Five Cancer Practices That Must Stop

9th Monday, 2012  |   Others  |  no comments

From Medscape Medical News > Oncology http://www.ccsettings.com/blog-posts/five-cancer-practices-that-must-stop/?goback=.gde_3660202_member_130001990 by Zosia Chustecka April 5, 2012 — Five common cancer procedures and tests have been identified that are not supported by evidence and should no longer be used, according to the American Society of Clinical Oncology (ASCO). Oncologists should stop the unnecessary use of chemotherapy in patients with advanced cancers who are unlikely to benefit, and should limit their use of colony-stimulating factor (CSF) drugs in patients undergoing chemotherapy. They should also curb their use of advanced costly imaging technologies for staging of early breast and prostate cancers, and for detecting breast cancer recurrences. These recommendations, compiled after an extensive review of the literature and with input from more than 200 ASCO members, were published online April 3 in the Journal of Clinical Oncology. The move is part of the Choose Wisely campaign, organized by the American Board of Internal Medicine, in which many different medical specialties identified tests and procedures that could be skipped. In total, 45 procedures and tests were deemed unsupportable by evidence. This campaign started when Howard Brody, MD, PhD, professor of family medicine at the University of Texas in Galveston, challenged each medical specialty to take a critical look at its field and identify 5 practices that are commonly performed despite a lack of evidence (N Engl J Med. 2010;362:283-285). “At ASCO, we took that challenge to heart,” lead author Lowell Schnipper, MD, from the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, and chair of the ASCO Cost of Care Task Force, said in a statement “By tackling the overuse of treatments and tests for some of the most common cancers, we hope to achieve substantial improvements in the quality of cancer care in the United States,” he added. Avoiding treatments that have little or no benefit means that “we also do our part to address the unsustainable cost increases that threaten our nation’s healthcare,” said Michael Link, MD, president of ASCO. Stop Chemotherapy Perhaps the most controversial of the new proposals is the recommendation to stop using or to withhold chemotherapy in patients with advanced solid tumors who are unlikely to benefit, and to focus instead on symptom relief and palliative care. This whole area has stirred fierce debate in recent years, and attempts in the United States to introduce legislation for end-of-life discussions were stalled after accusations that this was a form of “soft euthanasia” and that these were “death panels” to persuade people not to use medical resources. In their paper, Dr. Schnipper and colleagues emphasize that stopping chemotherapy is recommended only for a specific subgroup of patients with advanced solid tumors — those with low performance states (3 or 4) who are not eligible for a clinical trial, and in whom there was no benefit from previous evidence-based interventions and no strong evidence supporting the clinical value of further anticancer treatment. “If a patient’s cancer has grown during 3 different regimens, the likelihood of treatment success is so poor and toxicity so high that further anticancer treatment is not recommended,” the authors write. They cite results from the largest series of patients with nonsmall-cell lung cancer (NSCLC) from the M.D. Anderson Cancer Center in Houston, Texas, which showed that only 2% had a documented response to third-line chemotherapy, and 0% had a response to fourth-line chemotherapy (Lung Cancer. 2003;39:55-61). However, despite the evidence for lack of effect, administering nth-line chemotherapy is common, the authors note. They cite several studies showing that many NSCLC patients receive 4 lines of chemotherapy, and that many patients with solid tumors are still being given chemotherapy within days of death. “This practice is not being driven by profit, but by a desire to help patients,” the authors note, and “by the inability of patients, families, and their oncologists to make end-of-life transitions.” Oncologists admit that they find this difficult, as previously reported by Medscape Medical News. Stopping chemotherapy can feel like failure and “giving up,” and sometimes patients or their relatives can demand more — in one instance, because the “chemotherapy cheers her up.” “Stopping anticancer treatment should always be accompanied by appropriate palliative and supportive care and referral to a hospice,” the authors state. “Best practice would be continuation of palliative care started concurrently at the time of diagnosis for ‘any patient with metastatic cancer and/or high symptom burden,” they add. This reiterates the recent provisional clinical opinion issued by ASCO. Limit Use of G-CSF Products Another recommendation related to chemotherapy is to cut down on the use of granulocyte CSF (G-CSF) products for the primary prevention of the chemo-induced adverse effect of febrile neutropenia. Two G-CSFs are available in the United States: filgrastim (Neupogen) and sargramostim (Leukine). ASCO guidelines state that G-CSFs are recommended in patients who have “a high risk” (more than 20%) of developing febrile neutropenia as a complication of chemotherapy. In practice, however, there is a “clear overuse of these agents.” Use is inconsistent; the products are used both appropriately and inappropriately, the authors write. They note that these products are “costly” and should be used only in patients who are at high risk of developing febrile neutropenia, as specified in the guidelines. Stay Away From High-Tech Imaging The remainder of the new recommendations steer oncologists away from using advanced imaging technology in specific groups of cancer patients. One instance is patients with early-stage prostate cancer and early-stage breast cancer, who have a low risk for metastasis. In these cases, advanced imaging technologies, such as positron emission technology (PET), computed tomography (CT), and radionuclide bones scans, should not be used to determine whether the cancer has spread, the authors note. “These tests are often used in staging evaluation of low-risk cancers, despite a lack of evidence suggesting that they detect metastatic disease or survival,” the authors state. “Unnecessary imaging can lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis.” In addition to the potential harm from unnecessary exposure to ionizing radiation, best results with cialis as well as anxiety, there is also a huge monetary cost from such scans, the authors note. The list price of a fluorodeoxyglucose PET with concurrent CT scan is around $2500 to $5000, depending on the scan and location. In many instances, patients are directly responsible for a portion of these costs. The other instance where advanced imaging is discouraged is in patients who have been treated for breast cancer with curative intent who are now asymptomatic. “The majority of patients with breast cancer diagnosed today present with early-stage, node-negative disease that is found on screening mammography,” the authors write. “As a result of earlier diagnosis and the efficacy of adjuvant therapies…most of these women have a normal life expectancy and a low risk of recurrence.” Several studies have now shown that in such patients, there is no benefit from routine imaging with PET, CT, or radionuclide bone scans, or from serial measurement of serum tumor markers, including CEA, CA 15-3, and CA 27-29, the authors state. In addition to no benefit, there might be harm from false-positive results, leading to unnecessary invasive procedures, over-treatment, and misdiagnosis, they add. Instead, such patients should be followed with mammography, with careful attention paid to patient history and physical examination, they suggest. Breast magnetic resonance imaging is not recommended for routine surveillance, because it has a high-false positive rate. Lower Cost to Patients and Society Reconsidering the use of these top 5 cancer treatments, tests, and procedures is likely to improve the value of cancer care, the authors note. This means achieving the desired clinical outcome at the lowest cost to the patient and society. At the same time, each patient with a life-threatening disease is a challenge. In each case, the oncologist must take the unique features of each individual into consideration when making decisions on the management of their cancer, they add. Source: Schnipper LE, et al. J Clin Oncol. doi: 10.1200/JCO.2012.42.8375 Published online April 3, 2012.

This is the exception, not the rule

6th Friday, 2012  |   Uncategorized  |  no comments

The restaurant is also adding a full bar, and cocktails will be simple yet classic to start. “Jarry and I are both very nervous,” Mary says. “But I think we’re both ready.” 5121 Pershing Ave., Fort Worth, 817 737 8568.. Brandi and her Amazons are the first to arrive, followed by Lisa who Vanderpesters Brandi about her broken armand why she hasn’t seen a doctor yet. But, no, really Replica Bags, why haven’t you, Brandi? (THANKS, OBAMA, is the official answer.) But Brandi DOESN’T WANT TO TALK ABOUT IT and storms off for a Fatburger before she kills a Vandernagger. Lisa turns her Vanderttentions to one of Brandi’s Amazons, insisting that she take Brandi to the doctor, because that would certainly be easy.

Replica Bags 4. The same goes for deep throating. This is the exception, not the rule. I was seven months old when our Nation celebrated its 53rd Independence Day the first one after my birth. My grand dad used to describe the very first Independence Day celebration when he was a boy of seven and how the Tricolour was unfurled by a British Manager on the morning of August 15, 1947, at the Selaliparai tea factory premises in Valparai Anamalai hills. My great grand dad was the Headmaster of the local school and he sang the songs Thayin ManikodiPareer and Aaduvomey, pallu paaduvomey, Aanandasudanthiram adainthuvittomenru on that memorable occasion.. Replica Bags

Fake Bags These coaches of the best coaches I’ve ever seen. They care about their men, they are supportive https://www.replicaspace.com, try to produce the best athlete out of them, give them so many opportunities, love the game of football, and just so much more I could name off, but as you can see from just the little I said Replica Handbags, UVM football is an incredible program, please take my word for it and go watch these guys play I promise it won’t be a disappointment. All and all great group of men, incredible coaches, and a fantastic program.. Fake Bags

Replica Handbags “The status quo prevails. We’ve had this debate over and over again. I think from the very beginning it was a manufactured issue. Designated driver tickets are available for those not drinking for$20. July 3. Willow Springs Garden historical site, which often hosts festivals for the community willput ona celebration and car show fit for the whole family. Replica Handbags

Replica Designer Handbags At least select the payment method. Fashion Lanes accept all major credit cards such as credit cards, master card, visa, Debit cards, PayPal and Bank Transfer. After payment you will receive a conformation email from Fashion Lanes about your order.. Replica Designer Handbags

Fake Designer Bags Last month Replica Designer Handbags, AAA adopted a policy against pot legalization because of traffic safety concerns Replica Designer Handbags, Parmenter said. Manchester police Officer Scott Plourde, a DRE who is scheduled to speak at the summit as part of a panel presentation, said he has cited impaired drivers who had used only marijuana. Because the drug affects balance, clear thinking and judgment, stoned drivers fail the same tests as drunk drivers, Plourde said Fake Designer Bags.

Toxicity in Chemotherapy — When Less Is More

3rd Tuesday, 2012  |   Others  |  no comments

Alessandro Laviano and Filippo Rossi Fanelli. N Engl J Med 2012; 366:2319-2320 June 14, 2012

Food is a potent inducer of metabolic responses. Specific nutrients enhance muscle accretion, while others modulate the inflammatory response or boost appetite. On the other hand, caloric restriction under normal conditions (i.e., the prolonged intake of approximately 20 to 40% fewer calories than are required) has been shown to protect against the development of chronic diseases.1 Exploiting the differential effects of food and its absence on metabolic pathways during disease may be one strategy to enhance the efficacy of drug therapies.
Significant improvements in the field of oncology have enhanced prevention, screening, early diagnosis, and treatment. Nevertheless, the prevalence of cancer remains high, the costs of treatment are great, and cures for most cancers have yet to be found. The possibility that a patient’s response to anticancer therapy might be improved through changes in diet is attractive, since this approach is likely to be affordable and readily accessible.
Normal cells and cancer cells differ in their ability to respond to fasting. In the absence of nutrients, normal cells switch their metabolism toward maintenance pathways, whereas tumor cells are unable to activate this protective response. The differences in metabolism between normal cells and cancer cells could be used to enhance anticancer therapy by selectively increasing the resistance of normal cells to chemotherapy — that is, by augmenting differential stress resistance rather than by developing more aggressive and toxic drugs

Figure 1. Modulating the Effects of Chemotherapy by Means of Fasting.
Chemotherapy-induced oxidative stress reduces the rates of both the proliferation and the survival of cancer cells. It yields an objective response that can be quantified on the basis of shrinkage of the tumor volume (Panel A). However, chemotherapy also affects normal cells, leading to toxic side effects. Lee et al.2 recently reported that short-term fasting before or after chemotherapy, or at both times, induces differential stress resistance in normal and cancer cells. In normal cells, fasting activates protective metabolic pathways that confer resistance to oxidative stress (Panel B). In contrast, yeast transformed with an activated oncogene is unable to turn on the protective response and thus remains sensitive to oxidative stress. Additional experiments using mouse models of human cancer showed that fasting specifically augments levels of oxidative stress and sensitivity to oxidative damage (e.g., that inflicted by chemotherapeutic agents) in cancer cells and that these effects are accompanied by DNA damage and apoptosis

Lee et al.2 recently described data that support this approach. They found that short-term starvation increased the sensitivity of yeast cells that expressed an activated form of oncogene to oxidative stress, and thus to chemotherapy, as compared with its effect on wild-type yeast cells. Also, they found that restricting glucose and growth factors in the culture medium for 24 hours before and 24 hours after treatment with doxorubicin and cyclophosphamide rendered 15 of 17 cell lines more sensitive to these drugs.

To confirm these effects in vivo, Lee et al. studied mice with subcutaneous allografts of murine cancers or xenografts of human cancer cells. They observed that 48 to 60 hours of food deprivation retards tumor growth, in some cases as effectively as chemotherapy does, and they noted a synergy between starvation and drug therapy. Then, to investigate the effects of short-term starvation on metastatic advanced cancer, they studied mice bearing melanoma, neuroblastoma, or breast-cancer cells and observed that fasting potentiated the effects of chemotherapy and extended survival in these animals. They investigated the molecular mechanisms underlying these biologic effects, although only in breast-cancer allografts. After fasting, proliferation-associated genes were down-regulated in normal tissues but were up-regulated or unaffected in cancer cells. In addition, levels of phosphorylated Akt and S6K were elevated in the cancer cells of animals that had fasted, suggesting that levels of oxidative stress and sensitization to oxidative damage (a primary effect of chemotherapy in these cancer cells) were increased.

It is tempting to integrate these exciting results into the current comprehensive approach to patients with cancer.3 But this action would be premature. During the period of refeeding after fasting, several of the experimental cancers observed by Lee et al. returned to a size similar to those in control animals. The use of caloric restriction, as opposed to short-term starvation, is not advised in patients with cancer who are already prone to malnutrition owing to the tumor or to the side effects of anticancer therapies. Studies in animals suggest that it could take months of caloric restriction to bring about an antitumor response in humans, if at all. Malnutrition would inevitably develop, leading to increased morbidity and mortality.

Clinical trials could be considered as a way of testing the effects of fasting or of restricting specific nutrients for 2 or 3 days during and after chemotherapy. With respect to palliative care, preliminary results suggest that the integration of differential stress resistance may enhance patients’ responsiveness to and compliance with anticancer therapies. In a case series of 10 patients with cancer who voluntarily underwent short-term fasting prior to or after chemotherapy (or at both times), fatigue, weakness, and gastrointestinal side effects were reduced.4 Clinical trials are currently under way to test the effect of short-term fasting on chemotherapy-associated toxicity (ClinicalTrials.gov numbers, NCT01304251, NCT00936364, and NCT01175837). Although strong evidence has yet to be obtained to support the use of differential stress resistance as achieved through fasting for improving the response to chemotherapy, it may not be long in coming.5

References
1. Fontana L, Partridge L, Longo VD. Extending healthy life span — from yeast to humans. Science 2010;328:321-326
2. Lee C, Raffaghello L, Brandhorst S, et al. Fasting cycles retard growth of tumors and sensitize a range of cancer cell types to chemotherapy. Sci Transl Med 2012;4:124ra27-124ra27
3. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733-742
4. Safdie FM, Dorff T, Quinn D, et al. Fasting and cancer treatment in humans: a case series report. Aging (Albany NY) 2009;1:988-1007
5. Laviano A, Seelaender M, Sanchez-Lara K, Gioulbasanis I, Molfino A, Rossi Fanelli F. Beyond anorexia-cachexia: nutrition and modulation of cancer patients’ metabolism: supplementary, complementary or alternative anti-neoplastic therapy? Eur J Pharmacol 2011;668:Suppl:S87-S90

At the school in North Delta, 11584 Lyon Rd

3rd Tuesday, 2012  |   Uncategorized  |  no comments

Padua is a 2004 graduate of Glendale High School. Marine Corps Pfc. Edwin A. No Host Bar from 6 pm, Buffet Dinner at 7 pm. Also silent auction, Reverse Draw for $1,000, 50/50 draws. At the school in North Delta, 11584 Lyon Rd. According to official counts, more than 17,800 people have been infected with Ebola virus in this epidemic and more than 6,300 have died since this outbreak’s first known case in rural Guinea in December 2013. Many on the front lines believe the actual numbers are much higher and in any event, they continue to rise steeply. The virus has traveled to Europe and North America, where the resulting fear exceeded any actual threat to public health.

hermes replica “At the end of the day, there are going to be two things that are going to be the hurdle when you approach it from the state’s standpoint Hermes Replica,” Perry said in a localradio interview. “Liability is going to be number one for them. They don’t want the liability of someone going out to rescue someone and then not being able to find them (the rescuers) and, secondly, there’s a cost.”. hermes replica

Hermes Belt Replica Dr. Allan E. Goodman, IIE President and CEO expresses the importance of making study abroad a part of a student study abroad education need mentors, campus leaders, faculty and relatives https://www.designer-replica-hermes.com, to inspire and motivate students to study abroad so that the next generation of Americans is prepared to thrive in our globalized world.. Hermes Belt Replica

hermes replica birkin After all, if I did not believe in the good of humanity and the ability for people to change I would surely be headed down the wrong career path. I understand that many of my days in the future will be trying and, at times I will certainly wonder why I ever decided to choose such a stressful occupation. However, the rewards are bound to outweigh the speed bumps I will hit along the way Designer Replica Hermes, and I cannot wait to experience it all!. hermes replica birkin

replica hermes bags Owens said. When you consider that one billion passengers check two billion bags every year, Mr. Owens said, you begin to understand how stuff gets lost.. Det finns ngra alternativa lsningar fr steadying kameran om du inte har ett stativ eller inte vill bra en. Jag har en gammal (ren) socka fylld med ris som fungerar som en beanbag att stabilisera min kamera. Du kan anvnda den nstan var som helst, p en sten, en avsats Hermes Replica, bilfnster etc. replica hermes bags

hermes replica bags Photo by Mike Kepka / San Francisco ChronicleCaption History:Anna Sager of San Francisco, Calif. Holds newly purchased goods in a new degradable (not necessarily biodegradable) Walgreens bag in front of the 850 Market Street store on Monday May 19, 2008 in San Francisco Hermes Belts Replica, Calif. The store is in the process of phasing out non degradable plastic bags in preparation for the city wide ban on them starting May 20, 2008 hermes replica bags.

Inflammation and Cancer—Basic Facts

2nd Monday, 2012  |   Inflammation, Others  |  no comments


Chronic inflammation increases cancer risk.
Subclinical, often undetectable inflammation may be as important in increasing cancer risk (for instance, obesity-induced inflammation).
Various types of immune and inflammatory cells are frequently present within tumors.
Immune cells affect malignant cells through production of cytokines, chemokines, growth factors, prostaglandins, and reactive oxygen and nitrogen species.
Inflammation impacts every single step of tumorigenesis, from initiation through tumor promotion, all the way to metastatic progression.
In developing tumors antitumorigenic and protumorigenic immune and inflammatory mechanisms coexist, but if the tumor is not rejected, the protumorigenic effect dominates.
Signaling pathways that mediate the protumorigenic effects of inflammation are often subject to a feed-forward loop (for example, activation of NF-κB in immune cells induces production of cytokines that activate NF-κB in cancer cells to induce chemokines that attract more inflammatory cells into the tumor).
Certain immune and inflammatory components may be dispensable during one stage of tumorigenesis but absolutely critical in another stage.

Inflammatory responses play decisive roles at different stages of tumor development, including initiation, promotion, malignant conversion, invasion, and metastasis. Inflammation also affects immune surveillance and responses to therapy. Immune cells that infiltrate tumors engage in an extensive and dynamic crosstalk with cancer cells, and some of the molecular events that mediate this dialog have been revealed. This review outlines the principal mechanisms that govern the effects of inflammation and immunity on tumor development and discusses attractive new targets for cancer therapy and prevention.

Inflammation can affect every aspect of tumor development and progression as well as the response to therapy. In the past ten years, we have learned a great deal about the different mechanisms by which cancer and inflammation intersect, and the time is right to translate much of the basic knowledge gained thus far and use it to add new armaments to the arsenal of cancer therapeutics. Only by targeting every single aspect of cancer biology can we expect to make real gains in the fight against these currently incurable diseases. In addition to a combination of anti-inflammatory approaches that target the tumor microenvironment with more sophisticated and selective tumoricidal drugs, future therapies should also take notice of the natural genetic variation that affects inflammation and immunity. Such considerations are extremely important in the design of new preventive approaches to the reduction of cancer risk that need to be applied to large populations composed of relatively healthy individuals. Indeed, one of the major lessons learned from investigating the relationships between inflammation and cancer is that most cancers are preventable. Prevention is a much better and more economical way to fight cancer than treating an already advanced and often intractable disease, as is done at the present.

Source:
Grivennikov SI, Greten FR, Karin M. Immunity, Inflammation, and Cancer. Cell. Volume 140, Issue 6, 19 March 2010, Pages 883–899 http://dx.doi.org/10.1016/j.cell.2010.01.025,