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Chemo May Worsen Quality of Life for End-Stage Cancer Patients

THURSDAY, July 23, 2015 (HealthDay News) — Chemotherapy may worsen quality of life for some cancer patients who are nearing death, a new study finds.

“Oncologists may presume there to be no harm in giving dying patients chemotherapy, but these data point to more harm than benefit,” study author Dr. Holly Prigerson, from Weill Cornell Medical College in New York City, said in a college news release.

The research included more than 300 patients with advanced cancer who had about four months to live. Their average age was about 59. About half of the patients were receiving what’s known as palliative chemotherapy when the study began.

Palliative chemotherapy is generally given to people who have fewer than six months to live, according to the researchers. The hope is that palliative chemotherapy will ease symptoms and extend survival.

But that wasn’t the case for those patients who started the study with good ability to care for themselves. In fact, for people who could still work and perform day-to-day tasks, chemotherapy was associated with a worsened quality of life, the study found.

The study also found that for people who had a moderate or poor ability to care for themselves at the start of the study, such chemotherapy didn’t improve their quality of life.

“These data show that incurable cancer patients with a limited life expectancy who use chemotherapy are likely to impair the quality of their remaining days,” Prigerson said.

She and her colleagues wrote that American Society of Clinical Oncology (ASCO) guidelines “regarding chemotherapy use in patients with terminal cancer may need to be revised to recognize the potential harm of chemotherapy use in patients with progressive metastatic disease.”

The study was published online July 23 in the journal JAMA Oncology.

Many doctors question the benefits of chemotherapy for cancer patients who are nearing death. And an ASCO expert panel has said the use of chemotherapy in cases where there is no proven benefit for patients is “the most widespread, wasteful and unnecessary practice in oncology,” according to a journal news release.

The study findings “suggest that equating treatment with hope is inappropriate,” Dr. Charles Blanke and Dr. Erik Fromme, from Oregon Health & Science University, wrote in an accompanying editorial.

“Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment. At this time, it would not be fitting to suggest guidelines must be changed to prohibit chemotherapy for all patients near death without irrefutable data defining who might actually benefit, but if an oncologist suspects the death of a patient in the next six months, the default should be no active treatment,” the editorial concluded.

More information

The U.S. National Cancer Institute has more about end-of-life care for cancer patients.

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U.S. Oncologists Decry High Cost of Cancer Drugs

THURSDAY, July 23, 2015 (HealthDay News) — Soaring costs for cancer drugs are hurting patient care in the United States, a group of top oncologists claim.

“High cancer-drug prices are affecting the care of patients with cancer and our health care system,” Dr. Ayalew Tefferi, a hematologist at Mayo Clinic in Rochester, Minn., said in a Mayo news release.

Tefferi and his colleagues made a number of recommendations on how to address the problem in a commentary published July 23 in the Mayo Clinic Proceedings.

Allowing Medicare to negotiate drug prices is one of the suggestions the team of 118 leading cancer experts offered as a possible solution.

Along with their recommendations, the group also expressed support for a patient-based grassroots movement on change.org that is demanding action on the issue.

“The average gross household income in the U.S. is about $52,000 per year. For an insured patient with cancer who needs a drug that costs $120,000 per year, the out-of-pocket expenses could be as much as $25,000 to $30,000 — more than half their average household income,” Tefferi explained in the news release.

A study published earlier this year in the Journal of Economic Perspectives found that cancer drug prices have increased an average of $8,500 a year over the past 15 years.

“When you consider that cancer will affect one in three individuals over their lifetime, and [with] recent trends in insurance coverage [that] put a heavy financial burden on patients with out-of-pocket expenses, you quickly see that the situation is not sustainable,” Tefferi said. “It’s time for patients and their physicians to call for change.”

The changes the commentary called for included:

Create a review mechanism after a drug has been approved by the U.S. Food and Drug Administration that would propose a fair price for new cancer drugs that is based on the value to patients and health care.
Allow the Patient-Centered Outcomes Research Institute — established under the Affordable Care Act — to evaluate the benefits of new cancer therapies, and let similar organizations include drug prices in their assessments of a treatment’s value.
Permit patients to import cancer drugs from other countries. For example, prices in Canada are about half that of prices in the United States, the experts said.
Pass legislation to prevent drug companies from delaying the introduction of generic drugs, and reform the patent system to make it more difficult to unnecessarily extend patent protection of a drug.
Encourage groups that represent cancer specialists and patients to consider the overall value of drugs and treatments when developing their treatment guidelines.

The group wrote that “it should be possible to focus the attention of pharmaceutical companies on this problem and to encourage our elected representatives to more effectively advocate for the interests of their most important constituents among the stakeholders in cancer — American cancer patients.”

More information

The U.S. National Cancer Institute has more about cancer drugs.

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Exercise May Buffer Symptoms of Early Alzheimer’s

By Dennis Thompson
HealthDay Reporter

THURSDAY, July 23, 2015 (HealthDay News) — Regular exercise may be the best medicine for seniors facing the onset of dementia, according to three new clinical trials.

Physical activity improved mood, memory and ability to think for participants in all three studies.

One study found that intense aerobic exercise improves blood flow to key areas of the brain, and appears to reduce the tau protein tangles that are a hallmark of Alzheimer’s disease. Alzheimer’s is the most common form of dementia.

“Blood flow decreases in those areas for all of us with age, and yet exercise increased it,” said lead author Laura Baker, a cognitive neuroscientist at Wake Forest School of Medicine in Winston-Salem, N.C. “It seems to me we’re changing aging-related effects, and we may be changing Alzheimer’s-related effects, both with exercise.”

The new research was scheduled for presentation Thursday at the Alzheimer’s Association International Conference in Washington, D.C. Findings presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

The three studies “give us information about living better with the disease,” said Heather Snyder, director of medical and scientific operations for the Alzheimer’s Association.

“Physical exercise is potentially beneficial to people who are living with Alzheimer’s today,” Snyder said. “Even once you have cognitive impairment, there’s still a benefit to physical activity.”

Prior research has shown that exercise can improve the ability to think in healthy adults, so Baker and her colleagues turned to people with mild impairment to see if physical activity would help them, too. The 65 people in Baker’s study were 55 to 89 years old and had not been exercising beforehand. They also had prediabetes, which can increase risk of developing Alzheimer’s disease.

Participants were randomly assigned to one of two groups for six months. The first group performed stretching exercises that did not raise their heart rate much, while the second group had to perform at least 45 minutes of high-intensity aerobics four times a week.

The aerobics group had to stay within 75 percent to 85 percent of their maximum heart rate for at least 30 minutes of their workout, which most often took place on a treadmill. “For our typical 70-year-old, that means a heart rate of at least 130 beats per minute,” Baker said.

Ninety-two percent of people stuck to the exercise program, and wound up with improved fitness and better blood sugar levels, researchers found.

More important, MRI brain scans revealed that blood flow had significantly increased to the memory and processing centers of participants’ brains, with a corresponding improvement in their ability to plan, organize and pay attention.

Tests using cerebrospinal fluid samples drawn from the patients also showed a significant reduction in tau protein tangles, with the effect most pronounced in those older than 70.

“These findings are important because they strongly suggest a potent lifestyle intervention such as aerobic exercise can impact Alzheimer’s-related changes in the brain,” Baker said. “No currently approved medication can rival these effects.”

In another clinical trial, 200 people between ages 50 and 90 with Alzheimer’s were randomly assigned to either an aerobic exercise program or a control group that performed no extra exercise. The folks who exercised were asked to reach a target intensity of 70 percent to 80 percent of their maximum heart rate.

The Danish researchers found that those who exercised suffered from fewer mood problems such as anxiety, irritability and depression. The people who exercised most often and most vigorously also achieved significant improvements in mental speed and attention.

The third clinical trial took place in Canada and involved 71 people between ages 56 and 96 who had suffered ministrokes, diminishing their ability to think and remember. Half were assigned to a group that took part in regular aerobics classes.

The researchers found that participants who took aerobics significantly improved their memory and selective attention, compared with those not asked to exercise regularly.

Snyder and Baker said most seniors should be able to find some physical activity they can perform, even if they have some age-related infirmities.

“You don’t have to use any one exercise,” Baker said. “It’s anything you can get your heart rate up to where you are panting and sweating.”

However, she noted that seniors should consult their doctor before embarking on an exercise program, and ease into it. The Danish study gave participants four weeks to adapt before asking them to exercise more intensely.

If someone already has dementia, they still can benefit from exercise, but will probably need someone to guide their workout schedule, Baker added.

“But that supervision can be in the form of group exercise,” she said. “It doesn’t have to be one-on-one.”

More information

For more on Alzheimer’s disease, visit the U.S. National Institutes of Health.

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Stillbirths Now Outnumber Infant Deaths in U.S.

By Steven Reinberg
HealthDay Reporter

THURSDAY, July 23, 2015 (HealthDay News) — Stillbirths have eclipsed infant deaths for the first time in the United States, a new government report shows.

Several factors may be fueling the trend, including declining infant death rates, racial disparities in access to good care during pregnancy, and fertility treatments that often involve placing more than one embryo in a woman’s womb, experts said.

“The number of fetal deaths [stillbirths] is now slightly higher than the number of infant deaths,” said report co-author Elizabeth Gregory, a health statistician at the National Center for Health Statistics, part of the U.S. Centers for Disease Control and Prevention. In 2013, there were 23,595 fetal deaths at 20 weeks of gestation or more, compared to 23,446 infant deaths, the report showed.

The report did not include abortions, Gregory said.

“Both infant deaths and fetal deaths are going down,” said Dr. Edward McCabe, chief medical officer at the March of Dimes. “But infant deaths are declining more, and that’s leading to this difference.”

Infant death is when a baby dies before his or her first birthday, according to the CDC.

Although fetal death rates overall have remained largely unchanged, they are higher for certain populations, including teens, women aged 35 and over and unmarried women, along with male fetuses and multiple fetuses, the report showed.

But significant racial disparities also emerged in the report.

In 2013, the fetal death rate for black women stood at 10.5 per 1,000 pregnancies, which was more than twice the rate for white women and Asian or Pacific Islander women, researchers found.

The fetal death rate for American Indian or Alaska Native women was 27 percent higher than the rate for white women, while it was 7 percent higher for Hispanic women, the findings showed.

McCabe said those racial differences reflect a disparity in medical care.

“The fact that blacks and other minorities have the highest rate is concerning, because research shows that these are not genetic differences but differences in access to care,” he said. “This is something we as a society need to address.”

He added that the increased rate of fetal deaths among twins and triplets is largely due to an increase in the use of fertility treatments and the implanting of more than one embryo in a woman.

McCabe said that one way to reduce fetal deaths linked to reproductive technology is for women and doctors to opt for single-embryo transfers.

For all women, a key to reducing the risk of fetal deaths is to take good care of themselves before becoming pregnant, McCabe said.

That means not smoking, drinking alcohol or using illicit drugs or narcotic painkillers, he said. It also means getting weight and chronic conditions such as high blood pressure or diabetes under control.

McCabe added that 50 percent of pregnancies in the United States are still unplanned, which can lead to miscarriages, stillbirths and other pregnancy complications.

“By planning a pregnancy, and by being in the best health you can [be] before you become pregnant, [you] will help improve the outcome,” McCabe said.

The report was published in the July 23 issue of the CDC’s National Vital Statistics Reports.

More information

Visit the U.S. Department of Health and Human Services for more on miscarriages and stillbirths.

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