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.
Thyroid
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 Curetoday.com- 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.
BY SUSAN KRIGEL, PHD
PUBLISHED TUESDAY, FEBRUARY 17, 2015
- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

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.
BY SUSAN KRIGEL, PHD
PUBLISHED TUESDAY, FEBRUARY 17, 2015
- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf
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.
BY SUSAN KRIGEL, PHD
PUBLISHED TUESDAY, FEBRUARY 17, 2015
- See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf
 

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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.
BY SUSAN KRIGEL, PHD
PUBLISHED TUESDAY, FEBRUARY 17, 2015
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: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf
Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpuf

Chemobrain—It’s Real, It’s Complex, and the Science Is Still Evolving - See more at: http://www.curetoday.com/articles/ChemobrainIts-Real-Its-Complex-and-the-Science-Is-Still-Evolving?utm_source=Informz&utm_medium=Cure+Today&utm_campaign=CURExtra+email+2%2D18%2D15#sthash.aPk5cxOW.dpu

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 About.com'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.

Thyroid Cancer Care Collaborative offers paradigm to improve disease management, research

Thyroid Cancer Care Collaborative offers paradigm to improve disease management, research

 February 20, 2015

 

A comprehensive Web-based program developed by the Thyroid Head and Neck Cancer Foundation, in conjunction with a multidisciplinary forum of nationally-recognized thought leaders in thyroid cancer management, could significantly improve delivery of patient care and benefit clinicians and researchers, according to research published in Thyroid.

The Thyroid Cancer Care Collaborative (TCCC), which reports and stores all data related to individual patients’ thyroid cancer care, could represent a new paradigm for database research in thyroid cancer to improve clinicians’ understanding of managing the disease.
“Databases have provided valuable information about large groups of patients in the study of thyroid cancer, but research using current databases have significant limitations,” Saral Mehra, MD, MBA, of the head and neck program, section of otolaryngology, Yale School of Medicine, told Endocrine Today. “Aside from various time-saving quality improvement and educational services, the TCCC database feature has the potential to become an extremely powerful research tool to answer questions about thyroid cancer care that current databases simply cannot.”

Shortcomings among current registries
Recognizing the many unknowns surrounding optimal treatment and surveillance recommendations for differentiated thyroid cancer, Mehra and colleagues from other institutions undertook a review of health registries used for cancer research in the United States, concentrating on advantages and disadvantages relative to the study of thyroid disease.
Population-based cancer registries, health systems-based cancer registries and patient-based disease registries were included in the analysis.
“We wanted to critically analyze databases currently used in thyroid cancer research to educate practitioners about the pros and cons of such publications, and then describe the potential of a patient-centered disease-based health registry specific to thyroid cancer to improve the quality and depth of large-scale database research in thyroid cancer,” Mehra said.
For clinicians to critically interpret clinical research based on data from such registries, understanding their collection methods and composition is of fundamental importance, according to the researchers.
Most publications from population-based cancer registries, which exist in every state in the United States, use data from the Surveillance, Epidemiology and End Results database program, which is a group of 20 registries selected to be representative of the broader populace.
Although the surveillance program is a powerful tool to study epidemiology and outcomes, the program cannot capture data that could help to improve patient care, including details about nodal disease, according to the researchers. Further, follow-up is limited to survival status and cause of death.
Health systems-based cancer registries gather incident cases in a particular setting, whether it is a single institution, multi-institution, payer-based or hospital-based registry; the investigators highlighted the National Cancer Database as the premier multi-institution program, capturing an estimated 67% of new cancer cases in the United States.
Despite their utility in providing data to understand thyroid cancer, including predicting patient prognosis and stratifying patient risk, there exists a lack of depth in data collected and a bias in types of patients treated, according to the researchers. Further, quality of data from large databases can affect statistics, and follow-up can drop off as patients change treatment locations.
Patient-based registries, targeting specific questions among patients with a particular disease or who have undergone a certain treatment across clinical sites, would be especially helpful in thyroid cancer where much coordination is required among specialists and better data collection and analysis is needed, according to the researchers. As of now, there are no such tools.   
“A cancer registry that follows a specific patient, is integrated into physician work-flow, and collects data across different treatment sites and different payers does not exist in the current fragmented system of health care in the United States,” the researchers wrote.

A future of improved care
The TCCC could fill this gap, according to dozens of researchers who have worked with the Thyroid Head and Neck Cancer Foundation to pen a series of papers in the past year detailing why and how.  

“The TCCC provides portability of information for patients and physicians,” Mark L. Urken, MD, FACS, of the department of otolaryngology head and neck surgery, Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, told Endocrine Today. “It enhances communication between the physicians involved in the care of a single patient, in particular for clinicians who are not connected by a common electronic health record.”

In another review published in Thyroid, Mehra and colleagues demonstrated how the program, through advanced technology, addresses recommendations laid out by the Institute of Medicine to guide health care organizations and clinicians in redesigning the care process.
Among the TCCC features are: automated disease staging based on scoring systems; illustrated educational videos; personalized clinical decision-making modules; data portability for sharing purposes; “ask the experts” and “frequently asked questions” modules; workflow integration; and data for comprehensive analysis in addressing difficult questions in disease management.
The 12 clinical decision-making modules within the repository process patient data and display personalized treatment recommendations.
“This offers in-depth understanding for patients who are so empowered to participate in the numerous decisions that must be made during their thyroid cancer journey,” Urken said.
In an analysis of the management of patients with recurrent/persistent well-differentiated thyroid cancer published in Head & Neck, Urken and colleagues said the modules “allow for easy adoption of contemporary knowledge, making this information accessible to both patient and clinician.”
Fully compliant with the Health Insurance Portability and Accountability Act (HIPAA), the TCCC functions as a repository of disease-specific patient information; it already contains more than 700 patients, with at least 1,000 anticipated by the end of the first quarter of 2015, Urken said.
The TCCC has obtained approval for prospective and retrospective patient entry from the Western Institutional Review Board. It also has already achieved institutional review board approval at Oregon Health Sciences University and Stanford University and is in the final stages of approval at Johns Hopkins Medical Center.
The program continues to make additions and improvements. “We are launching an ultrasound imaging module that will provide a much more user friendly interface for efficient and rapid reporting of ultrasound results,” Urken said.
A demonstration of the TCCC is available to view online at www.thyroidccc.org/intro.
by Allegra Tiver
References:

 

 

FDA Approves Lenvima In Metastatic Thyroid Cancer


FDA Approves Lenvima In Metastatic Thyroid Cancer

FDA approved Lenvima (lenvatinib) for the treatment of locally recurrent or metastatic, progressive, radioactive iodine-refractory differentiated thyroid cancer. Lenvima was approved following a priority review.
Lenvima demonstrated a statistically significant progression-free survival prolongation and response rate in patients with progressive, differentiated thyroid cancer who had become refractory to radioactive iodine therapy.
In the phase III SELECT trial, which included 392 patients, Lenvima demonstrated a highly statistically significant improvement in PFS in patients with RAI-R DTC compared with placebo. The median PFS with Lenvima and placebo was 18.3 months and 3.6 months, respectively (HR 0.21; 95% CI: 0.16-0.28; p<0 .001="" span="">