Women treated for breast cancer with radiation with or without chemotherapy had more thinking and memory problems a few years after their treatment ended than women who'd never had cancer, in a new study.
Research has suggested some women experience mental haziness, dubbed "chemo brain," during and soon after chemotherapy treatment. And one recent study found evidence of changes in the activity of certain brain regions in women who'd undergone chemotherapy.
But some researchers have questioned whether those problems are due to the specific drug treatments, or possibly to the cancer itself. In the new report, breast cancer survivors showed certain small mental deficits, regardless of whether or not they'd had chemotherapy.
"It's a very, very subtle thing. We're not talking about patients becoming delirious, demented, amnesic," said Barbara Collins, a neuropsychologist who has studied chemotherapy-related cognitive changes at Ottawa Hospital in Ontario, Canada, but wasn't involved in the new study.
"We're talking about a group of people that are saying, 'I'm pretty much still able to function, but I find it harder...it doesn't come as easily, and I can't do as many things at the same time.'"
The current study involved 129 breast cancer survivors in their fifties, on average. About half of them had been treated with radiation and chemotherapy, while the other women only had radiation.
Six months after finishing treatment, and another three years later, women took a range of thinking and memory tests. Their scores were compared against the performance of 184 women who'd never had cancer, but were a similar age and from the same areas.
A notable finding is the absence of appropriate communication between women and their doctors –that is, a disconnect between what women tell their doctors about side effects and what they actually experience, and/or selective hearing by medical professionals on how treatment is influencing a woman’s quality of life.
“Clinicians consistently underestimate the side effects associated with treatment,” said lead investigator and clinical psychologist Dr. Lynne Wagner.
“They give patients a drug they hope will help them, so they have a motivation to underrate the negative effects. Patients don’t want to be complainers and don’t want their doctor to discontinue treatment. So no one knew how bad it really was for patients.”
The symptom most likely to cause women to stop using the drugs was joint pain. Other side effects women reported as compromising their quality of life were hot flashes, decreased libido, weight gain, feeling bloated, breast sensitivity, mood swings, irritability and nausea.
The medications — aromatase inhibitors — stop the production of estrogen in postmenopausal women, whose breast cancer cells are stimulated by estrogen.
The research is timely as two-thirds of breast cancers are estrogen sensitive, and aromatase inhibitors reduce the recurrence of cancer in postmenopausal women.
Investigators discovered women at the highest risk of stopping the medications before the recommended five years were those who were still experiencing residual side effects from chemotherapy or radiation therapy when they start the aromatase therapy.
Women who had surgery for breast cancer but not chemotherapy or radiation therapy, or who weren’t taking many other medications, were more likely to keep taking the aromatase medication.
“The more miserable they were before they started, the more likely they were to quit,” Wagner said. “By the time they get through chemotherapy or radiation, they have to face five more years of another medication that will make them feel lousy. They feel like they already lost enough time to cancer and have reached their threshold for feeling bad.”
Wagner called it “a wake-up call to physicians that says if your patient is feeling really beaten up by treatment, the risk of her quitting early is high. We need to be better at managing the symptoms of our patients to improve their quality of life.”
A significant finding of this study is the discrepancy between medical professionals’ opinion of the medication side effects and a woman’s actual experience.
This disconnect is clearly depicted when comparing previous research – where clinicians reported 5 percent of patients experiencing moderate to severe symptoms – as compared with the current study’s discovery of 36 percent reporting significant side effects.
Researchers found after three months of treatment 33 to 35 percent of women had severe joint pain, 28 to 29 percent had hot flashes, 24 percent had decreased libido, 15 to 24 percent had fatigue, 16 to 17 percent had night sweats and 14 to 17 percent had anxiety. These numbers increased as women were on treatment longer.
Earlier studies also asked women to recall their symptoms after treatment ended, which is less accurate than reporting them at regular intervals while taking the drugs.
As a result of the side effects, 36 percent of women ended treatment before an average of 4.1 years. After two years, 10 percent had quit; the remainder quit between 25 months and the 4.1 years.
“These findings can help us identify women at risk for quitting the therapy, counsel them about the importance of staying on it and provide treatment for troubling side effects,” Wagner noted.
Weight gain can be addressed with nutritional counseling, while mood swings and irritability can be treated with cognitive-behavioral therapy or mind-body techniques, Wagner said.
Joint pain can be reduced with nonsteroidal anti-inflammatory drugs, or women may be switched to a different hormonal medication. Nausea can be reduced with medication.
Researchers made a major advance in the decades-old effort to use gene therapy to treat the bleeding disorder hemophilia B, reporting that six patients in a study started to make more of a crucial blood-clotting factor that prevents severe bleeding episodes.
After a single gene-therapy treatment, four of the men started making enough of their own clotting factor that they no longer needed the regular protein injections that are currently used to prevent bleeding episodes. The other two required the protein injections but much less frequently than before, according to the paper, which was published online Saturday in the New England Journal of Medicine.
"The idea of treating hemophilia with gene therapy has been around for 25 years, but the problem was how to do it right," says Ronald G. Crystal, chairman of the department of genetic medicine at Weill Cornell Medical College, who is working on gene-therapy research but was not involved in the trial. "This is an important breakthrough because it is the first success in one of the plasma deficiency disorders and shows gene therapy is feasible."
Hemophilia B is caused by a defect in the gene that makes a protein called Factor IX, which is crucial for normal blood clotting. About 1 in 30,000 individuals, usually men, inherit the mutation. Without enough clotting factor, patients can have frequent, painful bleeding episodes.
With gene therapy, scientists try to correct the problem by delivering a normal gene to the body, using what is known as a vector to insert the gene into cells -- usually a virus that is genetically altered to contain human DNA.
Researchers altered the DNA of a common virus so that it would include the instructions for making FIX.
They then injected the men with the altered virus. They hoped that it would do what all viruses do: infect cells and hijack their operating instructions.
Ordinarily when viruses infect cells, they turn the cells into factories that crank out more copies of the virus. That keeps the infection going.
In this case, the infected cells churned out the missing protein.
After a single treatment, four of the six men in the study have been able to stop their weekly protein injections altogether. Two others have been able to stretch the time between their shots from days to up to two weeks.
"You've got people who are maybe not quite cured," says Ponder, an expert on blood disorders who was not involved in the research.
The study and an editorial by Ponder are published in The New England Journal of Medicine.
The results are also scheduled to be presented at the annual meeting of the American Society of Hematology in San Diego.
Hope on the Horizon for Hemophilia and Other Diseases
So far, researchers have only been able to coax the body to make the protein that helps people with the less common form of the disease, hemophilia B.
But researchers say this approach could work for people who have the more common form, hemophilia A, too. They just need to find the right virus to deliver the genes that would help that disease.
"I think this approach will lead to a cure. I think it's not there yet," says study researcher Andrew M. Davidoff, MD, a pediatric surgeon at St. Jude Children's Research Hospital in Memphis, Tenn.
"We have made a significant impact on the severity of the disease," Davidoff tells WebMD. "We are looking to cure patients, and I think with improvements in the vector and higher doses, we will be able to cure them."
Before they were enrolled in the study, the six men all had levels of FIX protein that were less than 1%. After the gene therapy, their FIX levels improved to 2% to 11%.
That's high enough to prevent spontaneous bleeding events. But it's not enough clotting factor to keep them out of danger during surgery, for example, or in the event of other significant trauma.
Researchers think they may be able to give people with hemophilia B higher doses of the altered virus to help boost FIX levels even more.
Questions Remain
But it's unclear how much people will be able to tolerate.
In this study, patients who got the highest doses made the most FIX. But they also saw their liver enzymes spike, a sign of inflammation.
"We were able to control this inflammation with a very short course of steroids," says study researcher Amit C. Nathwani, MBChB, PhD, a hematologist at University College London.
After steroid treatment, liver enzymes returned to normal. And patients continued to make FIX protein on their own, though their levels dropped slightly.
It's also not clear how long the treatments may last.
All patients who got the gene therapy continue to make FIX protein. Some have been followed for nearly two years.
But as liver cells die, the treatment could wear off. In animal studies, results of gene therapies that target liver cells have lasted for 10 years or more.
Even if it's temporary, the gene therapy is likely to save money. If it is approved by the FDA, the treatment is estimated to cost around $30,000 per patient.
It may also turn out to be safer than injecting blood products. In the 1980s, many hemophiliacs were infected with HIV after being treated with clotting factors that contained the virus.
Nathwani says many people with hemophilia in developing countries continue to face that risk, if they are able to get treatment at all.
"Eighty percent of hemophilia patients around the world have no access to treatment," he says. "This is one of the reasons why we wanted to develop a simple gene transfer approach," which could be delivered in almost any clinical setting, he says. "This is life changing."
A recent study has linked late night shifts to diabetes. Diabetes is one of those deadly diseases which if not cured or treated timely then it may damage the working of the essential organs of body like liver, kidney and heart.
The study was conducted by the researchers of Harvard School of Public Health. It is for the very first time when a study has linked late night shifts to diabetes. It is estimated that one in 12 Americans suffer from diabetes because of late night shifts.
For the study, the researchers recruited 175,000 nurses, the conducted various tests on them. It was found that the nurses who worked in the night shifts had 60% higher risk of developing type 2 diabetes. The study also indicated that within the estimated period of 20 years, these nurses are prone of being diagnosed with diabetes.
The researchers have pinpointed that by giving priority to sleeping one can prevent diabetes. Sleep of 9 to 10 hours is important for every human being after performing stressful task. Besides, regular exercise should also be made a habit as it helps in improving the function of the body.
The study, involving more than 175,000 nurses, found that those who worked night shifts three or more times a month were more likely to develop type 2 diabetes over 20 years compared with people who didn’t work night shifts with as much as a 60 percent greater risk in those who did shift work for two decades.
While the new study, published in the Proceedings of the National Academy of Sciences, doesn’t prove that night shift work causes diabetes, other research has shown that those who come off a night shift tend to have higher insulin levels and higher levels of inflammation - both involved in diabetes - possibly due to a disruption in the body’s delicate circadian rhythms.
Shift workers had higher obesity rates - which is an independent risk factor for diabetes - and they had a tendency to get fewer than six hours of sleep each day, according to study leader An Pan.
Here’s what he recommends to minimize risks of night shift work:
1. Make adequate sleep a priority. Get 9 or 10 hours of sleep on the two previous nights before the shift. If you work the graveyard shift every night, make a plan to sleep seven to eight hours in a quiet darkened room when you get home in the morning.
2. Commit yourself to daily exercise. That will help you sleep better during nights you don’t have shift work.
3. Minimize caffeine. Try to avoid all caffeine within eight hours of your scheduled bedtime.
Stephen Lewis says that the modern world's economy was built on Africa's human and natural resources and still depends on them; therefore Western donors have an obligation to stop needless AIDS deaths in Africa by contributing the required money.
With your indulgence, I'm going to deviate from the assigned topic. I shall address the Millennium Development Goals, but not in the way that was anticipated. There are two reasons. First, I want to speak in an unusually personal way, and from the heart, and in a fashion that leaves no room for ambiguity. Second, I consider the attack on the Global Fund to be the most serious assault it has endured in its ten-year history. I would feel utterly delinquent to let the issue slide.
I am seized by frustration and impatience. Let me explain. I'm thrilled when UNICEF tells us of the possibility of the virtual elimination of paediatric AIDS by 2015. But I know -- as knowledgeable people in this audience know -- that it remains an unlikely prospect, but more important, that we lost several precious years during the last decade where we simply didn't apply the knowledge we possessed to prevent vertical transmission. It was a terrible failure on the part of international agencies and governments. Worse, the mother barely factored into the so-called 'PMTCT' equation at all. As we come to this thrilling moment of progress, I cannot forget the millions of infants who died unnecessarily and the women who were never given treatment.
I'm thrilled at the creation of UN Women, and the possibility, once they join as a formal co-sponsor of UNAIDS, that the focus on women will be given a new lease on life. But I can't dislodge from my mind the experience of my years in the role as envoy, and subsequently working with AIDS-Free World, when it became clear that in every aspect of the pandemic women were rendered subordinate. Gender inequality doomed their lives. Sexual violence fed and feeds the virus. The entire survival of communities and families was placed on their shoulders. Men were the social determinants of women's health, and men simply didn't care. As we come to this thrilling moment of potential progress, I can't avoid the spectral faces of stigma, discrimination, isolation and pain, and they are the faces of women. That doesn't mean that women aren't the core of courage and strength in this pandemic; it simply means that they have to struggle valiantly to challenge the phalanx of male privilege, of male hegemony. Just a few days ago, coincident with World AIDS Day, the Harvard School of Public Health held a symposium called AIDS@30 to assess the past and plot the future. The symposium had a Global Advisory Council of 19 eminent experts on the pandemic: 17 men and two women. It is ever thus. It's the rare woman indeed who doesn't ultimately report to a man in the world of HIV, or who can command, ever-so-rarely, the place and presence that legions of men command automatically.
Of the nearly 1.2 million people living with HIV in the U.S., only an estimated 28 percent have a suppressed viral load (defined as viral load less than 200 copies of the blood-borne virus per milliliter of blood) — meaning that the virus is under control and at a level that helps keep them healthy and reduces the risk of transmitting the virus to others.
However, of those living with HIV who are in ongoing care and on antiretroviral treatment, 77 percent have suppressed levels of the virus. Effective HIV treatment and care benefit infected individuals by improving their health, and are also important for HIV prevention. Results from a recent study of heterosexual couples from the National Institutes of Health showed that consistently taking antiretroviral therapy, in combination with safer behaviors, can reduce the risk of spreading HIV by approximately 96 percent.
A study by the Williams Institute found that five percent of dental offices in Los Angeles County have a blanket policy of refusing dental services to People Living with HIV/AIDS (PLWHA). The study also revealed that an additional five percent of dental providers would treat PLWHA differently than other patients in ways that could potentially violate anti-discrimination laws. Examples include only providing the most basic of services, such as a cleaning, or only treating them on certain days of the week or in an isolated room.
“Thirty years into the epidemic, HIV-positive patients continue to face discrimination when accessing dental care,” said study co-author Brad Sears, executive director of the Williams Institute. “While it is definitely encouraging that 90 percent of dentists in Los Angeles County do treat HIV-positive patients, it is likely that the rate of discrimination is higher in other parts of the country.”
Similar studies of health care providers in Los Angeles County conducted by Sears between 2003 and 2006 found that 55 percent of obstetricians, 46 percent of skilled nursing facilities and 25 percent of plastic surgeons had unlawful blanket policies of refusing service to PLWHA.
Youth groups secure major grants
LOS ANGELES, Calif. — Liberty Hill Foundation has selected five community organizations from around the country to receive $100,000 multi-year grants in an effort to end violence against LGBTQ communities and advance safety, self-determination and justice for LGBTQ youth. The grants will be made through the Queer Youth Fund, one of Liberty Hill’s donor advised funds.
The 2011 Queer Youth Fund grantees are Brown Boi Project (Oakland, Calif.); Colorado Anti-Violence Program (Denver, Colo.); Make the Road New York (Brooklyn, N.Y.); The Theatre Offensive (Cambridge, Mass.); and Three Wings (Seattle, Wash.).
The Queer Youth Fund was established in 2002. So far, more than $3.5 million has been awarded to groups in 21 states and Canada. Each grant is $100,000 and paid out over three to five years.
The Human Rights Campaign Foundation announced is launching the first-of-its-kind Jewish Organization Equality Index (JOEI) survey. Modeled after HRC’s Corporate Equality Index (CEI) and Healthcare Equality Index (HEI), JOEI is designed to measure LGBT inclusion in the programs and employment practices at Jewish non-profit organizations.
Rabbi Hyim Shafner of the Bais Abraham Congregation in St. Louis, Mo., said, “It is my hope that the Jewish Organization Equality Index will serve as a strong step toward strengthening the important Torah value of seeing all Jews as made in the image of God and deserving of the highest of human dignity and kavod, no matter their gender, gender identity, sexual orientation or background.”
Baltimore County must grant equal employment benefits to same-sex couples, the result of a binding arbitration decision secured after Lambda Legal and the police union filed grievances on behalf of Baltimore County police officers Margaret Selby and Juanika Ballard, who had been turned down for benefits for their same-sex spouses.
“Under Maryland law, Officer Selby and Officer Ballard both have legal spouses who should be recognized. We are pleased that Baltimore County will finally have to fulfill its obligation to these dedicated long-time employees who just want to protect their families,” said Susan Sommer, Lambda Legal director of constitutional litigation. “This binding arbitration order is the final step in a long process. For years, these police officers have put themselves in harm’s way to keep Baltimore County safe. Now they will get the same employee protections for their spouses that other officers get.
“We are thankful to the Fraternal Order of Police for standing by its lesbian and gay members to make sure these officers are treated like their colleagues,” Sommer added.
The National LGBT Cancer Network, the first program in the country to address the needs of all LGBT people with cancer and those at risk, has expanded its directory of LGBT-friendly cancer screening facilities beyond New York City. The list now covers facilities in California, Colorado, Connecticut, the District of Columbia, Florida, Georgia, Illinois, Maine, Maryland, Massachusetts, Minnesota, Oregon, Pennsylvania and Vermont.
Liz Margolies, executive director of the National LGBT Cancer Network, explained, “We have selected each facility for inclusion based on its commitment to offering safe, affordable, welcoming care to all LGBT people. Each has demonstrated proven cultural competence in respecting the bodies, histories and families of LGBT patients. We will research additional facilities and expand the list until every LGBT person in the country is within driving range of a safe and welcoming facility where they will be respected. …
“On average,” she added, “medical students receive under 5 hours of training on LGBT issues in their entire medical education. To address these concerns from patients, we have included, wherever possible, a contact person at each facility who has agreed to shepherd members of the LGBT community through the process of being screened.”
The list of facilities is available at cancer-network.org/screenings/facilities.
On Nov. 29, the Nigerian Senate unanimously outlawed same-sex marriages and civil unions, with penalties of up to 14 years in jail for participants and 10 years in jail for anyone who helps or witnesses such a marriage or union. The measure also bans public displays of affection between gay couples.
During the bill’s third reading, which determined its passage, senators chided U.K. Prime Minister David Cameron’s October threat that aid might be withheld if the bill is enacted. Senate President David Mark said, “Any country that does not want to give us aid or assistance, just because we hold on very firmly to our values, that country can (keep) their assistance.”
The bill was approved in a form that is even more restrictive than when it was read at a public hearing some weeks ago. Now, the bill additionally criminalizes the registration of gay clubs, organizations and “same-sex amorous relationships” in general.
At press time, the bill is awaiting three readings in the House of Representatives, at which time it is expected to be approved. If it is, the measure will then be submitted to the president for final assent.
