Medicine Man

Receiving treatment for non-cancer health issues while being treated by specialists for cancer improves cancer survival rates according to a study published in the December 20 issue of the Journal of Clinical Oncology.

The study, by researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Roudebush Veterans Administration Medical Center, is the first to look at the effect of primary care on health outcomes in cancer patients.

Receiving care from a primary care physician (a general internist or family practice doctor) during cancer treatment from an oncologist appears to improve cancer survival rates, likely due to the comprehensiveness of care that is received in primary care, according to study authors Caroline Carney Doebbeling, M.D., M.Sc. and Laura Jones, Ph.D. The researchers focused on lung cancer because of the low one-year lung cancer survival rate in these patients.

"We cannot afford to ignore the chronic medical conditions that most cancer patients have because treating these conditions may bring increased longevity as well as improved quality of life. Lung cancer patients are often faced with many additional health issues, such as high blood pressure, emphysema and other respiratory conditions, all of which can and should be treated," said Dr. Carney Doebbeling, associate professor of medicine and of psychiatry at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

"When doctors think their patients have a higher risk of mortality, as they do with lung cancer, chronic disease management may be not as big a focus," said Dr. Jones, who is with the Roudebush VA Medical Center's Center of Excellence on Implementing Evidence-Based Practice and is a health services researcher.

Lack of primary care utilization in the first six months following lung cancer diagnosis had a marked effect on survival even when controlling for extent of the disease. The researchers looked at electronic medical record data of 323 male veterans diagnosed with lung cancer. The median survival rate was only 3.68 months for those without primary care utilization, but increased by a factor of more than four if the patient had at least 3 primary care visits during the first 6 months following cancer diagnosis.

"Further investigation is needed to gain a better understanding of how and why primary care utilization improved outcomes in lung cancer patients. What we do know is that over 80 percent of lung cancer patients have at least one additional serious medical condition. The take home message to cancer patients is to not stop seeing your primary care doctor even if you have cancer," said Dr. Carney Doebbeling. "The importance of managing the health of the whole person, not just one disease at a time, cannot be overstated."

http://newsinfo.iu.edu/

One of the nation's pre-eminent genetic researchers, Eric Hoffman, PhD, of Children's Research Institute at Children's National Medical Center, predicts that in relatively short order, medicine's next innovation--individualized molecular therapies--will have the unprecedented ability to treat muscular dystrophies, and other disorders.

In the latest edition of the New England Journal of Medicine, Dr. Hoffman posits that the results of a small clinical trial involving a new treatment for Duchenne muscular dystrophy provides a proof-of-principle for personalized molecular medicine. Practical implementation of the 'exon-skipping' approach described in the co-published report of vanDeutekom et al. will require advances in systemic administration of large amounts of customized DNA-like drugs, and proof that long-term delivery is not toxic. However, these advances are likely to come in short order, with the oversight and regulations of the FDA critical for appropriate labeling and marketing of such personalized molecular target drugs.

Though this particular treatment remains in its early stages, within the foreseeable future the now-standard Phase I, II, and III pathway to drug approvals may need to be re-evaluated.

How can DNA-like drugs specific to a single patient's mutation go through the existing approval process" Are the current standards of rodent and monkey toxicity studies relevant and appropriate for DNA-like drugs, when the animals do not have the same DNA target (or off-target) sequences as humans" These and other questions are certain to pose exciting challenges to both the approval and marketing processes of drugs.

The study featured in the latest edition of The New England Journal of Medicine, involves application of a nucleic acid drug called PRO051. It shows some success at restoring the expression of the specific protein--dystrophin, that is linked to healthy muscle tissue. This approach was shown to reactivate dystrophin protein production in small areas of muscle tissue at the injection site of muscular dystrophy patients.

"Dozens of specific sequences will be required for effectively treating the majority of patients with Duchenne muscular dystrophy," writes Dr. Hoffman. "But in order to realize the promise of personalized molecular medicine in muscular dystrophies and, ultimately, other disorders, it will be important to re-evaluate current measures of toxicity, efficacy, and marketing that ensure both safety for the patient, as well as rapid development and distribution of life-saving drugs."

Dr. Hoffman envisions that some parts of the approval process may be developed for DNA-like molecular medicine as a 'class' of drugs, rather than individual testing of hundreds of different sequences.

"The patients and their families are crossing their fingers that the drug's overall chemistry can be shown to be safe," he says.

http://www.dcchildrens.com/

A new study finds that most general surgeons do not discuss reconstruction with patients before surgical breast cancer treatment.

The analysis shows that only one in three patients eligible for mastectomy or breast conserving surgery have such discussions. The study is published in the February 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.

The option of breast reconstruction has increased treatment choices for women with breast cancer. Women with early stage disease who are not likely to need post-mastectomy radiation are considered eligible for reconstruction at the time of surgery. However, little is known about how often surgeons discuss breast reconstruction with patients.

Led by Dr. Amy Alderman of the University of Michigan Medical Center, researchers surveyed a 1,178 women aged 79 years or younger who had undergone a surgical procedure for stage I, II, or III breast cancer between December 2001 to January 2003.

The researchers found only 33 percent of patients had a general surgeon discuss breast reconstruction with them during the surgical decision-making process for their cancer. Surgeons were significantly more likely to have this discussion with younger, more educated patients. Patients who discussed reconstruction with their surgeon were more willing to consider having a mastectomy and were more than 4 times likely to undergo the surgery. The findings suggest that discussing reconstruction will impact women?s decisions regarding initial surgery for their breast cancer.

According to the authors, these results have important implications for patient care and policy. "This research suggests that patients should be informed of all options in order to be educated consumers of healthcare and ensure maximal breast cancer treatment decision quality," they conclude. "Our results suggest a need for comprehensive breast cancer treatment decision aids, including information on initial surgery and other treatment options such as reconstruction."

http://www.cancer.org

Stem cells -- popularly known as a source of biological rejuvenation -- may play harmful roles in the body, specifically in the growth and spread of cancer. Amongst the wildly dividing cells of a tumor, scientists have located cancer stem cells.

Physician-scientists from Weill Cornell Medical College are studying these cells with hopes of combating malignant cancers in the brain.

"Some patients' brain tumors respond to chemotherapy and some don't," says Dr. John A. Boockvar, the Alvina and Willis Murphy Assistant Professor of Neurological Surgery and head of the Brain Tumor Research Group at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "We believe cancer stem cells may be the cause."

Dr. Boockvar is capturing and classifying these cancer stem cells in order to determine how they react to certain available drug therapies. Doing so will lead to more accurate and specific cancer diagnosis, allowing for tailored drug treatments. Results explaining the techniques used to harvest normal neural and brain-tumor-derived stem cells will be described in the January 2008 edition of the journal Neurosurgery.

"Cataloging brain tumor stem cells will be an enormous tool for patient diagnosis," explains Dr. Boockvar, "but it will also help to create a library of knowledge for the scientific community to understand how brain tumors form and to test and develop new drugs."

To stave off cancer stem cell growth in the brain, Dr. Boockvar is studying the use of two drugs already available for cancer treatment. Tarceva -- approved for the treatment of lung and pancreatic cancer -- works by stopping the growth and spread of cancer cells. Avastin -- approved for the treatment of colorectal cancers -- is also being studied for inhibiting cancer cell growth and works by stopping the growth of blood vessels (angiogenesis) that feed the tumor.

Preliminary results from these trials have shown that some patients' cancers are wiped out, whereas others remain resistant. Dr. Boockvar believes that these patients' drug resistance might be due to a class of stem cells resilient to available treatments. Finding biomarkers that distinguish these stem cells from those that are destroyed by known drugs might help researchers formulate new drugs.

"Determining a patient's cancer stem cell profile will take a lot of the guessing out of choosing a course of treatment," says Dr. Boockvar. "It will save money, medical resources and precious time for the patient."

http://www.med.cornell.edu

Scientists in Australia and America believe they have found a way to deal with the increasing antibiotic resistance of deadly superbugs such as MRSA.

A team of researchers which includes Professor Ron Skurray and Dr. Neville Firth from the School of Biological Sciences at the University of Sydney and Dr. Maria Schumacher from the University of Texas, have been working on new ways to combat resistance.

They have already identified a potential method of stopping bacteria passing on resistance genes to the next generation when they divide.

Hospitals worldwide are facing serious problems in dealing with bacteria which are resistant to multiple types of antibiotics and particularly powerful bugs such as methicillin-resistant Staphylococcus aureus (MRSA) are entrenched in many hospitals.

The problem causes significant concern because such superbugs mean longer hospital stays and are a serious and sometimes fatal threat to patients' health.

The researchers say bacterial strains become resistant by acquiring a pre-existing resistance gene from other bacteria and this happens because resistance genes are often carried on mobile DNA molecules called plasmids, which are mini-chromosomes that can be transmitted between bacteria.

Bacteria that have these resistance genes are more likely to survive when exposed to the antibiotic, and as a result become more common.

The researchers have created a detailed picture of the golden staph bacteria's division process, and have identified a biological step they hope can be targeted to stop the plasmids being passed on to the next generation.

Lead researcher Dr. Neville Firth says it is this specific system which moves the plasmid DNA into the daughter cells when the cells divide into two - ensuring both daughter cells get a copy, rather than two in one cell and none in the other.

Dr. Firth says they hope they will eventually be able to disrupt that process and so force the cells to lose their resistance.

He says cells which lose their plasmids as a rule develop faster and become more prevalent and at present the resistance is all one way; as antibiotics are used the bacteria gets resistance and spreads and the situation gets worse.

Dr Firth suggests a biological agent designed to knock out the target, if one was found, could be included in a disinfectant to be used in hospitals and he says that would "throw a spanner in the works of the whole evolutionary process."

However such a spanner appears to be at least 10 years away but at least there does now seem to be a more detailed picture of a possible target which is an important step in being able to develop an agent, says Firth.

The researchers are looking for other possible targets within the division process.

The research, conducted in conjunction with University of Texas scientists, is published in the journal Nature.