment for the mood disorder and counseling on the dangers of relying on opioids to reduce stress and improve sleep.
For male patients taking opioids for non-cancer chronic pain, doctors should closely monitor known or suspected behavioral problems, conduct frequent urine screenings, pill counts and compliance monitoring.
The study appears online in the The Journal of Pain.
Decades of vaccination and prevention efforts may have the hepatitis viruses on the run, according to a new report from the U.S. Centers for Disease Control and Prevention.
The CDC researchers tracked individuals’ levels of antibodies to various hepatitis strains. Antibodies are a kind of immune system record of exposure to a particular pathogen, either through infection or vaccination.
Since the late 1980s, there’s been a significant increase in the number of U.S.-born American children and teens with hepatitis A antibody and a decrease in the number of adults aged 40 and older with the antibody, the study found.
The recent trends likely result from increased immunity in children due to immunization and a resulting decrease of hepatitis A virus (HAV) exposure and infection among adults, according to the CDC researchers.
The investigators also found that hepatitis B virus (HBV) infection among people aged 6 to 39 significantly decreased in recent years as a result of vaccination programs. By 2003-2006, more than 90 percent of U.S. children had received at least one dose of hepatitis B vaccine, according to a news release from the CDC.
The rate of hepatitis C virus (HCV) infection is decreasing among people at highest risk of infection, possibly due to prevention programs that target risky behavior such as injection drug use, the researchers noted. The peak age of HCV infection changed from 30 to 39 years during 1988-1994 to 40 to 49 years during 1999-2008.
Viral hepatitis is a major public health concern in the United States and HAV, HBV and HCV are the three most important types of hepatitis. HBV and HCV can cause chronic infection that’s associated with chronic liver disease and liver cancer. HCV is the most common chronic blood-borne infection in the U.S. because 70 percent to 85 percent of people acutely infected become chronically infected.
SOURCE: U.S. Centers for Disease Control and Prevention, news release.
Pneumonia, a respiratory infection of the lung, can be caused by bacteria, viruses or fungi.
The U.S. National Library of Medicine says the following factors may increase your risk of contracting pneumonia:
Smoking cigarettes.
Having a recent respiratory infection, including the flu or a cold.
Having a chronic lung disease, such as cystic fibrosis.
Having cerebral palsy.
Having a neurological condition that makes swallowing more difficult, such as Parkinson’s disease.
Having a chronic health condition such as diabetes, cirrhosis of the liver or heart disease.
Being in a nursing home.
Having a compromised immune system.
Having had a recent surgery or medical trauma.