Author Interviews, Colon Cancer, JAMA, Surgical Research / 16.04.2014

MedicalResearch.com Interview Invitation Dorna Jafari, M.D. and Michael J Stamos, MD Professor of Surgery John E. Connolly Chair, Department of Surgery University of California, Irvine Orange, CA 92868 MedicalResearch.com: What are the main findings of the study? Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population. We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010.  However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population. (more…)
Author Interviews, JAMA, Lung Cancer, Pulmonary Disease / 15.04.2014

Renda Soylemez Wiener, MD, MPH Assistant Professor of Medicine The Pulmonary Center Boston University School of Medicine Center for Healthcare Organization & Implementation Research Edith Nourse Rogers Memorial VA HospitalMedicalResearch.com Interview with: Renda Soylemez Wiener, MD, MPH Assistant Professor of Medicine The Pulmonary Center Boston University School of Medicine Center for Healthcare Organization & Implementation Research Edith Nourse Rogers Memorial VA Hospital MedicalResearch.com: What are the main findings of the study? Dr. Soylemez Wiener: The main finding is that evaluation of pulmonary nodules to determine whether or not they are cancerous is inconsistent with clinical practice guideline recommendations in almost half of cases, suggesting there is room for improvement in clinical care of these patients. Patients with pulmonary nodules are sometimes evaluated more aggressively than they should be (18%), which can cause harms to patients from unnecessary invasive tests (biopsies or surgery) or unneeded radiation exposure from imaging studies. Still more patients (27%) are followed less aggressively than they should be, which in the worst case scenario could lead to delays in the diagnosis and treatment of cancer. It is particularly important to improve care of these patients now, because new guidelines from the US Preventive Services Task Force recommend CT screening for lung cancer screening, which often finds pulmonary nodules that require evaluation. (more…)
OBGYNE, Ovarian Cancer / 15.04.2014

Barbara A. Cohn, Ph.D. Director, Child Health and Development Studies A Project of the Public Health Institute Berkeley, CA 94709MedicalResearch.com Interview with: Barbara A. Cohn, Ph.D. Director, Child Health and Development Studies A Project of the Public Health Institute Berkeley, CA 94709   MedicalResearch.com: What are the main findings of the study?
  • Women with irregular menses had a statistically significant 2.4 fold increase in risk of death due to any form ovarian cancer, and a statistically significant 3-fold increase in risk of death due to late stage serous disease. Consistent with these findings, the incidence of late stage disease at diagnosis, and late stage serous cancer was increased about 2-fold in women with irregular menses.
  • Irregular menses was defined as irregular cycles (variation of 10 days or more) or infrequent cycles (>35 days) or history of annovulatory cycles identified during an in-person interview with women at an average age of 26 years or mentioned in their medical records. (more…)
Author Interviews, Breast Cancer, JNCI, Nutrition / 11.04.2014

dr_sabina-sieriMedicalResearch.com Interview with: Sabina Sieri, PhD Epidemiology and Prevention Unit Department of Preventive & Predictive Medicine Fondazione IRCCS Istituto Nazionale dei Tumori 20133 Milan – Italy MedicalResearch.com: What are the main findings of this study? Dr. Sieri: In our study we found that there was an increased risk of developing breast cancer from high saturated fat intake. High total and saturated fat intake were associated with greater risk of ER PR positive breast cancer. High saturated fat intake was also associated with a greater risk of HER2 negative disease. So, a high-fat diet increases breast cancer risk and, most conspicuously, a high saturated fat intake increases the risk of developing hormone-sensitive diseases, suggesting saturated fat involvement in the etiology of hormone-sensitive breast cancer. (more…)
Author Interviews, Breast Cancer, Mayo Clinic / 10.04.2014

Dr. Judy C. Boughey MD Professor of Surgery Mayo Clinic, Rochester MNMedicalResearch.com Interview with Dr. Judy C. Boughey MD Professor of Surgery Mayo Clinic, Rochester MN MedicalResearch.com: What are the main findings of the study?   Dr. Boughey: This study showed that the rate of reoperation after lumpectomy for breast cancer was significantly lower at Mayo Clinic in Rochester compared to national data. Mayo Clinic in Rochester uses frozen section analysis of margins at time of lumpectomy to direct any margin re-excisions during the surgery and therefore has a significantly lower rate of need for a second operation to ensure clean margins. The rate of reoperation was four times higher in the national data set than in the Mayo Clinic data set. (more…)
Chemotherapy, Lung Cancer / 06.04.2014

Dr. Heather Wakalee MD Associate Professor of Medicine (Oncology) Stanford University Medical CenterMedicalResearch.com Interview with: Dr. Heather Wakalee MD Associate Professor of Medicine (Oncology) Stanford University Medical Center   MedicalResearch.com: What are the main findings of the study? Dr. Wakalee: CO-1686, with the new hydrobromide formulation, has been active at multiple dose levels (500, 750 or 1000 mg orally twice daily). The response rate in patients with EGFR mutant (non-small-cell Lung Cancer) NSCLC that has progressed after therapy with EGFR TKI, and has centrally confirmed T790M, is 64% per RECIST.  The majority of responses are ongoing at the time of this report.  The drug has been overall very well tolerated. (more…)
Breast Cancer, JAMA, Outcomes & Safety / 03.04.2014

Dr. Lydia Pace, MD, MPH Division of Women’s Health, Brigham and Women’s Hospital Boston, MassachusettsMedicalResearch.com Interview with: Dr. Lydia  Pace, MD, MPH Division of Women’s Health, Brigham and Women’s Hospital Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Pace: We reviewed the existing literature about the benefits and harms of mammography, focusing on the reduction of breast cancer deaths associated with mammography, as well as the two most often-discussed harms: false positive results and overdiagnosis. We also reviewed the literature about interventions to help patients make informed decisions. We found that the literature suggests that routine screening mammography does reduce mortality associated with breast cancer, across all age groups. However, it is also associated with high rates of false positive results, and considerable rates of overdiagnosis. Overdiagnosis is the most concerning potential risk of mammography screening. Overdiagnosis is the detection of a tumor through screening that would never have caused problems for a patient. It occurs either because of a very slow-growing tumor, or because a woman has medical problems (or is old enough) such that she will likely die of another cause before the cancer became apparent. Overdiagnosis is concerning because we cannot know when a cancer is overdiagnosed, and thus a patient who is overdiagnosed will receive unnecessary treatment for cancer. The scientific literature on mammography is complex, and there are important limitations to the studies both of mammography’s benefits and harms. However, we feel that the best available data suggest that among 10,000 50 year old women undergoing annual mammography for 10 years, 5 deaths will be averted through screening mammography, while about 6130 women will experience at least one positive result. Furthermore, there is about a 19% chance that, if that woman is diagnosed with cancer detected by a mammogram, that cancer is one that would never have caused her problems. Lastly, our review showed that we need more studies to guide us in how an individual woman’s risk should dictate her mammography decisions, and how to support women in making those decisions. However, we know that most women with higher risk for breast cancer will experience higher benefit from mammography screening. (more…)
Author Interviews, Biomarkers, Cancer Research, Radiation Therapy / 02.04.2014

Jan Akervall, M.D., Ph.D. Co-director, Head and Neck Cancer Multidisciplinary Clinic Beaumont Hospital, Royal Oak Clinical Director of Beaumont’s BioBankMedicalResearch.com Interview with: Jan Akervall, M.D., Ph.D. Co-director, Head and Neck Cancer Multidisciplinary Clinic Beaumont Hospital, Royal Oak Clinical Director of Beaumont’s BioBank MedicalResearch.com: What are the main findings of the study? Dr. Akervall: We identified biomarkers that can predict who will have an unfavorable response from radiation for head and neck cancer. These can be analyzed using standard laboratory techniques on biopsies that routinely are taken for diagnosis. (more…)
Author Interviews, Erectile Dysfunction, JAMA, Prostate, Prostate Cancer, Radiation Therapy / 01.04.2014

Dr. Thomas M. Pisansky MD Mayo Clinic, Rochester, MinnesotaMedicalResearch.com Interview with: Dr. Thomas M. Pisansky MD Mayo Clinic, Rochester, Minnesota MedicalResearch.com: What are the main findings of the study? Dr. Pisansky: This patient-reported outcomes research did not identify a beneficial effect of once-daily tadalafil to prevent radiotherapy-related erectile dysfunction in men with prostate cancer. (more…)
Author Interviews, Colon Cancer, JAMA / 31.03.2014

MedicalResearch.com Interview with: M.S. ReimersM.S. Reimers, MD PhD Student and Dr. Jan Liefers MD Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands MedicalResearch.com: What are the main findings of the study? Answer: Aspirin use was associated with an improved survival, as we have published before when investigating this cohort (Bastiaannet et al, Brit J Cancer 2012/ Reimers et al. J Am Geriatr Soc. 2012. In this study we have focused on investigating which patients will benefit from aspirin treatment by investigating some tumor markers, such as PTGS2 expression, HLA class I expression and PIK3CA mutation status. Interestingly, only patients with HLA class I expression on their tumor membrane will benefit from aspirin treatment and have a better outcome. We raise the hypothesize that aspirin inhibits platelet aggregation to circulating tumors cells. By interfering with this process, the metastatic potential of these circulating tumour cells is inhibited, thereby preventing metastasis and colon cancer death.HLA class I expression might be needed for signalling between platelets and circulating tumor cells. If this hypothesis is confirmed by others or in vitro studies, than this might explain the finding that aspirin seems not only beneficial as an adjuvant therapy for colorectal cancer patients, but also for patients with other malignancies (oesophagus, breast, etc). Interestingly, preliminary findings from our team investigating aspirin use in oesophageal cancer also showed that aspirin use in these tumors was associated with an improved survival. (more…)
Aging, Author Interviews, Breast Cancer, Chemotherapy, JNCI / 30.03.2014

Hanna Sanoff MD, MPH Lineberger Comprehensive Cancer Center Department of Medicine University of North Carolina, Chapel Hill, NCMedicalResearch.com Interview with: Hanna Sanoff MD, MPH Lineberger Comprehensive Cancer Center Department of Medicine University of North Carolina, Chapel Hill, NC MedicalResearch.com: What are the main findings of the study? Dr. Sanoff: We measured p16, a protein that increases with cellular aging, in blood cells of women receiving chemotherapy for breast cancer. We found that a standard course of chemotherapy led to an increase in p16 expression equivalent to what we have previous seen in people over the course of 10-15 years of chronological aging. This increase persisted in cancer survivors an average of three and half years after treatment. (more…)
Author Interviews, Cancer, Prostate Cancer / 27.03.2014

MedicalResearch.com Interview with: Florence K. Keane, MD Harvard Radiation Oncology Program, Harvard Medical School and Anthony V. D’Amico, MD, PhD Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts MedicalResearch.com: What are the main findings of the study: Answer: Patients with unfavorable intermediate-risk prostate cancer (PC) [1] have an increased risk of PC-specific mortality (PCSM) after radiotherapy (RT) with or without androgen suppression therapy (AST) compared to favorable intermediate-risk patients [2,3]. We provided validation for this prognostic subdivision using mature data with a median follow-up of 14.3 years from a prospective randomized trial comparing RT alone with RT and 6 months of AST [4].  We also assessed the risk of PCSM in patients with unfavorable intermediate-risk PC compared with high-risk prostate cancer. Our main findings were as follows.
  • First, there were no prostate cancer deaths observed in favorable intermediate-risk patients, despite 50% receiving RT alone.
  • Second, there was not a statistically significant difference in the risk of PCSM in men with unfavorable intermediate-risk prostate cancer compared to men with high-risk PC after randomizing for age, comorbidities and treatment arm. While it is possible that a difference may emerge with longer follow-up, these results suggest that some men with unfavorable intermediate-risk PC may harbor occult GS 8-10 disease and could benefit from a 3.0-Tesla multiparametric MRI and targeted biopsy to rule out GS 8-10 disease.
(more…)
Author Interviews, Breast Cancer, Cancer, NIH / 26.03.2014

Yun Gong, M.D. Associate Professor Department of Pathology, Unit 53 M D Anderson Cancer Center Houston, TX 77030MedicalResearch.com Interview with: Yun Gong, M.D. Associate Professor Department of Pathology, Unit 53 M D Anderson Cancer Center Houston, TX 77030 MedicalResearch.com: What are the main findings of the study? Dr. Gong:  Androgen receptor (AR) was positive in 39% of the inflammatory breast cancer (IBC) tumors, approximately one-third of estrogen receptor (ER)-negative and progesterone receptor (PR)-negative tumors and 42.6% triple-negative tumors. AR positivity was significantly associated with lymphovascular invasion but not with other clinicopathologic parameters. There was a trend toward association between AR expression and PR expression. Univariate survival analysis indicated that patients with AR-negative/ER-negative tumors had significantly worse overall survival and disease-specific survival than the patients with tumors showing other combinations of AR/ER status (i.e., AR-negative/ER-positive, AR-positive/ER-negative,  or AR-positive/ER-positive). Notably, the study was performed using post-neoadjuvant IBC surgical specimens. (more…)
Author Interviews, Cancer Research, OBGYNE, Weight Research / 25.03.2014

Dr. Kristy Ward Department of Reproductive Medicine UCSD School of MedicineMedicalResearch.com Interview with: Dr. Kristy Ward Department of Reproductive Medicine UCSD School of Medicine   MedicalResearch.com: What are the main findings of this study? Dr. Ward: As the second leading cause of preventable death, obesity is one of the nation’s most serious public health problems.  Over two-thirds of the US population is currently overweight or obese and the prevalence continues to increase.  A number of studies have linked obesity with an overall elevated risk of cancer and with many individual cancer types. Among obesity related cancers in women, endometrial cancer is most strongly associated with increasing body mass, with 39% of cases in the US attributable to obesity. In patients with clinically severe obesity (BMI ≥ 40 kg/m2), bariatric surgery results in rapid weight loss and has greater long-term success when compared to non-surgical weight loss methods. Surgical weight loss procedures have been found to reduce obesity-related comorbidites and improve outcomes in clinically severe obese populations. In addition to improved cardiovascular risk factors and mitigation of physical symptoms, there is increasing evidence that cancer risk is reduced after bariatric surgery. (more…)
Author Interviews, Cancer Research, JNCI, Pancreatic / 25.03.2014

Dr. Karolina Sjöberg Jabbar, MD, Medicine Policlinic II, Bla Straket 5, Sahlgrenska University Hospital Gothenburg, SwedenMedicalResearch.com Interview with Dr. Karolina Sjöberg Jabbar, MD, Medicine Policlinic II, Bla Straket 5, Sahlgrenska University Hospital Gothenburg, Sweden   MedicalResearch.com: What are the main findings of the study? Answer: The main finding of this study is that the presence of mucin proteins in pancreatic cyst fluid, as evaluated by mass spectrometry, can predict with high accuracy (97%) which pancreatic cysts contain premalignant and malignant tumours. This is important, given that pancreatic cystic lesions are an increasingly common incidental finding on imaging. While most of them pose no threat to the patient, a minor proportion has malignant potential, and may be considered precursors to pancreatic cancer. (more…)
Author Interviews, Case Western, Chemotherapy, Genetic Research, Lung Cancer, UT Southwestern / 22.03.2014

Dr. Azi Gazdar, MD UT Southwestern Medical Center W. Ray Wallace Distinguished Chair in Molecular Oncology Research Hamon Center for Therapeutic Oncology, PathologyMedicalResearch.com Interview with: Dr. Azi  Gazdar, MD UT Southwestern Medical Center W. Ray Wallace Distinguished Chair in Molecular Oncology Research Hamon Center for Therapeutic Oncology, Pathology MedicalResearch.com: What are the main findings of the study? Dr. Gazdar: We describe the characteristics of lung cancers arising in subjects who inherited a germline mutation that predisposes to lung cancer.  The mutation is rare in the general populations, and is inherited equally by both sexes.  However it is a potent predisposing gene, and one third of the never smoking carriers will develop lung cancer.  Thus, about 1% of patients who develop lung cancer carry the germline mutation.  This figure may rise as awareness of the condition and its link to lung cancer is raised among doctors diagnosing lung cancer. However, lung cancers mainly develop in women who are lifetime never smokers.  Lung cancer development is much less common among smokers and men, although accurate figures are not yet available. So the risk among carriers is somewhat similar to the BRCA genes predisposing to breast cancer, where a female carrier has about a 50% lifetime chance of developing breast cancer. The specific germline mutation (known as T790M) occurs in a gene known as epidermal growth factor receptor (EGFR) gene.  Sporadic mutations in this gene usually predict for effective responses to a class of drugs known as tyrosine kinase inhibitors (TKIs), which are widely used in the treatment of lung cancer.  However, the T790M mutation, when it occurs in sporadic tumors not associated with germline inheritance are resistant to TKI therapy.  Thus the prediction is that lung cancers arising in carriers with the germline mutation would also be resistant to TKI therapy. (more…)
Author Interviews, Cancer, Endocrinology, Pediatrics, Thyroid / 20.03.2014

Melanie Goldfarb MD Assistant Professor of Surgery, Endocrine Surgery University of Southern California Keck School of Medicine, Los Angeles, CaliforniaMedicalResearch.com Interview with Melanie Goldfarb MD Assistant Professor of Surgery, Endocrine Surgery University of Southern California Keck School of Medicine, Los Angeles, California MedicalResearch.com: What are the main findings of the study? Dr. Goldfarb: Adolescents and young adults (AYAs) who develop thyroid cancer as a secondary cancer are six times more likely to die than AYAs with primary thyroid cancer, though survival with treatment is excellent for both primary and secondary cancers at greater than 95 percent. Additionally, Hispanics, Males, and those of lower socioeconomic status have worse overall survival. (more…)
Breast Cancer, Exercise - Fitness / 20.03.2014

Professor Mathieu Boniol PhD International Prevention Research Institute Lyon, FranceMedicalResearch.com Interview with: Professor Mathieu Boniol PhD International Prevention Research Institute Lyon, France MedicalResearch.com: What are the main findings of the study? Prof. Boniol: We conducted a meta-analysis of all prospective epidemiological studies on physical activity and risk of breast cancer. It includes 37 studies, so covers more than 4 million women among which more than 100,000 breast cancer were diagnosed. We showed that when comparing the most active women (about 20% of the population) to least active women (another 20% of the population), vigorous physical activity reduce the risk of breast cancer by 11%. And the good news is that this decline is irrespective of age, BMI, menopausal status, country,... It is also true for the most aggressive breast cancer (ER-/PR-). However, we also showed that this decline is not observed for women taking hormonal replacement therapies, as if these treatments (which are already infamous for poor efficacy and increasing the risk of breast cancer) would nullify any benefit from physical activity. (more…)
Author Interviews, Biomarkers, Colon Cancer, NEJM / 19.03.2014

Dr. Thomas Imperiale MD Professor of Medicine, Indiana University School of Medicine Research Scientist, Indiana University Center for Health Services and Outcomes Research Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc. Core Investigator, VA HSR&D Center for Health Information and CommunicationMedicalResearch.com Interview Invitation with: Dr. Thomas Imperiale MD Professor of Medicine, Indiana University School of Medicine Research Scientist, Indiana University Center for Health Services and Outcomes Research Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc. Core Investigator, VA HSR&D Center for Health Information and Communication MedicalResearch.com: What are the main findings of the study? Dr. Imperiale: The main findings are the performance characteristics of the multi-target test (sensitivity of 92.3%, specificity of 86.6%) and its performance as compared with the commercial FIT: more sensitive for colorectal cancer and advanced precancerous polyps, but less specific. (more…)
Author Interviews, Prostate Cancer, Radiology / 18.03.2014

Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland 6525 GA, The NetherlaMedicalResearch.com Interview with: Dr. Maarten de Rooij MD, PhD Candidate Department of Radiology Radboud University Nijmegen Medical Centre Nijmegen, Gelderland 6525 GA, The Netherlands   MedicalResearch.com: What are the main findings of the study? Dr. de Rooij : Prostate cancer is the most common cancer in men and the second leading cause of cancer related death. The current diagnosis is based on ‘random or blind’ systematic transrectal ultrasound guided prostate biopsies in men with an elevated PSA. This can lead to over-diagnosis and over-treatment of prostate cancer, but can also miss important tumors. The role of multiparametric MRI (mpMRI) to improve the diagnosis of prostate cancer is evolving. In this meta-analysis we determined the diagnostic accuracy of mpMRI for the detection of prostate cancer. Our analysis included 7 studies using mpMRI which showed high overall specificity (0.88; 95% CI 0.82-0.92), with variable but high negative predictive values (0.65 - 0.95) and sensitivities (0.74; 95% CI 0.66-0.81). (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Medical Research Centers, Outcomes & Safety / 18.03.2014

MedicalResearch.com Interview with: Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 MedicalResearch.com: What are the main findings of the study? Answer: We evaluated 100 randomly selected patients from a cohort of 1771 patients evaluated for asymptomatic hematuria in 2004 at our institution in order to assess physician adherence to the 2001 American Urological Association (AUA) guidelines for evaluating patients and its impact on the diagnosis of urologic cancer. We found that most (64%) patients were not evaluated according to the guidelines, that there was substantial variation in the evaluation, and that the evaluation depended largely on the type of hematuria and physician specialty. Only 5% of patients were found to have urologic cancer, and all of them were evaluated according to the guidelines. No additional urologic cancers were diagnosed in patients in whom guidelines were not followed; however, since not all patients were tested thoroughly, occult malignancies may have been present. (more…)
Author Interviews, Biomarkers, Electronic Records, JNCI, Prostate Cancer / 14.03.2014

Primo N. Lara, Jr, MD, Professor of Medicine, University of California Davis School of Medicine Associate Director for Translational Research UC Davis Comprehensive Cancer Center Sacramento, CA 95817MedicalResearch.com Interview with: Primo N. Lara, Jr, MD, Professor of Medicine, University of California Davis School of Medicine Associate Director for Translational Research UC Davis Comprehensive Cancer Center Sacramento, CA 95817 MedicalResearch.com: What are the main findings of the study: Dr. Lara:  “We found that blood markers of bone turnover can be used to predict outcomes in men with advanced prostate cancer with spread to bone. We also found that a small proportion of men could be predicted to benefit from an investigational drug based on these same markers.” (more…)
Author Interviews, BMJ, Cancer Research, Chemotherapy, End of Life Care / 05.03.2014

Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Co-Director, Center for End-of-Life Research Weill Cornell Medical College New York Presbyterian Hospital New York City, New York 10065MedicalResearch.com Interview with: Holly G. Prigerson, Ph.D. Irving Sherwood Wright Professor in Geriatrics Professor of Sociology in Medicine Co-Director, Center for End-of-Life Research Weill Cornell Medical College New York Presbyterian Hospital New York City, New York 10065 MedicalResearch.com: What are the main findings of the study? Dr. Prigerson: The main outcome of the research was end-of-life treatment and location of death with secondary outcomes being length of survival, late hospice referrals and attainment of preferred place of death. We found that 56 percent of patients receiving palliative chemotherapy in their final months.  Patients treated with palliative chemotherapy were five to 10 times more likely to receive intensive medical care and to die in an intensive care unit (ICU). Fewer than half died at home as compared with two-thirds of patients with metastatic cancer not treated with palliative chemotherapy. More specifically, we found that palliative chemotherapy was associated with:
  • Increased use of CPR and mechanical ventilation: 14% versus 2%
  • Late hospice referral: 54% versus 37%
  • Death in an ICU: 11% versus 2%
  • Death away from home: 47% versus 66%
  • Death away from their preferred place: 65% versus 80%
Survival did not differ significantly between patients who received palliative chemotherapy and those who did not (hazard ratio 1.11, 95% CI 0.90-1.38). Additionally, patients receiving palliative chemotherapy were less likely to acknowledge their illness as terminal (35% versus 49%, P=0.04), to have discussed end-of-life wishes with a physician (37% versus 48%, P=0.03), and to have completed a do-not-resuscitate order (36% versus 49%, P<0.05). (more…)
Author Interviews, BMJ, Cancer Research, HPV, Vaccine Studies / 05.03.2014

MedicalResearch.com Interview with: Dr Julia Brotherton Victorian Cytology Service, Melbourne, Victoria, Australia Dr Elizabeth Crowe The University of Queensland, School of Population Health, Brisbane, Australia NHS Borders, Department of Public Health, Melrose, Scotland, UK Prof. David Whiteman Group Leader / Department Coordinator QIMR Berghofer Medical Research Institute Royal Brisbane Hospital, QLD 4029 MedicalResearch.com: What are the main findings of the study? 1.       We conducted a case-control study in which we retrieved the HPV vaccination histories of young Australian women who were notified to the Pap smear registry with high-grade cervical lesions or with other types of cervical lesions, and compared them with the vaccination histories of women whose Pap smears showed only normal cytology. 2.       We found that women with high grade cervical lesions were significantly less likely than women with normal cytology to have received 3 doses of the quadrivalent HPV vaccine, equivalent to a vaccine effectiveness of 46%. 3.       The vaccine effectiveness among 15-19 year old women was even higher at 57%. We believe this reflects the fact that HPV16 causes an even higher proportion of high grade disease in young women due to its higher oncogenicity and shorter latent period. 4.       The HPV vaccine had 34% effectiveness against other cervical lesions (i.e. those not proven to be high grade lesions on histology). 5.       We also observed that 2 doses of the vaccine were 21% effective in preventing both high grade lesions and other grade lesions. (more…)
Author Interviews, BMJ, Cancer Research, University of Michigan / 04.03.2014

Sameer Saini MD Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USAMedicalResearch.com Interview with: Sameer Saini MD Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA MedicalResearch.com: What are the main findings of the study? Dr. Saini: The way that quality measures are defined can have important implications for how care is actually delivered. Current colorectal cancer screening quality measures use age to identify screen-eligible patients, encouraging screening in patients between 50 and 75 years of age. But they do not explicitly incorporate health status. In this context, our study had two main findings.
  • First, by focusing on age alone, we are not screening everyone who is likely to benefit. Specifically, many healthy people over 75 years of age (who are outside the target age range of the quality measure) may benefit from screening, but the current measure does not encourage screening in this population, leading to low screening use.
  • Second, some people who are NOT likely to benefit are being screened unnecessarily, like those with serious health problems. For example, people between ages 70-75 with serious health problems (who have limited life expectancy) are unlikely to benefit from screening, and may even be harmed by it. But the current quality measure encourages screening in such individuals due to their age, yielding relatively high screening rates. If the system focused on age and health status (rather than age alone), screening use would be more aligned with screening benefit, and we would have better health outcomes.
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Author Interviews, Brain Cancer - Brain Tumors, Cancer Research, NEJM / 22.02.2014

Minesh P. Mehta, M.B., Ch.B. F.A.S.T.R.O. Professor of Radiation Oncology, University of Maryland School of Medicine Radiation oncologist, University of Maryland Marlene and Stewart Greenebaum Cancer Center, Chair, RTOG brain tumor committeeMedicalResearch.com Interview with: Minesh P. Mehta, M.B., Ch.B. F.A.S.T.R.O. Professor of Radiation Oncology, University of Maryland School of Medicine Radiation oncologist, University of Maryland Marlene and Stewart Greenebaum Cancer Center MedicalResearch.com: What are the main findings of the study? Dr. Mehta: RTOG 0825 was a clinical trial evaluating whether the addition of a novel drug that inhibits tumor vascular growth, bevacizumab, to the standard of care for glioblastoma, an aggressive brain tumor, would prolong survival. Patients were allocated randomly to one of two different treatment regimens – the standard of care, which includes radiotherapy and a drug known as temozolomide, or another regimen of radiation, temozolomide and bevacizumab. The trial design was double-blinded, and therefore, on one arm patients received the bevacizumab, whereas on the other arm they received a placebo. The survival on both arms was equivalent, and therefore it was fairly concluded that bevacizumab failed to prolong survival when given initially as part of treatment for glioblastoma. Freedom from progression, referred to as progression-free survival was also measured on this trial, and although bevacizumab appeared to lengthen progression-free survival, this level of benefit did not meet the pre-defined goals, and is therefore regarded as statistically not demonstrating an improvement. Additional endpoints included outcomes reported by the patient, including the burden of symptoms, and the impact of these on the quality of life, as well as effects on the brain, known as neurocognitive changes. Bevacizumab did not improve these endpoints either. (more…)
Author Interviews, Breast Cancer, PLoS / 22.02.2014

Bodour Salhia, PhD Assistant Professor Integrated Cancer Genomics Division Translational Genomics Research Institute Phoenix, Arizona, 85004MedicalResearch.com Interview with: Bodour Salhia, PhD Assistant Professor Integrated Cancer Genomics Division Translational Genomics Research Institute Phoenix, Arizona, 85004 MedicalResearch.com: What are the main findings of the study? Dr. Salhia: Our study identified novel rare genomic and epigenomic events underlying breast cancer metastasis to brain. We demonstrated that we could molecularly subtype breast cancer brain metastasis the same way we can subtype primary breast cancer. From this analysis we found that the Luminal B subtype was the most common subtype in our cohort, followed by Her2+/ER- enriched tumors and Basal-like tumors. Each of these subtypes displayed genetic and epigenetic features reminiscent of primary breast cancer. We demonstrated that these tumors have a strong predilection to grow by activating pathways involved in G2/M cell cycle progression, whereas, many genes involved in cell migration were epigenetically silenced. Broad amplification of chromosome 8q was common, which resulted in the upregulation of important genes. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, JNCI / 22.02.2014

MedicalResearch.com Interview with: Jiyoung Ahn, PhD Assistant Professor of Epidemiology Department of Population Health NYU School of Medicine New York, NY 10016Jiyoung Ahn, PhD Assistant Professor of Epidemiology Department of Population Health NYU School of Medicine New York, NY 10016 MedicalResearch.com: What are the main findings of the study? Dr. Ahn: Before we did our research, it was suspected that gut bacteria were related to colorectal cancer. We, for the first time, found colorectal cancer patients have a different gut bacteria composition than healthy subjects. (more…)