Guidelines To Improve Care Of Three Symptoms At End Of Life

The guidelines say that clinicians should regularly assess people with serious illness at the end of life for symptoms of pain, shortness of breath, and depression; that they should use proven therapies to treat these conditions; and should ensure that advance care planning occurs for all patients with serious illness.

"Many Americans will face a serious illness at the end of life and their families will be involved in their care," said Amir Qaseem, MD, PhD, MHA, Senior Medical Associate in the Clinical Programs and Quality of Care Department of the Medical Education and Publishing Division at ACP. "We wanted to pull together best available evidence on improving care that relieves or soothes symptoms at the end of life. Evidence review showed that the three most common symptoms were pain, difficult breathing and depression, so our guidelines address these."

Elaborating on the recommendations to use therapies of proven effectiveness to manage pain, shortness of breath, and depression, the guidelines say that clinicians should regularly assess patients with serious illness at the end of life.

* For patients with cancer, pain has been proven to be controlled with anti-inflammatory drugs, narcotic drugs and bisphosphonates.
* In patients at the end of life with difficult breathing, unrelieved dyspnea can be relieved by narcotic drugs and oxygen for short-term relief of hypoxemia.
* Patients with depression can be treated with antidepressants and psychosocial intervention.

ACP, through its Clinical Efficacy Assessment Subcommittee, has been developing guidelines since 1981. ACP guidelines have relied on evidence or clinical documentation rather than consensus or expert opinion.

In the case of the EOL guidelines, the reviewing committee found that high-quality evidence on end-of-life care is limited, and most of the evidence comes from literature on patients with cancer. Therefore the new evidence-based guidelines could not address many other important aspects of EOL care, such as symptoms specific to heart disease, lung disease, or dementia, or therapies such as nutritional support, complementary and alternative therapies, and spiritual care.

The EOL guidelines were passed by the ACP Board of Regents on July 14, 2007.

"End of life care has been identified by the Institute of Medicine as one of the priority areas to improve quality of health care. We hope that these guidelines would benefit physicians taking care of patients with seriously disabling or symptomatic chronic conditions."

The guidelines grade the evidence recommendations using the American College of Physicians' clinical practice guidelines grading system. All of the ACP recommendations on EOL care are considered strong recommendations, meaning that benefits clearly outweigh the risks. All of the EOL recommendations are considered to have moderate quality of evidence because most of the published literature is on patients with cancer.

Recommendation 1: In patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 2: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage pain. For patients with cancer, this includes nonsteroidal antiinflammatory drugs, opioids, and bisphosphonates. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 3: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage dyspnea, which include opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 4: In patients with serious illness at the end of life, clinicians should use therapies of proven effectiveness to manage depression. For patients with cancer, this includes tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention. (Grade: strong recommendation, moderate quality of evidence.)

Recommendation 5: Clinicians should ensure that advance care planning, including completion of advance directives, occurs for all patients with serious illness. (Grade: strong recommendation, low quality of evidence.)

Source:www.sciencedaily.com

Edelson to step down as director of Yale Cancer Center

Richard Edelson, director of the Yale Cancer Center since 2003, has decided to step down from his office and resume his responsibilities in cancer research and as dermatology chair at the Yale School of Medicine full-time, YSM Dean Robert Alpern announced last week.

The change in leadership comes at a moment of transition for the cancer center, which Edelson drastically reorganized and expanded under his directorship, Alpern said. Among Edelson’s administrative achievements was securing the five-year renewal of the cancer center’s core grant from the National Cancer Institute, he said. The NCI grant awards $1.87 million in funding per year to support the center’s research activities, faculty members and facilities. Receiving the competitive grant also ensures that the center continues to enjoy comprehensive status, the most prestigious level of designation from the NCI.

“We owe Rick an extraordinary debt of gratitude,” Alpern said. “At the time of the last search for a director, in 2002-’03, there were significant issues facing the center, which caused real concern within the institution as to whether the core grant would be renewed. Rick selflessly agreed to take over, fixed the problems and renewed the grant.”

Edelson will continue to serve as director while the YSM conducts a national search for his successor, Alpern said. The YSM has formed a committee to oversee the search process, he said.

Source:www.yaledailynews.com

Proteomic profiling shown more accurate than traditional biomarkers in identifying liver cancer

Proteomic profiling shown more accurate than traditional biomarkers in identifying liver cancer

BOSTON – As the incidence of liver cancer continues to grow-- fueled in large part, by rising rates of hepatitis C infections – so too does the need for tests to help diagnose the disease at an earlier stage. A study appearing in the January 15 issue of Clinical Cancer Research demonstrates that a novel mass-spectrometry based form of proteomic profiling is more accurate than traditional biomarkers in distinguishing liver cancer patients from patients with hepatitis C liver cirrhosis, particularly with regard to identifying patients with small, curable tumors. Led by researchers at Beth Israel Deaconess Medical Center (BIDMC), the study could help lead to earlier diagnostic methods – and subsequent treatments -- for liver cancer.

“Proteomics represents a potentially powerful tool for the serologic recognition of protein profiles associated with cancer,” explains co-senior author Towia Libermann, PhD, Director of the Genomics Center at BIDMC and Associate Professor of Medicine at Harvard Medical School.

“Although this particular proteomics technology, SELDI-TOF MS [surface enhanced laser desorption/ionization time of flight mass spectrometry] had already proven capable of identifying liver cancer in some limited studies, this was the first time that the technology was compared side-by-side with the clinical standard biomarker in a cohort of patients at risk for developing the disease,” adds Liebermann, who is also Director of the Dana-Farber/Harvard Cancer Center Proteomics Core in the Division of Interdisciplinary Medicine and Biotechnology at BIDMC.

Over a single decade, the incidence of liver cancer (hepatocellular carcinoma) increased from 1.8 to 2.5 per 100,000 patients, in large part due to a rise in the spread of hepatitis C virus.

“Hepatitis C has become a tremendous public health problem,” explains co-senior author Nezam Afdhal, MD, Director of the Liver Center at BIDMC and Associate Professor of Medicine at Harvard Medical School. “And a significant number of hepatitis C-infected patients will go on to develop liver cirrhosis.” Cirrhosis results when healthy tissue is replaced by scar tissue, preventing the liver from properly functioning. Cirrhosis itself is responsible for more than 25,000 deaths each year. But, adds Afdhal, secondarily, cirrhosis greatly increases a person’s chances of developing liver cancer.

“Each year, cirrhosis patients have a two to five percent chance that their condition will escalate to cancer,” he explains. “And the problem is that, right now, there is no reliable means of detecting liver cancer at an early stage, when surgical treatment is an option. Typically by the time the disease is discovered, the cancer has advanced and treatment options become much more limited.”

The best hope for early detection is cancer biomarkers, serum proteins found in altered amounts in blood or other body fluids. The current biomarker for liver cancer in clinical use is alpha fetoprotein (AFP). In many cases, patients with hepatitis C undergo routine monitoring for AFP levels as an indicator of whether tumors may have developed in their livers.

But, as Libermann explains, the AFP biomarker has a number of shortcomings, including false positives and false negatives. “AFP not only fails to detect many early tumors, but it also lacks specificity. Consequently, elevated AFP levels could be indicators of not only cancer, but also of other liver diseases or even benign conditions, while on the other hand, many patients with small tumors will test negative for AFP.”

The authors, therefore, decided to evaluate the sensitivy and specificity of SELDI-TOF MS for the detection of liver cancer and to compare its effectiveness with AFP.

Examining serum samples of 92 patients – including 51 patients with liver cirrhosis and 41 patients with liver cancer, and among the cancer patients, individuals with both large and small (less than 2 cm) tumors -- by SELDI-TOF mass spectrometry, the investigators were able to identify an 11-protein signature that accurately discriminated between the cirrhosis and cancer patients, first in a training set (made up of 26 cirrhosis and 20 liver cancer patients), and then again in an independent validation set (consisting of 25 cirrhosis and 19 liver cancer patients). The resulting diagnostic value – 74 percent sensitivity and 88 percent specificity – compared favorably with the diagnostic accuracy of AFP (73 percent sensitivity and 71 percent specificity) as well as with two other biomarkers currently in clinical development for liver cancer, AFP-L3 and PIVKA-IL.

“Most strikingly,” notes Libermann, “in patients with small tumors (less than 2 cm), where AFP identified only three, and AFP-L3 and PIVKA-II only one each, the 11-protein signature correctly identified seven of eight patients at this early stage of disease.

“Biomarkers play a major role in all aspects of personalized medicine, not only in early disease detection, but also in outcome prediction and evaluation of therapeutic responses,” he adds. “This study provides strong evidence that serum contains early detection biomarkers and supports the notion that a combination of multiple biomarkers may prove more effective than individual biomarkers for diagnosis of liver cancer, as well as other cancers.”

Source:www.eurekalert.org

The University of Oxford's Institute of Cancer Medicine

The evening will include presentations highlighting the groundbreaking cancer research and clinical care at the University of Oxford, a world leading biomedical university. The University of Oxford's Institute of Cancer Medicine is transforming research breakthroughs into more effective ways of diagnosing and treating cancer. This event marks the commencement of the exciting partnership between the international Ludwig Institute for Cancer Research and the University of Oxford.

Source:www.nyas.org

Genzyme Announces License Agreement with Moffitt Cancer Center for Exclusive Rights to Lung Cancer Diagnostic

Genzyme Corp. announced today that it has entered into a license agreement with Moffitt Cancer Center to obtain exclusive worldwide diagnostic testing rights to the discovery of the relationship of two proteins to patient response to non-small cell lung cancer (NSCLC) treatment. The expression level of these proteins may help predict how these patients will respond to therapy. Genzyme Genetics' relationship with Moffitt broadens its lung cancer testing portfolio.

The expression levels of the two proteins, RRM1 and ERCC1, have been shown by Dr. Gerold Bepler, M.D., and his team from Moffitt, to correlate with patient response to platinum drugs and gemcitabine, both of which are commonly used in treating NSCLC. Through this license, Genzyme plans to develop and market a diagnostic test that can be used to measure the expression levels of these proteins in NSCLC patients. This test may be used to guide first-line treatment for these patients, which in turn may improve patient outcomes while avoiding unnecessary side effects from ineffective treatment.

"In 2007, an estimated 30 percent of all cancer deaths will have been from lung cancer," said Dr. Bruce Horten, M.D., national medical director for Genzyme Genetics. "Our agreement with the renowned Moffitt Cancer Center will enable Genzyme to develop and market a diagnostic test designed to assist physicians in identifying the appropriate first-line therapy for their NSCLC patients -- a key decision point in the management of patients for whom getting the right drug as quickly as possible is critical. A personalized medicine approach to treatment such as this has the potential to help patients lead longer, healthier lives."

"Lung cancer is responsible for more cancer deaths in women than breast cancer and more deaths in men than prostate cancer," said Bepler, program leader of Moffitt's thoracic oncology program. "We hope this test will advance our fight against this disease and improve treatment options for patients."

Under the license agreement, Genzyme has agreed to pay Moffitt when various milestones are reached and provide Moffitt with running royalties on the sales of licensed services and products.

About Moffitt Cancer Center

Located in Tampa, Florida, Moffitt Cancer Center (www.moffitt.org) is the only Florida-based cancer center with the NCI designation as a Comprehensive Cancer Center for its excellence in research and contributions to clinical trials, prevention and cancer control. Moffitt currently has 15 affiliates in Florida, one in Georgia and two in Puerto Rico. Additionally, Moffitt is a member of the National Comprehensive Cancer Network, a prestigious alliance of the country's leading cancer centers, and is listed in U.S. News & World Report as one of "America's Best Hospitals" for cancer and ear, nose and throat. Moffitt's sole mission is to contribute to the prevention and cure of cancer.

About Genzyme Genetics

Genzyme Genetics is a leading, nationwide provider of high quality genetic testing and genetic counseling services for physicians and their patients. With laboratories and counseling facilities located across the U.S., Genzyme Genetics offers extensive reproductive and cancer testing services, supported by innovative technology and a commitment to quality service and trusted information. Genzyme Genetics is a business unit of Genzyme Corporation.

About Genzyme

One of the world's leading biotechnology companies, Genzyme is dedicated to making a major positive impact on the lives of people with serious diseases. Since 1981, the company has grown from a small start-up to a diversified enterprise with more than 9,500 employees in locations spanning the globe and 2006 revenues of $3.2 billion. In 2007, Genzyme was chosen to receive the National Medal of Technology, the highest honor awarded by the President of the United States for technological innovation. In 2006 and 2007, Genzyme was selected by FORTUNE as one of the "100 Best Companies to Work for" in the United States.

With many established products and services helping patients in nearly 90 countries, Genzyme is a leader in the effort to develop and apply the most advanced technologies in the life sciences. The company's products and services are focused on rare inherited disorders, kidney disease, orthopaedics, cancer, transplant, and diagnostic testing. Genzyme's commitment to innovation continues today with a substantial development program focused on these fields, as well as immune disease, infectious disease, and other areas of unmet medical need.

This press release contains forward-looking statements, including the statements regarding the ability of the ERCC1 and RRM1 proteins to help predict patient response to therapy, and Genzyme's plans to develop and market a diagnostic test which may be used to measure expression of these proteins and to guide first-line treatment for NSCLC patients. These statements are subject to risks and uncertainties that could cause actual results to differ materially from those projected in these forward-looking statements. These risks and uncertainties include, among others, scientific, technical and supply issues that prevent the development of a ERCC1/RRM1 test, the failure of ERCC1/RRM1 testing to produce diagnostic results as anticipated, the continued availability of ERCC1/RRM1 testing resulting from the lack of commercial acceptance of this test, including the acceptance of the test at price levels that are economically viable for Genzyme Genetics, and the other risks and uncertainties described in reports filed by Genzyme with the Securities and Exchange Commission under the Securities Exchange Act of 1934, as amended, including without limitation the information under the heading "Risk Factors" in the Management's Discussion and Analysis of Financial Condition and Results of Operations section of the Genzyme Quarterly Report on Form 10-Q for the quarter ending September 30, 2007. Genzyme cautions investors not to place substantial reliance on the forward-looking statements contained in this press release. These statements speak only as of the date of this press release, and Genzyme undertakes no obligation to update or revise the statements.

Source:money.cnn.com

Too Much of a Good Thing?

The number of Americans undergoing CT scans has increased dramatically in recent years, driving a significant increase in the amount of radiation that many people are being exposed to from medical procedures.
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Too Much of a Good Thing?
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The Ubiquitous CT Scan
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Before Getting Scanned, Patients Would Be Wise to Ask: Is It Essential?
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Prostate Cancer Saved My Life. Let Me Explain.

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That trend is raising concern that the high-tech exams could cause a small but significant excess of cancers in coming decades and spurring debate about whether the increasingly ubiquitous tests are being overused, exposing millions of Americans to needless risk. "The radiation doses from CT have been pretty clearly demonstrated to increase cancer risk," said David J. Brenner, a professor of radiation oncology at Columbia University who co-authored the most recent of a series of reports in the past year warning about the potential risks of CT scans. "On an individual basis there's probably not a big risk, but a small cancer risk applied to an increasingly large population spells trouble down the road. That's the concern."

Although some prominent medical groups have issued warnings against overusing the exams -- especially for children -- some experts worry about frightening patients away from the invaluable tests.

"You don't want people to avoid getting a potentially lifesaving diagnosis or therapy because they are afraid to get a CT scan," said Arl Van Moore Jr., a Charlotte radiologist who chairs the American College of Radiology's board of chancellors. "When a scan is done the right way for the right reasons, the benefits clearly outweigh the risks of doing it."

CT (computed tomography), sometimes called CAT (computed axial tomography), is performed by computerized machines that scan patients with X-rays to create three-dimensional cross-sectional images of organs and other parts of the body, providing far greater detail than standard single X-rays.

The number of scans performed each year in the United States has increased sharply, rising from about 3 million in 1980 to at least 67 million in 2006. There are many reasons for the increase, including improvements in the technology that have speeded the procedure, a growing list of uses and a proliferation of the machines.

"CT has become ubiquitous," said Jason Launders, a senior project officer at the ECRI Institute, an independent nonprofit health-care research organization outside Philadelphia that released a report last year warning about the potential risks. "Now if you go into an emergency room you can be scanned in a few minutes. You can't get that kind of information any other way. So physicians tend to use CT as sort of a first line in working out a diagnosis."

The use of CT scans is expected to continue to rise as possible new applications, such as for lung and colon cancer screening, become more widespread.

While the value of CT scans for screening remains the focus of debate, no one questions the value of the tests for allowing doctors to quickly diagnose a wide variety of health problems, including head injuries, heart problems, cancer, appendicitis, fractures and gallstones.

"CT is probably the biggest advance in diagnostic radiology that has ever occurred," said Thomas Ohlhaber, deputy director of the Division of Mammography Quality and Radiation Programs at the Food and Drug Administration. "Exploratory surgery that was common 10 or 15 years ago has virtually disappeared and all the risks associated with that have gone away because of CT. But nothing comes free of risks."

The concern comes from the fact that CT scans expose patients to much more radiation than standard X-rays. A CT chest scan, for example, exposes a patient to more than 150 times more radiation than a standard chest X-ray. That's more than twice as much as a typical person receives from the environment in an entire year. (See graphic.)

The upsurge in CT use has fueled a big jump in the annual amount of radiation that each American is receiving from medical procedures of all kinds. The average level of that exposure has increased about 600-fold since 1980, according to a federal report being published this year.

"At the moment, about half of medical radiation exposure is from CT scans," said Fred A. Mettler Jr., a radiation health expert at the University of New Mexico who helped prepare the report. CT scans represented just a few percent of the average American's exposure to radiation from medical tests in 1980, he noted.

Because it would take decades to follow a large number of patients who have undergone CT scans to determine the exact risks posed by the exams, there are no direct data demonstrating the danger. But researchers have estimated the risk based on what is considered the best information available about the health effects of radiation -- data collected from survivors of the atomic bombings of Hiroshima and Nagasaki, as well as exposure of nuclear plant and medical workers.

Using that information, experts have estimated that every 1,000 to 2,000 CT scans may produce one fatal cancer that would not have occurred otherwise.

Although that overall risk is relatively small, the large number of scans being performed could translate into a significant number of cancers. Brenner and his colleagues estimate that CT scans may be responsible for perhaps 2 percent of all cancers in the United States. The ECRI Institute estimated the scans may be causing 6,000 extra cancers each year, half of them fatal.

"Twenty years from now we could see a huge bonus of cancer coming through because of indiscriminate use of CT today," Launders said. "That's the real issue people are worried about."

The individual risk varies depending on the age of the patient and the type of scan. Younger people face more risk than older people because they have more time for a cancer to develop. Children are especially vulnerable because their rapidly developing bodies are at least four times as sensitive to the damaging effects of radiation. A child's risk may run as high as one case of cancer for every 500 scans, experts say.

Among adults, "young women have the highest risk," said Andrew Einstein of Columbia University, who evaluated the risks from cardiac CT scans in a paper published in July in the Journal of the American Medical Association. A 20-year-old woman faced the greatest risk -- one additional cancer for every 143 scans, he reported.

Some question the estimates, saying the risk of exposure from radiation from multiple CT scans may not be the same as from radiation from an atomic bomb.

"It's very difficult, in our opinion to equate the data from Hiroshima, where you had an instantaneous entire-body dose of radiation, compared to a cumulative dose for multiple CT scans," said Moore, the radiologist. "It's apples and oranges. It's not really the same."

Einstein, Mettler and others, however, disagree. "Radiation is radiation. Those are X-rays that the folks at Hiroshima and Nagasaki got. These are X-rays from a CT scan. They're really the same thing," said Brenner, whose report was published in November in the New England Journal of Medicine. "If the dose is the same, then the risk is going to be the same."

Although the companies that make the CT machines have been developing new protocols designed to minimize radiation exposure, particularly for children, everyone agrees that the most prudent thing to do is to eliminate unnecessary use.

While there are scant hard data about how often CT scans are done needlessly, several experts estimated that perhaps one-third could be eliminated. There are many reasons CTs may be overused. Some CTs are full-body "virtual physicals" performed on people who appear perfectly healthy -- a practice widely opposed by medical authorities.

Some say part of the blame lies with physicians who have financial interests in imaging facilities. "There is statistical evidence that indicates that more scans are ordered when a physician has a financial interest than when he doesn't," said Moore.

Defensive medicine also plays a role, with some doctors ordering the tests to stave off accusations that they withheld the most cutting-edge technology from their patients.

In other cases, overuse results from worried patients and from parents demanding CT scans that may not be needed. Other times doctors may not realize how many tests involving radiation patients have already undergone -- information that could influence a doctor's decision -- or may order a CT scan when other tests that do not involve radiation, such as a blood test, an MRI or an ultrasound, would suffice. "There are alternatives that are arguably just as good," Brenner said.

And patients also can take more responsibility for reducing the number of unnecessary scans.

"If a patient walks in and says, 'Tell me what the dose is from this and tell me what the risk is,' they are going to make the doctor start thinking about it," Mettler said. ¿

Source:www.washingtonpost.com

Fruit Flies All Aglow Light The Way To Cancer Prevention

A green glow from a fruit fly is giving researchers the green light when they are on the right path in their quest to develop compounds that help prevent cancer.The glow, the result of some tinkering in Drosophila, the workhorse of the genetics world, lets researchers know when powerful cancer-prevention signals similar to those spurred by protective chemicals in broccoli, cabbage, and other foods, have been turned on in the organism.

The chemical signaling system is one of the major ways that the body defends itself against toxic assaults and threats like cigarette smoke, diesel exhaust, and dangerous microbes. A gene known as KEAP1 senses danger and then unleashes NRF2, which triggers rampant anti-oxidant activity in a cell.

Now scientists from the University of Rochester Medical Center have discovered that the pathway, long recognized in people and other animals, is active in fruit flies, too, opening the door to faster, less expensive ways to find compounds that spur our natural anti-oxidant activity. The work, funded by the National Cancer Institute, is reported in the Jan. 15 issue of Developmental Cell.

"This is one of the main mechanisms the body uses to fight off the things that give you cancer," said Dirk Bohmann, Ph.D., professor in the Department of Biomedical Genetics and a geneticist who studies fruit flies in an effort ultimately aimed at improving human health.

"This puts cells into an anti-oxidant defense mode. Drug development and testing is very, very expensive and time-consuming. This work should speed the development of new drugs aimed at preventing cancer," added Bohmann.

Bohmann did the work along with former postdoctoral Gerasimos P. Sykiotis, M.D., Ph.D., who teamed up with Bohmann to develop novel approaches for the study of the NRF2 pathway after earning his medical and doctoral degrees from the University of Patras in Greece. Sykiotis is now with the Model Organisms Unit of the Novartis Institutes for Biomedical Research in Cambridge, Mass., where he is applying the genetic tools generated in the study to characterize the role of NRF2 signaling in Drosophila models of human diseases.

Scientists have known that the pathway exists in people, rodents, and zebrafish, and so Bohmann and Sykiotis went hunting for it in the fruit fly genome. They found that one form of a gene called CNC, which is widely known to be involved in determining the development of a fruit fly's head, serves like NRF2, turning on cellular defenses on a broad scale.

The defenses include activation of molecules known as thioredoxins and glutathione S-transferases, which are anti-oxidants that help a cell get rid of toxins and damaged molecules in its environment. Unlike popular anti-oxidants in certain foods and vitamins, whose effects in the body are transient, Bohmann points out that a fundamental genetic change like a boost in NRF2 activity throughout an organism would supply an ongoing amplified anti-oxidant response.

While the main application of the work is in boosting the body's ability to resist cancer, the research could also make a difference for patients who have cancer that is resistant to current drugs. In 2006, a team from Johns Hopkins showed how this same signaling pathway allows some cancer cells to fight off drugs intended to kill them. Gaining a foothold on the system in fruit flies gives researchers an added tool as they search for ways to thwart these rogue cancer cells.

In their experiments, Bohmann and Sykiotis modified fruit flies so they would glow green when exposed to ultraviolet light when the signaling pathway is functioning. Sure enough, flies with more active CNC glow more brightly than regular flies, giving the team an easy, visual way to see whether the pathway is activated.

The team demonstrated the technology using a compound called oltipraz, which targets the pathway and has been tested in people as a cancer-prevention agent. The flies that ate food with the compound glowed more strongly, demonstrating that the NRF2 pathway was more active in these flies.

"Turning on our natural anti-oxidants is big business for many companies trying to develop compounds to protect us from cancer and to slow the aging process," said Bohmann. "The same genetic principles govern many organisms, from flies to rodents to people, and we're hopeful that our tool in fruit flies will speed this work for the benefit of patients."

When Bohmann and Sykiotis boosted the activity of the pathway, fruit flies were three times more likely to survive an exposure to a toxin than regular flies. And flies with a more active signaling system can live 10 percent longer than the other flies.

It's the first time that the system, long known to be an important anti-oxidant and cancer prevention pathway, has also been shown to play a role in giving an organism a longer lifespan. The link gives new insight into the well-established connection between aging and cancer risk.

Two of Bohmann's colleagues at the University of Rochester Medical Center are also studying the NRF2 pathway. Steve Georas, M.D., professor of medicine and chief of the Division of Pulmonary and Critical Care, is looking at the role of NRF2 in people with asthma. And Irfan Rahman, Ph.D., associate professor of Environmental Medicine, has shown how NRF2 protects the lungs of smokers against the assault of cigarette smoke and other pollutants. He has shown that organisms in which NRF2 is weakened or absent have weak lungs and are much more prone to conditions like emphysema.

Source:www.sciencedaily.com

Talks on personal medicine, medical science open series

Lectures on personalized medicine and medical science in clinical practice will open two University of Arizona lecture series Wednesday in downtown Phoenix.

The first, a breakfast discussion series called Start the Day with the UA, will feature researcher Scott Leischow from the UA's Arizona Cancer Center in Tucson discussing personalized medicine. It will be from 7:30 to 9 a.m. at Tom's Tavern, 2 N. Central Ave. The talk is free; participants pay for breakfast. Reservations required. 602-827-2007.

Vimla Patel will launch the seminar on basic medical sciences presented by the UA College of Medicine-Phoenix with Arizona State University. Patel is a professor at both universities. Her talk is from noon to 1 p.m. at the medical college's Virginia G. Piper Auditorium, 550 E. Van Buren St. The talk and lunch are free. Reservations required. 602-827-2102.ALS benefit walk

The Walk to Defeat ALS raises money to help find a cure for amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, and to provide services for people living with the disease.

ALS is a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal cord, making even simple movements such as walking and talking almost impossible, the ALS Association says. The mind usually is unaffected.

This year, walks will be held in about 150 locations nationwide, including Tempe. All walk routes are wheelchair accessible.

Details: On-site registration begins at 9 a.m. and the walk at 10 a.m. Saturday at Tempe Beach Park, Rio Salado Parkway and Mill Avenue. There's no fee to participate. Register at www.alsa.org or 602-297-3800.

Chronic-pain support

People with reflex sympathetic dystrophy syndrome, also known as chronic regional pain syndrome, are invited to a meeting of the RSD Care & Share Support Group. Family, friends and caregivers also may attend.

RSD is a chronic neurological condition characterized by intense burning pain, changes in skin color and temperature over the affected body part, excessive sweating, tissue swelling and sensitivity to touch, according to the National Institutes of Health.

Details: 1 p.m. Saturday in Dining Room A at St. Joseph's Hospital and Medical Center, 350 W. Thomas Road, Phoenix. Free. Contact Margie St. Pierre at 602-843-2412.

New mom get-together

Learn how to keep your baby healthy now and into the future at the next Spirit of Women New Mom Tea and Social Hour. The gathering, hosted by Banner Desert Medical Center, also will provide tips for childproofing your home.

Details: 9:30-11:30 a.m. Saturday at Banner Desert's Rosati Education Center, 1400 S. Dobson Road, Mesa. $5. Reservations required. 602-230-CARE.

Healthful cooking

The Cancer Project, a non-profit collaboration of physicians, researchers and nutritionists that educates people in the ways a nutritious diet can help them prevent and survive cancer, will offer an eight-week cooking course with Scottsdale Healthcare.

Valley cooking instructor Kevin Breitbart will teach participants how to prepare foods that taste good and are good for them. Topics include low-fat foods, high-fiber foods, dairy alternatives, replacing meat, meal planning, antioxidants and phytochemicals, immune-boosting foods and maintaining a healthful weight.

Details: 3-5 p.m. Wednesdays, Jan. 23-March 12, at the Virginia G. Piper Cancer Center, Education Conference Room, 10460 N. 92nd St., Scottsdale. Free, but registration required. 480-882-4636.

Women's conference

A conference for women only will address physical and emotional issues that affect their sexuality after being diagnosed with and treated for cancer.

Physician Charles Loprinzi, head of oncology for the Mayo Clinic in Rochester, Minn., and author of Mayo Clinic Guide to Women's Cancer, will lead the discussion.

Details: 9 a.m.-noon Jan. 26 at the Wellness Community of Central Arizona, 360 E. Palm Lane, Phoenix. Free, but reservations required. 602-712-1006.

Source:www.azcentral.com

Hormonal Dietary Supplements Might Promote Prostate Cancer Progression

components in over-the-counter dietary supplements may promote the progression of prostate cancer and decrease the effectiveness of anti-cancer drugs, researchers at UT Southwestern Medical Center have discovered.The findings, which appear in today's issue of Clinical Cancer Research, reaffirm that patients should inform their doctors about any herbal or hormonal dietary supplements they are taking or considering taking. The researchers also recommend that documentation of supplement usage become part of routine health assessments for all patients, particularly cancer patients.

"Physicians need to ask their patients not only about the prescription drugs they may be taking, but -- perhaps even more importantly -- about the over-the-counter drugs and supplements, which may have a profound impact on certain health conditions," said Dr. Claus Roehrborn, chairman of urology at UT Southwestern and one of the study's authors.

The researchers began their investigation when two patients being seen by UT Southwestern doctors developed aggressive prostate cancer within months of starting daily consumption of the same dietary supplement. Both men purchased the same product, one to develop stronger muscles and enhance sexual performance, the other to gain muscle.

Dr. Roehrborn, Dr. Shahrokh Shariat, a resident in urology and the study's lead author, and their colleagues analyzed the supplement, which is not named in the study. They found that the product's label listed ingredients that were not present, misrepresented the concentrations of the ingredients present and failed to list all the steroid hormones contained in the product.

Hormone analysis revealed that the supplement contained testosterone and estradiol, a sex hormone. Researchers then tested the effect of the product on human prostate cancer-cell lines. The product proved to be a more potent stimulator of cancer-cell growth than testosterone. Additionally, attempts to stop the cancer-cell growth with increasing concentrations of the anti-cancer drug bicalutamide proved to be futile.

"Bicalutamide is an oral nonsteroidal anti-androgen used to treat prostate cancer," Dr. Shariat said. "The fact that this supplement caused the drug to be less effective is very troubling."

Based on the clinical data and cell culture experiments, the researchers filed an adverse event report with the Food and Drug Administration. The government agency in turn issued a warning letter to the manufacturers, which led to the removal of the product from the market.

"Unlike prescription and over-the-counter drugs, the law does not require nutritional supplements to undergo pre-market approval for safety and efficacy," Dr. Shariat said. "The current FDA regulatory system provides little oversight or assurances that dietary supplements will have predictable pharmacological effects or even that product labels provide accurate information for consumers."

The researchers say expanded research is needed to define the mechanism, safety and efficacy of common herbal and hormone dietary supplements.

"For most supplements efficacy is not established in randomized, controlled trials. What is worse, safety is often equally poorly established," said Dr. Roehrborn, who directs the Sarah M. and Charles E. Seay Center for Pediatric Urology.

Source:www.sciencedaily.com

Hormonal Dietary Supplements Might Promote Prostate Cancer Progression

components in over-the-counter dietary supplements may promote the progression of prostate cancer and decrease the effectiveness of anti-cancer drugs, researchers at UT Southwestern Medical Center have discovered.The findings, which appear in today's issue of Clinical Cancer Research, reaffirm that patients should inform their doctors about any herbal or hormonal dietary supplements they are taking or considering taking. The researchers also recommend that documentation of supplement usage become part of routine health assessments for all patients, particularly cancer patients.

"Physicians need to ask their patients not only about the prescription drugs they may be taking, but -- perhaps even more importantly -- about the over-the-counter drugs and supplements, which may have a profound impact on certain health conditions," said Dr. Claus Roehrborn, chairman of urology at UT Southwestern and one of the study's authors.

The researchers began their investigation when two patients being seen by UT Southwestern doctors developed aggressive prostate cancer within months of starting daily consumption of the same dietary supplement. Both men purchased the same product, one to develop stronger muscles and enhance sexual performance, the other to gain muscle.

Dr. Roehrborn, Dr. Shahrokh Shariat, a resident in urology and the study's lead author, and their colleagues analyzed the supplement, which is not named in the study. They found that the product's label listed ingredients that were not present, misrepresented the concentrations of the ingredients present and failed to list all the steroid hormones contained in the product.

Hormone analysis revealed that the supplement contained testosterone and estradiol, a sex hormone. Researchers then tested the effect of the product on human prostate cancer-cell lines. The product proved to be a more potent stimulator of cancer-cell growth than testosterone. Additionally, attempts to stop the cancer-cell growth with increasing concentrations of the anti-cancer drug bicalutamide proved to be futile.

"Bicalutamide is an oral nonsteroidal anti-androgen used to treat prostate cancer," Dr. Shariat said. "The fact that this supplement caused the drug to be less effective is very troubling."

Based on the clinical data and cell culture experiments, the researchers filed an adverse event report with the Food and Drug Administration. The government agency in turn issued a warning letter to the manufacturers, which led to the removal of the product from the market.

"Unlike prescription and over-the-counter drugs, the law does not require nutritional supplements to undergo pre-market approval for safety and efficacy," Dr. Shariat said. "The current FDA regulatory system provides little oversight or assurances that dietary supplements will have predictable pharmacological effects or even that product labels provide accurate information for consumers."

The researchers say expanded research is needed to define the mechanism, safety and efficacy of common herbal and hormone dietary supplements.

"For most supplements efficacy is not established in randomized, controlled trials. What is worse, safety is often equally poorly established," said Dr. Roehrborn, who directs the Sarah M. and Charles E. Seay Center for Pediatric Urology.

Source:www.sciencedaily.com