Friday, June 26, 2015

Medically complex patients with Type 2 diabetes could benefit from seeing a specialist soon | EurekAlert! Science News

Medically complex patients with Type 2 diabetes could benefit from seeing a specialist soon

Healthier patients do well with family doctors
St. Michael's Hospital

TORONTO, June 25, 2015 - People recently diagnosed with Type 2
diabetes and who have other serious chronic health issues have less
heart disease and lower death rates if they see an endocrinologist
within one year of diagnosis, new research suggests.
Patients with Type 2 diabetes who are not as medically complex did
well when managed solely by primary care providers - a finding the
researchers called optimistic.

"This study showed that Ontario's primary care system is functioning
as it should by providing good care for the majority of newly diagnosed
patients with Type 2 diabetes," said Dr. Gillian Booth, an
endocrinologist at St. Michael's Hospital and researcher at the
Institute for Clinical Evaluative Sciences.

"With more than a million people living with diabetes in Ontario,
endocrinologists don't expect, or necessarily need, to see every
patient. We really wanted to look at who would stand to benefit from
early specialist care and should be referred as soon as possible."

The study, published online today in Diabetic Medicine,
found medically complex patients with newly diagnosed diabetes receiving
early endocrinologist care had 10 to 20 per cent lower risk of
cardiovascular events (heart attack, stroke and death from coronary
heart disease); those with at least three or more visits had 30 per cent
lower rates.

The study used Ontario health data examining almost 80,000 adults 30
and older diagnosed with Type 2 diabetes between April 1, 1998, and
March 3, 2006.

There are no specific guidelines in Canada for referring patients
with Type 2 diabetes for specialist care. Often, primary care providers
(doctors, together with nurses and dieticians) will solely manage the
care of patients with Type 2 diabetes. But Type 2 diabetes can be a
complicated condition to manage, involving a combination of diet,
physical activity and medications to control blood sugar, blood pressure
and cholesterol levels. When a patient's care becomes complex,
endocrinologists often step in. Endocrinologists are doctors who
specialize in the diagnosis and treatment of medical conditions caused
by hormone imbalances.

"The earlier we can help provide targeted care to these patients, the better," said Dr. Booth.

"Our research will hopefully contribute to the efficiency of our
health-care system, ensuring people with diabetes are living healthy
lives, as long as possible."

It's estimated 360 million people worldwide live with Type 2
diabetes, in which the pancreas does not produce sufficient insulin, or
doesn't properly use the insulin it produces. This leads to a buildup of
glucose in blood, instead of energy use.

Diabetes rates in Ontario have doubled in the last 12 years, with
one in 10 adults now living with the disease; this number rises to one
in four adults over the age of 65. The Canadian Diabetes Association
forecasts that with the aging population and dramatic rise in obesity,
one in three Canadians will live with diabetes by 2020.

Dr. Booth's work was funded by an Applied Health Research Grant from
the Canadian Diabetes Association and by the University of Toronto
Dean's Fund.

About St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who
enter its doors. The hospital also provides outstanding medical
education to future health care professionals in 27 academic
disciplines. Critical care and trauma, heart disease, neurosurgery,
diabetes, cancer care, cares of the homeless and global health are among
the hospital's recognized areas of expertise. Through the Keenan
Research Centre and the Li Ka Shing International Healthcare Education
Centre, which make up the Li Ka Shing Knowledge Institute, research and
education at St. Michael's Hospital are recognized and make an impact
around the world. Founded in 1892, the hospital is fully affiliated with
the University of Toronto.

About ICES

ICES is an independent, non-profit organization that uses
population-based health information to produce knowledge on a broad
range of health care issues. Our unbiased evidence provides measures of
health system performance, a clearer understanding of the shifting
health care needs of Ontarians, and a stimulus for discussion of
practical solutions to optimize scarce resources. ICES knowledge is
highly regarded in Canada and abroad, and is widely used by government,
hospitals, planners, and practitioners to make decisions about care
delivery and to develop policy. For the latest ICES news, follow us on
Twitter: @ICESOntario

Media contacts

For more information, or to arrange an interview with Dr. Booth, please contact:

Melissa Di Costanzo

Adviser, Media Relations, St. Michael's Hospital

416-864-6060 ext. 6537

Kathleen Sandusky

Media Advisor, ICES

(o) 416-480-4780

Friday, May 1, 2015

New test can predict cancer up to 13 years before disease develops

New test can predict cancer up to 13 years before disease develops

People who develop cancer have shorter telomeres, the caps at the end of chromosomes which protect the DNA







Telomeres sit at the end of chromosomes like the caps on shoelaces to prevent DNA from fraying
Telomeres sit at the end of chromosomes like the caps on shoelaces to prevent DNA from fraying 
A new test which can predict with 100 per cent accuracy whether a person will develop cancer up to 13 years in the future, has been devised by scientists.
Harvard and Northwestern University discovered that tiny but significant changes are already happening in the body more than a decade before cancer is diagnosed.
They found that the protective caps on the ends of chromosomes, which prevent DNA damage, had significantly more wear and tear in people who went on to develop cancer. In fact, they looked like they belonged to a person who was 15 years older.
Those caps, known as telomeres, were much shorter than they should be and continued to get shorter until around four years before the cancer developed, when they suddenly stopped shrinking. All the people with the changes went on to develop cancer.
"Understanding this pattern of telomere growth may mean it can be a predictive biomarker for cancer," said Dr. Lifang Hou, the lead study author and a professor of preventive medicine at Northwestern University Feinberg School of Medicine.
"Because we saw a strong relationship in the pattern across a wide variety of cancers, with the right testing these procedures could be used to eventually diagnose a wide variety of cancers."
Although many people may not want to know that they will develop cancer in the future, it could allow them to make lifestyle changes to lower their risk. Stanford University is also working on a project looking at how telemores can be regrown.
However insurance companies warned that such a test could push up policy premiums.
Matt Sanders, in charge of protection insurance products at GoCompare, said people with such a diagnoses could be priced out of the insurance marker.
“If this test showed 100 per cent probability over a certain number of years then it could affect premiums. It would be the equivalent of living in a high theft area for someone looking for home insurance,” he said.
“Premiums could rise to a point where some people would simply be priced out. However if it was shown that diagnosing earlier could prevent cancer then that could bring down premiums.”
Aviva also said that continually monitored advances in medical sciences ‘ to ensure they are reflected in the premiums paid by our customers, where appropriate.’

Telomeres sit at the end of chromosomes, and protect the tightly bound strands of DNA
In the new study, scientists took multiple measurements of telomeres over a 13-year period in 792 persons, 135 of whom were eventually diagnosed with different types of cancer, including prostate, skin, lung and leukaemia.
Initially, scientists discovered telomeres aged much faster, indicated by a more rapid loss of length, in individuals who were developing but not yet diagnosed with cancer.
Telomeres in all the people who went on to develop cancer looked as much as 15 years older than those of people who were not developing the disease.
But then scientists found the accelerated aging process stopped three to four years before the cancer diagnosis.
Telomeres shorten every time a cell divides. The older a person is, the more times each cell has divided, and the shorter their telomeres.
Because cancer cells divide and grow rapidly, scientists would expect the cell would get so short it would self-destruct. But that's not what happens, scientists discovered.
“We found cancer has hijacked the telomere shortening in order to flourish in the body,” added Dr Hou.
The team is hoping that if it can identify how cancer hijacks the cell, then treatments could be developed to cause cancer cells to self-destruct without harming healthy cells.
The research was published in the online journal Ebiomedicine

Thursday, February 26, 2015

Another reason to cut back on soda

Another reason to cut back on soda

Some soda contains a potential carcinogen, and a new Consumer Reports' study shows many Americans drink enough to put their health at risk

 Published: February 18, 2015 02:00 PM

The amount of soda you sip not only boosts your sugar intake and packs on pounds—it might also increase your risk for cancer.
The culprit? A chemical called 4-methylimidazole (4-MeI). This potential carcinogen is found in some types of caramel color, the artificial ingredient used to turn colas and other soft drinks brown. Every day, more than half of Americans between the ages of 6 and 64 typically drink soda in amounts that could expose them to enough 4-MeI to increase their cancer risk, according to a new analysis of national soda consumption conducted by scientists at Consumer Reports and the Center for a Livable Future at the Johns Hopkins Bloomberg School of Public Health. The study was published today in the scientific online journal PLOS ONE.

The risks of 4-MeI

This analysis was a follow-up to testing we did in 2013 to measure 4-MeI content in soft drinks. We looked at 110 samples of colas and other soft drinks purchased in California and the New York metropolitan region. Excluding a clear soda used as a control, we found that average 4-MeI levels in the samples we tested ranged from 3.4 to 352.5 micrograms (mcg) per 12-ounce bottle or can. There’s no federal limit for the amount of 4-MeI permitted in foods and beverages currently, but California requires manufacturers to label a product sold in the state with a cancer warning if it exposes consumers to more than 29 mcg of 4-MeI per day. We submitted our test findings to the California State Attorney General’s office, and we’ve also petitioned the federal government to set limits for 4-MeI in food.

How big a threat is soda?

We conducted this new study in response to debate surrounding the amount of soda Americans actually drink on a daily basis. We estimated soda consumption in a typical 24-hour period by analyzing seven years of data (2003 to 2010) from the National Health and Nutrition Examination Survey (NHANES). Then we used that data to estimate the potential cancer risk at different levels of consumption.
Among the more than half of Americans age 6 to 64 who drink soda on a typical day, it turns out that the average intake ranges from a little more than one 12-ounce can to nearly 2.5 cans a day. About a third of very young children (age 3 to 5) drink soda on a typical day; the average intake is approximately two-thirds of a can. The biggest soda consumers are in the 16 to 44 year-old age group. Those who drink the most average about three cans a day. "The findings of this comprehensive study have scientific, policy, and legal implications for calculating cancer risk and establishing limits for 4-MeI in food,” says Urvashi Rangan, Ph.D., toxicologist and executive director of Consumer Reports’ Food Safety & Sustainability Center.
Our analysis shows that at this level of consumption, we would expect to see between 76 and 5,000 cases of cancer in the U.S. over the next 70 years from 4-MeI exposure alone. “We don’t think any food additive, particularly one that’s only purpose is to color food brown, should elevate people’s cancer risk,” says Rangan. “Ideally, 4-MeI should not be added to food.”

Soda is not the only source of 4-MeI

According to the Food and Drug Administration, caramel-color-containing carbonated drinks contribute about 25 percent of the amount of 4-MeI in the diets of people over age 2. That’s more than any other source, but caramel color is found in a wide variety of foods, including bread and other baked goods, dark sauces such as soy or barbecue, pancake syrup, and soups. While we don’t know what type of caramel color or how much 4-MeI is in those foods, it’s clear that many people are already getting concerning amounts of 4-MeI in their diets just from the soda they drink.
—Consumer Reports


Thyroid cancer incidence increases in all races, ethnicities

Thyroid cancer incidence increases in all races, ethnicities


New Thyroid Cancer Drug Hits the Market

New Thyroid Cancer Drug Hits the Market

Cancer treatment has come a long way recently. New drugs are constantly being developed to treat all kinds of cancers and another one has just hit the market.
“It’s an encouraging time for the advancement of treating patients with many different kinds of cancer,” said Dr. Gregory Masters,
The oncologist at Christiana Care Health System in Newark, Del. continues, “We’re achieving a greater understanding of the pathways by which these cancers grow, and we’re using that understanding to block those pathways.”
Masters is also a member of the American Society of Clinical Oncology and he says, “It’s been a disease where it’s been very difficult to treat once it’s become resistant to radioactive iodine.”
A new study has found that the drug Lenvatinib could be a groundbreaking for thyroid cancer patients.
Study leader Dr. Steven Sherman explains, “In our study, we not only saw a dramatic improvement in progression-free survival, there was also a 65 percent response rate — almost unprecedented results for thyroid cancer patients with such advanced disease.”
The associate vice provost for clinical research and professor and chair of Endocrine Neoplasia and Hormonal Disorders with the MD Anderson Cancer Center at University of Texas in Houston goes on to say: “Almost for sure, significant improvement like this in disease-free survival ultimately will translate into overall survival. Sometimes you don’t see an improvement in overall survival because patients haven’t been followed long enough.”
American Cancer Society deputy chief medical officer Dr. Len Lichtenfeld adds,
“These results are impressive as far as they go, meaning we don’t know yet whether it improves the survival outlook for these patients. We don’t know if it’s going to help people live longer, and given side effects we don’t know if it will help them live better.”


Chemobrain - It's Real, It's Complex, and the Science is Still Evolving

No kidding!  Interesting article.  It's something that's bothered me the entire time I've been on treatment.  Click on the link below for the article from JHH

Chemobrain - It's Real, It's Complex, and the Science is Still Evolving

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.
- See more at:

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.
- See more at:
Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.
- See more at:


Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving

Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that fuzzy, murky state that patients blame for impaired memory. A review of the research shows how we're focusing on the problem.
Talk with almost any cancer survivor, and he or she is likely to bring up the topic of “chemobrain,” that  that fuzzy, murky state that patients blame for impaired memory. When physicians first began hearing patients complain about chemobrain, they may have wondered whether it truly existed. As time has passed, they may now be wondering why science hasn’t found a solution.

A review of the research documenting cognitive decline after chemotherapy indicates that the most common complaints have concerned learning and memory, processing speed, verbal and spatial abilities and executive function (planning and decision-making).

Interestingly, about half of the studies reviewed documented cognitive decline even before the initiation of chemotherapy. Cognitive impairment due to chemotherapy can significantly impair a patient’s quality of life. A recent review of 17 qualitative studies focusing on patients’ experience of chemobrain documented that patients reported fearing that they “were going crazy,” or developing Alzheimer’s. Patients noted they had difficulty learning and had to work harder to accomplish tasks. As a result, they were less confident in work and social situations.

[Read "Finding Solutions for Chemobrain" from CURE's winter 2013 issue]

Estimates vary on the prevalence and duration of chemobrain, due in part to timing of assessment and degree of impairment. A recent meta-analysis demonstrated that about 16 percent to 75 percent of breast cancer patients had moderate to severe impairment. As may be expected, deficits are most evident during treatment, with most patients returning to baseline within a few months of completing chemotherapy. However, a subset of patients has been found to have ongoing deficits, even after 20 years. Older patients with lower cognitive reserve at baseline are most likely to have higher levels of impairment. Co-occuring factors may also contribute to chemobrain. Approximately 30 percent of cancer patients experience depression, anxiety or distress during treatment, and depressed individuals score lower than non-depressed individuals on neuropsychological tests in attention, sustained attention, processing speed, recall, fluency, and speed of retrieval.

Fatigue, an almost universal symptom during and shortly after cancer treatment, may impair memory by decreasing attention, processing speed, and motivation. In addition, about 30 percent to 60 percent of cancer patients report having insomnia, which may cause poor concentration and memory.

What Is the Evidence Behind Chemobrain?

Although cancer patients have been reporting symptoms of cognitive impairment for many years, the first scientific studies began appearing in the mid-1990s. Some of the first studies began exploring the impact of particular chemotherapy protocols on cognition.

But as studies progressed, it seemed that more questions arose than were being resolved. There were so many confounding factors, such as age, hormonal status, baseline cognitive performance, educational level, genetic predisposition, comorbidities that impact oxygenation, depression, anxiety, fatigue, pain, anemia, time since treatment and dietary factors. How would it be possible to control for all those factors?
- See more at:
Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at:

Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at:

Wednesday, February 25, 2015

Facing the (Very Real) Financial Fears of a Cancer Diagnosis

 Interesting subject that doctors should be more aware of when planning treatments with their patients

 Facing the (Very Real) Financial Fears of a Cancer Diagnosis



Updated January 30, 2015.

Written or reviewed by a board-certified physician. See's Medical Review Board.
Hearing “You have cancer” unleashes a tornado of fears.  Will my hair fall out?  Will I spend days dry-heaving over the toilet?  Will I need surgery?  Will I die?  But when first hearing the diagnosis, many cancer patients and their loved ones don’t immediately fear financial ruin.  But, sadly, the enormous financial threat that faces many cancer patients is all too real, and the statistics and implications of financial stress are tragic.
If you have cancer, you’re more than twice as likely to file for bankruptcy as someone without cancer.  Among cancer patients, this bankruptcy risk is even more pronounced for young adults, who are likely to have less income, greater expenses (kids, school loans), and private insurance payment obligations than are Medicare age patients.  In fact, bankruptcy rates in the youngest adults can reach ten times that seen in the older cancer population.  Bankruptcy risk of is also increased in women and non-Caucasians with cancer.  Overall, about six out of 1,000 cancer patients ultimately declare bankruptcy.

And while people can eventually recover financially, bankruptcy has additional implications which are potentially even more devastating, as it is unlikely that bankrupt patients can afford to complete their recommended cancer treatment.
Severe financial stress on cancer patients and their loved ones causes significant damage in the many who don’t go the bankruptcy route.  An astonishing 10% to 20% of cancer patients may ultimately choose to not receive the recommended therapy or may deviate from the recommended treatment plan due to personal financial constraints…10% to 20%!
Why does this happen?
For the many cancer patients not yet of Medicare age, a major portion of treatment payment obligation falls directly on them.  Out of the $20.1 billion annual cost of care, non-Medicare cancer patients personally pay more than $1.3 billion (6.5% of total cost).  On average, cancer patients pay about $9,000 annually for treatment, with some paying significantly more.

The main driver of this massive and accelerating cost of cancer care is new cancer drugs.  And simply replacing newer agents with older generics doesn’t always make clinical sense, as newer drugs are often significantly better, providing targeted killing of malignant cells and reduced toxicity.  Thus, patients may have not clinically equivalent but cheaper alternative, and breakthrough drugs now routinely cost $10,000 per month of treatment, twice the cost of newer agents only a decade ago, with patients regularly paying a portion, including some who must cover up to 20% of costs.

We can bash the pharmaceutical industry for these seemingly outrageous prices, and many have.  Cancer physicians have led the vocal outcry, depicting drug manufacturers as profiteering off the desperation of cancer patients.  Backing their accusations are up to 40% lower costs abroad for the same chemotherapy agents.  Drug manufacturers fight back, countering that their companies spend billions on drug research, only a small percentage of which eventually translate into commercialized products which, therefore, must cover the significant cost of the many dead ends.
There are several ways to seek help if your cancer treatment or treatment of a loved one is causing significant financial stress, and I encourage you to pursue them long before deciding to alter or abandon the treatment most likely to be of benefit.

First of all, speak with your oncologist to learn if there are less expensive treatment alternatives that offer similar potential clinical benefit in treating your malignancy.  Ask to receive your chemotherapy in the doctor’s office rather than at the hospital, as hospital chemo administration is routinely more expensive.  Next, reach out to the drug companies that manufacture the chemo agents you are receiving.  Several pharmaceutical companies have financial assistance programs for patients who specifically need their drugs but are financially stressed.  In addition, many U.S. states offer State Pharmaceutical Assistance Programs for financially stressed patients.  And for those enrolling in a new health insurance plan or changing plans through a state health insurance marketplace (as part of the ACA, or “ObamaCare”), you should definitely use the Cancer Insurance Checklist to guide your decisions before we reach the February 15th enrollment deadline.
Finally, although it is an additional expense, getting advice from a qualified financial advisor is often a good investment.  These specialists can quickly understand your assets and projected expenses (including treatment-related) and offer guidance on managing your financial risk, protecting you and your family.
In following any of these paths, remember that you are the cancer owner and, therefore, you must drive the process.  At times while searching for financial alternatives and support, you may become frustrated, even angry.  Take a deep breath, try to be patient and, when necessary, be assertive (while remaining respectful).  In the end, you will hopefully discover real options to reduce your financial exposure without giving up your best chance at fighting your cancer.