Cardiovascular Fitness Not Affected By Cancer Treatment

The cardiovascular fitness level of cancer survivors is not affected by many standard cancer therapies, say researchers from Georgetown University Medical Cancer. That is the finding of a new observational study to be presented today at the American College of Sports Medicine in Seattle.

"We know physical activity is a critical component of cancer survivorship, both during and after cancer treatment," says Jennifer LeMoine, PhD, a post-doctoral research fellow with training in exercise physiology at GUMC's Lombardi Comprehensive Cancer Center. "In order to prescribe an exercise program, it's critical that we understand our patient's fitness level and whether or not treatment has had an impact on their cardiovascular health."

For the study, the researchers conducted a chart review of 49 women who attended a physician-directed fitness clinic for cancer survivors, founded and run by Priscilla Furth, MD, the study's co-author. The data included demographics, physical activity levels and cancer treatment type, duration and time since their treatment. Fitness assessments were conducted using a three-minute step test during a clinic visit. The purpose of the study was to access the step test as a way of determining a patient's current cardiovascular fitness level.

LeMoine says, "Often, what people think they are physically capable of doing and what they can actually do are two very different things. Many have a better fitness level than they expect while some find they're not as fit as they thought. The step-test gives us a better idea of their exercise tolerance and cardiovascular-fitness."

All the patients in the study were women and were diverse by age and body mass index. Their cancer diagnoses and treatments varied. Overall, 33 percent of the survivors were sedentary and 67 percent reported being physically active. Thirty-five (71 percent) of the participants completed the step test. Test completion and heart rate recovery were not affected by treatment, BMI, or age.

"What's really exciting to us was that we found that cardiovascular fitness was not affected by the expected culprits -- cancer treatment, type, duration or time since treatment," LeMoine explains. "That isn't to say there aren't side-effects of some treatments that may hinder physical activity, but when it comes to actual cardiovascular fitness as measured in our clinic, many of the standard treatments didn't have a role."

"We've modified an in-clinic cardiovascular assessment tool , the three-minute step test, with the goal of finding a test that can easily and quickly be performed in a physician's office," explains Priscilla A. Furth, MD, a professor of oncology and medicine at Lombardi. "Having this kind of evaluation tool is critical for physicians, like me, who are interested in prescribing physical activity for this population."

LeMoine and Furth report no related financial interests. There was no external funding for this research.

Source: http://www.sciencedaily.com/releases/2009/05/090528110617.htm

Conflicts of interest found in many cancer studies

WASHINGTON, May 11 (Xinhua) -- A U.S. study have found that nearly one third of cancer research articles published in medical journals have financial ties with pharmaceutical companies.

The study, published online on Monday in the journal Cancer, indicates that conflicts of interest may cause some researchers to report biased results that are favorable to pharmaceutical companies.

Reshma Jagsi of the University of Michigan and her colleagues reviewed 1,534 cancer studies published on eight medical journals, including Cancer, the New England Journal of Medicine and the Lancet.

According to the researchers, 17 percent of the studies declared industry funding while 12 percent had a study author who was an industry employee. Randomized trials with reported conflicts of interest were more likely to have positive findings.

"It's becoming increasingly clear that we need to look more at how we can disentangle cancer research from industry ties," said Jagsi. "If we wish to minimize the potential for bias, we need to increase other sources of support."

"Medical research is ultimately a common endeavor that benefits all of society, so it seems only appropriate that we should be funding it through general revenues rather than expecting the market to provide," she said.

Many medical journals now require researchers to disclose potential conflicts of interest in the articles they submit for publication, but the researchers urged that "journals should embrace both rigorous standards of disclosure and heightened scrutiny when conflicts exist."

Kidney disease may raise cancer risk

Sunday May 10, 2009 (foodconsumer.org) -- Reduced kidney function may put men at a higher risk for cancers of the lung and the urinary tract, according to a new study published in the April 30, 2009 issue of Journal of the American Society of Nephrology.

The study, led by Dr. Germaine Wong and colleagues at the Westmead Hospital in Australia, showed that 23 out of 1000 men who had chronic kidney disease were diagnosed with cancer during a 10-year follow-up, compared to 17 out of 1000 men without kidney disease. This association was not found among women with kidney disease.

Dr. Wong and his colleagues examined data on 3049 people aged 49 to 97 years to establish a correlation between kidney disease and prevalence of cancers of the lung and the urinary tract.

They found that nearly a third of the study participants had moderate kidney disease, but none were serious enough to have used dialysis and underwent kidney transplantation. The researchers suggested that prevention of chronic disease may be a novel and worthwile strategy for reducing cancer risk in the general population.

(By David Liu and edited by Will Levine)

City-dwellers susceptible to late-stage cancer

WASHINGTON: A new study has revealed that people who live in urban areas are at higher risk of developing late-stage cancer than those who live
in suburban and rural areas.

The findings indicate a need for more effective urban-based cancer screening and awareness programs.

To explore the rural and urban differences in late-stage cancer diagnoses, Sara L. McLafferty, Ph.D., of the University of Illinois and Fahui Wang, Ph.D., of Louisiana Sate University analyzed data from the Illinois State Cancer Registry from 1998 to 2002.

The researchers assessed late-stage cancer diagnoses of the four major types of cancer (breast, colorectal, lung, and prostate) throughout the state, comparing data from cities with those from less-populated regions.

They found that for all four cancers, risk was highest in the most highly urbanized area (Chicago) and decreased as areas became more rural.

However, in the most isolated rural areas, risk was also high. Risks were considerably low among patients living in large towns in rural areas.

For colorectal and prostate cancers, and to a lesser extent breast cancer, these disparities stemmed mainly from differences in the ages and races of individuals in the various geographic areas.

A high concentration of vulnerable populations and economically disadvantaged areas in Chicago and its suburbs accounted for the high rates of late-stage diagnosis found in these highly urban areas.

Among the different races, the black population was particularly vulnerable to late diagnosis. On the other hand, the lower rates of late-stage diagnosis in rural areas reflected the greater presence of elderly patients who have a lower risk of late-stage diagnosis, likely because of frequent doctors' visits and age-related cancer screenings.

Differences in age and race did not explain the geographic disparities seen for lung cancer, indicating that other factors-such as cancer awareness or diagnostic differences-account for the rural-urban differences in late-stage lung cancer diagnosis.

The researchers said that their study found a reversal of the commonly held view that late-stage cancer risks are highest for rural residents.

"The concentration of health disadvantage in highly urbanized places emphasizes the need for more extensive urban-based cancer screening and education programs, especially programs targeted to the most vulnerable urban populations and neighbourhoods," they said.

The study is published in the June 15, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

Mathematical Model Helps Predict Cancer Tumor Size

Tuesday, August 19, 2008; 12:00 AM

TUESDAY, Aug. 19 (HealthDay News) -- A mathematical model to find blood biomarkers that can help doctors estimate the size of cancer tumors has been developed by researchers at Stanford University.

The team says its work may help guide development of new tests to improve early detection of cancer. Currently, there's no reliable method of using the results of blood-screening tests to gauge tumor size.

The Stanford researchers developed their mathematical model using two common blood biomarkers: prostate specific antigen (PSA), which is often elevated in prostate cancer, and CA125, used as a marker for follow-up therapy in ovarian cancer patients.

Using this model, the researchers found that the minimum tumor sizes predicted by their calculations were close to what was actually seen in clinical practice.

"We're pretty happy that we came up with rather realistic tumor sizes. Although this is a very basic model, it should give researchers a tool to use when deciding if a particular secreted protein would be a good biomarker," radiologist Dr. Amelie Lutz said in a Stanford news release.

"Early cancer detection is a very challenging but important goal for the cancer field. This modeling work enables a very deep understanding of the problems that will have to be solved for blood-based cancer biomarkers to be successful in this effort," study senior author Dr. Sanjiv Sam Gambhir, a professor of radiology, said in the news release.

The study was published in the Aug. 18 issue of the journalPLoS Medicine.

More information

The American Academy of Family Physicians has more about early detection of cancer.

SOURCE: Stanford University, news release, Aug. 18, 2008

http://www.washingtonpost.com/wp-dyn/content/article/2008/08/19/AR2008081902116.html

Baby with massive tumor saved by liquor tycoon

I Would like to share a story I read at CNN. As a cancer advocate I just hope that people will continue doing good deeds just like this. Here it goes.

Two-year-old Safa'a gently holds his mother's hand, a 12-pound tumor bulging from his frail body. The tumor is nearly as big as he is.

The Iraqi boy has come to Jordan for surgery with help from a most unlikely source: an 85-year-old liquor tycoon living on the other side of the world.

"There is a real chance that Safa'a may die during the operation," Dr. Iyad Sultan tells the boy's parents.

His mother, Manal, cradles her son's hand as she trembles inside the King Hussein Cancer Center. His father, Mohammed, struggles with his words.

"We are afraid," he says softly.

Safa'a was diagnosed in Iraq with Wilms' tumor, the most common kidney tumor in children. If caught and treated early on, the cancer has a high survival rate. But by the time Safa'a arrived in Jordan, Sultan says, it was a miracle the boy was alive.

"The tumor is massive," Sultan says. "The liver, kidney, intestines are all squished to the sides. His lungs are very small. It's hard to believe he is able to breathe." Watch Iraq baby gets second chance »

The tumor prevented him from developing like other children.

"Sometimes when we see other children play, he starts to cry," his father says. "I don't buy him certain toys like soccer balls. Because he looks at me and when he throws it far away, he can't go and get it. Even at his age, he understands."

Safa'a had received chemotherapy in Baghdad for a year, but the tumor kept growing, and doctors said there was nothing else they could do.

"You know, he is my first baby," Mohammed said from his modest Baghdad home at the time. "I used everything I have to rescue my baby. I tried to do something, but I can't."

The boy's treatment in Iraq became even more volatile as sectarian violence flared. The family is Sunni, and the hospital treating Safa'a fell under the control of the Mehdi Army, a Shiite militia loyal to radical cleric Muqtada al-Sadr.

Traveling to the facility for something as simple as picking up the child's medical records became impossible. Watch the struggles of getting help inside Iraq »

About 6,000 miles away, in Boston, Massachusetts, Safa'a came to the attention of Ray Tye. A liquor distributor and philanthropist, Tye runs the Ray Tye Medical Aid Foundation with his wife, Eileen. Their motto: "We will never stop caring."

With the help of their friends, the couple formed the foundation five years ago after their son died of multiple myeloma, a cancer of the plasma cell that is incurable.

"I found out that all the money in the world couldn't save him, but I did realize that money could save lives," Tye says from Boston.

The foundation offered to foot the bill for Safa'a to travel to Jordan, even if the boy only had the slightest chance of survival. The foundation also is paying the medical expenses of at least three other Iraqis at the Amman cancer center.

"The mission is to bring people to hospitals who have life-threatening problems and don't have money. I don't care where they come from," Tye says.

The Iraqi family then began the journey to neighboring Jordan.

Safa'a is considered lucky to have a donor. Each month, about two dozen desperate Iraqis end up at the doors of the King Hussein Cancer Center with little or no money for treatment, officials say. See how you can make a difference

"The center is almost the only beacon of hope for patients seeking treatment for cancer," says Princess Dina, director-general of the hospital's foundation. "We said we cannot turn a blind eye to these patients. They are pleading, 'Please help.' So we cannot just ignore that. We don't have the millions to cover so many Iraqi patients, so we said let's try something else."

The scope of the crisis prompted the foundation to establish the Iraqi Goodwill Fund. It has raised more than $1 million and helped dozens of patients, but the need for such care far surpasses what the fund can do.

For many parents, the knowledge that their children didn't have to suffer so much is often too much to bear. Iraq's decrepit medical institutions can't deliver even the most basic health care, and the emigration of skilled medical professionals means that many curable diseases inside Iraq end in death.

"In many cases, children come with diseases who have just advanced to a level that you can't give any curable treatment," says Sultan, Safa'a's doctor. "If you saw the patients months earlier -- six, eight, 10 months earlier -- you can do many other things that now just aren't doable."

One patient is 2-year-old Mariam, who was born with an extreme and potentially fatal tumor on the side of her face. Her young mother, Rasha, 22, was deserted by her husband. She had to fight to get her daughter seen by a doctor in Iraq; the staff was too overwhelmed with the daily casualties.

"We tried to get her into a hospital in Iraq, and the doctor kicked us out," Rasha says. "There was shooting and firing outside. We fought with the doctor; we fought to get her in. I lost all hope."

The tumor grew to such a mass, it displaced Mariam's eye, broke her jaw and burst through her scalp. "I was watching my daughter die in front of me slowly, and there was nothing I could do," Rasha says.

U.S. troops discovered Mariam, and through a joint effort with the Jordanian government, she ended up in Amman. Now, little Mariam gurgles at her favorite nurse. Small smiles play across her deformed face as her mother tickles her.

Back in the operating room, Safa'a whimpers as his parents kiss him tearfully, fearing that it could be a final goodbye.

"We don't know what will happen when we open Safa'a's abdomen and we take this tumor out," the doctor says. "Safa'a has a chance of survival definitely, if he survives today. So today is the most critical day in Safa'a's life."

The surgery lasted five hours, and the doctors called it a success. The massive tumor was removed completely. Safa'a's parents could barely express their happiness and gratitude.

"I cannot put my happiness into words," his mother says, laughing.

The boy's father adds, "this is such a happy occasion. You brought happiness into the hearts of parents."

Safa'a has a lengthy recovery ahead of him, but his parents know he is lucky to have a chance at life, thanks to the kindness of strangers.

"I will tell you the truth. Tears come to your eyes. You're saving a life," Tye says after hearing about Safa'a's successful surgery.

"When you look at somebody that had a life-threatening problem and you could, with money, save that life, you've got to sit back and say you helped make this world just a little better, and that's what it's all about."

http://www.cnn.com/2008/WORLD/meast/08/13/iraq.baby/

Targeted Radiation Therapy Can Control Limited Cancer Spread

ScienceDaily (Aug. 12, 2008) — Precisely targeted radiation therapy can eradicate all evidence of disease in selected patients with cancer that has spread to only a few sites, suggests the first published report from an ongoing clinical trial.

In the August 15, 2008, issue of Clinical Cancer Research, (published online August 12) researchers from the University of Chicago Medical Center report that targeted radiation therapy had completely controlled all signs of cancer in 21 percent of patients who had five or fewer sites of metastatic disease.

"This was proof of principle in patients who had failed the standard therapies and had few, if any, remaining options," said the study's senior author, Ralph Weichselbaum, MD, professor and chairman of radiation and cellular oncology at the University of Chicago Medical Center. "We had encouraging results, including several long-term survivors, in patients with stage-IV cancers that had spread to distant sites."

In 1994, Weichselbaum and colleague Samuel Hellman proposed that there was an intermediate state between cancer that had not spread at all and cancer that had spread extensively. They named this phenomenon "oligometastases," meaning cancer that had spread to a few distant sites.

In some cases, surgeons have successfully treated such limited cancer spread, producing long-term survival by removing the primary cancer and one or two distant tumors, off-shoots of the original cancer--usually in the lung or liver. However, some patients are not fit for surgery or have cancer that is inoperable.

Recent improvements in tumor detection and precise image-guided radiation therapy, however, have made simultaneous treatment of multiple tumor sites with radiation feasible. So in 2004, Weichselbaum organized a clinical trial to test the ability of local radiation therapy to control a limited number of related tumors which colleague Joseph Salama, MD, assistant professor of radiation oncology at the University of Chicago has directed since 2005,.

Patients with stage-IV cancer with one to five distant metastases and no tumors bigger than 10 centimeters (about four inches) in diameter were eligible to participate in the study either before or after chemotherapy treatment.

Each patient received three doses, separated by at least two days, of precisely targeted radiation therapy focused on each metastatic tumor. Treatment was usually completed within one week. The first patients in the study received lower doses. As few side effects were seen, radiation doses were gradually increased in subsequent groups of patients.

"Previous studies determined the maximal radiotherapy doses for single organs," said Salama, lead author of the study, "but this technique has not been tested for simultaneous use on multiple organs. So we designed a dose-escalation trial to determine the optimal dose, starting with fairly low levels and increasing the dose in later groups of patients."

From November 2004 through February 2008, 29 patients, with a total of 56 cancerous lesions, enrolled in the trial. Of the 29 patients, 24 had progressed after at least one round of systemic chemotherapy. For the other five, there was no promising choice of therapy.

Six of the 29 initial patients had lasting tumor control, with no detectable evidence of disease 15 months after treatment.

Many patients had a complete response in at least one tumor. Thirty-one of the 56 treated tumors (55%) completely disappeared. Two tumors (4%) had a partial response, defined as reduction in tumor volume of more than 30 percent. Only three of the 56 tumors progressed (5%), growing in size by 20 percent or more during the treatment phase.

Tumor control improved as the radiation dose increased. Thirty-nine percent of the 31 tumors treated with 24 gray of radiation met the criteria for tumor control--a complete or partial response. That increased to 79 percent for the 19 tumors treated with 30 gray, and to 83 percent for the six tumors treated with 36 gray.

"This suggests that the initial doses were too low," said Salama. "We have seen improved response rates with higher radiation doses without an increase in side effects yet."

Typical treatment doses for a patient with breast cancer, for example, are in the range of 50 to 60 gray, spread over 20-30 sessions. The trend however, is toward delivering higher doses in fewer sessions.

Patients tolerated the treatment, the authors write, with "limited difficulty." All had some fatigue but few had serious side effects. The most severe included one patient being treated for abdominal tumors who developed vomiting that required hospitalization. One lung cancer patient developed a severe cough. One patient had gastrointenstinal bleeding three months after treatment that required blood transfusion and laser treatment.

Crucial to this approach is careful patient selection, distinguishing between patients who have a treatable number of tumors and those who have widespread metastasis, including multiple tumors too small to detect. Currently, there are no known genetic "signatures" to differentiate between widespread cancer versus oligometastasis, the authors point out. This is one area of active research. Only five of the 29 patients treated so far, however, had tumor progression in more than five sites.

The technique could also be applied after chemotherapy, the authors suggest, in cases where the drugs had eliminated most the smaller cancer, leaving only a few larger tumors behind.

The trial is still underway. "We now have about 50 patients," said Weichselbaum, "and several of them remain disease-free, one of them three years after treatment."

The Ludwig Center for Metastasis Research and the University of Chicago Cancer Research Center funded this study. Additional authors include Steven Chmura, Neil Mehta, Kamil Yenice, Walter Stadler, Everett Vokes, Daniel Haraf and Samuel Hellman, of the University of Chicago Medical Center.

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Adapted from materials provided by University of Chicago Medical Center, via EurekAlert!, a service of AAAS.

http://www.sciencedaily.com/releases/2008/08/080812094526.htm