Jane Salodof MacNeil

LOS ANGELES — Contrary to conventional wisdom among many urologists, brachytherapy is a good option for younger prostate cancer patients, according to investigators who reviewed outcomes for 1,763 men treated with radiation seed implants.

Five years after treatment, men 60 years of age and younger had “excellent” biochemical control rates that were comparable with those of older men, Dr. Alice Ho reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

At a median follow-up of 59 months, 96% of younger men maintained biochemical freedom from failure (BFFF), she said. In comparison, men aged 61–75 had a control rate of 92% at 62 months of follow-up. For those 76 years of age and older, the rate was 88% at 54 months.

These differences were statistically significant on univariate analysis, but the outcomes became comparable when the investigators adjusted for such factors as risk, Gleason score, pretreatment prostate-specific antigen levels, additional radiation, stage, treatment era, use of hormonal therapy, and radiation dose.

“Age should not be a deterrent when considering radiation seed implantation for prostate cancer,” said Dr. Ho, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York.

Dr. Ho did the research while a resident at Mount Sinai Medical Center, also in New York. She and her coauthors identified 2,850 patients who had been treated with radiation seed implantation from 1990 to 2005 at Mount Sinai Hospital. They included in the study only those who had clinically localized prostate cancer, had received low-dose brachytherapy with or without external beam radiation or hormone therapy, and had been followed for at least 2 years.

Nearly two-thirds of the patients studied, 1,142 men, were between the ages of 61 and 75 years. Another 400 men aged 60 and younger accounted for 23% of the sample. The remaining 221 men, 12%, were 76 years of age or older. Overall, the population had been followed for a median of 5 years.

The younger men were more likely to have low-risk disease (57% vs. 40% of the older groups) and to be treated after 1997 (72% vs. 60%)–two observations that were probably related, according to Dr. Ho. In addition, the younger men were more likely to receive a full biologically effective dose of radiation: 92% vs. 88% of the older groups.

“In earlier years, we were not even seeing younger men in our clinic,” she said at a press briefing. Later on, with improved [prostate-specific antigen] screening, urologists began diagnosing more prostate cancers in younger men. Radiation techniques also improved, she said, so that “it is very possible to deliver high radiation doses safely and effectively.”

“Radiation oncologists in prostate cancer … tend to get the patients who have the worse prognosis because the common belief always has been that surgery is better,” she said.

“When offering radiation to a younger population of patients, the risk of second malignancy is something that needs to be considered very carefully,” she said.

LOS ANGELES — Contrary to conventional wisdom among many urologists, brachytherapy is a good option for younger prostate cancer patients, according to investigators who reviewed outcomes for 1,763 men treated with radiation seed implants.

Five years after treatment, men 60 years of age and younger had “excellent” biochemical control rates that were comparable with those of older men, Dr. Alice Ho reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

At a median follow-up of 59 months, 96% of younger men maintained biochemical freedom from failure (BFFF), she said. In comparison, men aged 61–75 had a control rate of 92% at 62 months of follow-up. For those 76 years of age and older, the rate was 88% at 54 months.

These differences were statistically significant on univariate analysis, but the outcomes became comparable when the investigators adjusted for such factors as risk, Gleason score, pretreatment prostate-specific antigen levels, additional radiation, stage, treatment era, use of hormonal therapy, and radiation dose.

“Age should not be a deterrent when considering radiation seed implantation for prostate cancer,” said Dr. Ho, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York.

Dr. Ho did the research while a resident at Mount Sinai Medical Center, also in New York. She and her coauthors identified 2,850 patients who had been treated with radiation seed implantation from 1990 to 2005 at Mount Sinai Hospital. They included in the study only those who had clinically localized prostate cancer, had received low-dose brachytherapy with or without external beam radiation or hormone therapy, and had been followed for at least 2 years.

Nearly two-thirds of the patients studied, 1,142 men, were between the ages of 61 and 75 years. Another 400 men aged 60 and younger accounted for 23% of the sample. The remaining 221 men, 12%, were 76 years of age or older. Overall, the population had been followed for a median of 5 years.

The younger men were more likely to have low-risk disease (57% vs. 40% of the older groups) and to be treated after 1997 (72% vs. 60%)–two observations that were probably related, according to Dr. Ho. In addition, the younger men were more likely to receive a full biologically effective dose of radiation: 92% vs. 88% of the older groups.

“In earlier years, we were not even seeing younger men in our clinic,” she said at a press briefing. Later on, with improved [prostate-specific antigen] screening, urologists began diagnosing more prostate cancers in younger men. Radiation techniques also improved, she said, so that “it is very possible to deliver high radiation doses safely and effectively.”

“Radiation oncologists in prostate cancer … tend to get the patients who have the worse prognosis because the common belief always has been that surgery is better,” she said.

“When offering radiation to a younger population of patients, the risk of second malignancy is something that needs to be considered very carefully,” she said.

LOS ANGELES — Contrary to conventional wisdom among many urologists, brachytherapy is a good option for younger prostate cancer patients, according to investigators who reviewed outcomes for 1,763 men treated with radiation seed implants.

Five years after treatment, men 60 years of age and younger had “excellent” biochemical control rates that were comparable with those of older men, Dr. Alice Ho reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

At a median follow-up of 59 months, 96% of younger men maintained biochemical freedom from failure (BFFF), she said. In comparison, men aged 61–75 had a control rate of 92% at 62 months of follow-up. For those 76 years of age and older, the rate was 88% at 54 months.

These differences were statistically significant on univariate analysis, but the outcomes became comparable when the investigators adjusted for such factors as risk, Gleason score, pretreatment prostate-specific antigen levels, additional radiation, stage, treatment era, use of hormonal therapy, and radiation dose.

“Age should not be a deterrent when considering radiation seed implantation for prostate cancer,” said Dr. Ho, a radiation oncologist at Memorial Sloan-Kettering Cancer Center in New York.

Dr. Ho did the research while a resident at Mount Sinai Medical Center, also in New York. She and her coauthors identified 2,850 patients who had been treated with radiation seed implantation from 1990 to 2005 at Mount Sinai Hospital. They included in the study only those who had clinically localized prostate cancer, had received low-dose brachytherapy with or without external beam radiation or hormone therapy, and had been followed for at least 2 years.

Nearly two-thirds of the patients studied, 1,142 men, were between the ages of 61 and 75 years. Another 400 men aged 60 and younger accounted for 23% of the sample. The remaining 221 men, 12%, were 76 years of age or older. Overall, the population had been followed for a median of 5 years.

The younger men were more likely to have low-risk disease (57% vs. 40% of the older groups) and to be treated after 1997 (72% vs. 60%)–two observations that were probably related, according to Dr. Ho. In addition, the younger men were more likely to receive a full biologically effective dose of radiation: 92% vs. 88% of the older groups.

“In earlier years, we were not even seeing younger men in our clinic,” she said at a press briefing. Later on, with improved [prostate-specific antigen] screening, urologists began diagnosing more prostate cancers in younger men. Radiation techniques also improved, she said, so that “it is very possible to deliver high radiation doses safely and effectively.”

“Radiation oncologists in prostate cancer … tend to get the patients who have the worse prognosis because the common belief always has been that surgery is better,” she said.

“When offering radiation to a younger population of patients, the risk of second malignancy is something that needs to be considered very carefully,” she said.

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview.

Physicians should focus on compliance rather than resistance, he said, recommending that patients be tested for aspirin use when they appear to be resistant. “We found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant.”

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After that period, they removed 45 patients from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“We were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing reveals whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. The researchers used PPA-stimulated light aggregometry to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's post-aspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

The seven low responders had a decrease that was less than one standard deviation, but the investigators suggested they might not be a distinct population but the bottom of a normal bell-shaped distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The patient admitted taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said patients should be counseled about the importance of aspirin to their survival. “If you don't get your aspirin, you don't get your benefit,” he said. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

'We found about 30% of patients could be labeled as aspirin resistant, and 90% of them were noncompliant.' DR. SCHWARTZ

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview.

Physicians should focus on compliance rather than resistance, he said, recommending that patients be tested for aspirin use when they appear to be resistant. “We found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant.”

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After that period, they removed 45 patients from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“We were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing reveals whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. The researchers used PPA-stimulated light aggregometry to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's post-aspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

The seven low responders had a decrease that was less than one standard deviation, but the investigators suggested they might not be a distinct population but the bottom of a normal bell-shaped distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The patient admitted taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said patients should be counseled about the importance of aspirin to their survival. “If you don't get your aspirin, you don't get your benefit,” he said. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

'We found about 30% of patients could be labeled as aspirin resistant, and 90% of them were noncompliant.' DR. SCHWARTZ

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview.

Physicians should focus on compliance rather than resistance, he said, recommending that patients be tested for aspirin use when they appear to be resistant. “We found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant.”

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After that period, they removed 45 patients from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“We were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing reveals whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. The researchers used PPA-stimulated light aggregometry to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's post-aspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

The seven low responders had a decrease that was less than one standard deviation, but the investigators suggested they might not be a distinct population but the bottom of a normal bell-shaped distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The patient admitted taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said patients should be counseled about the importance of aspirin to their survival. “If you don't get your aspirin, you don't get your benefit,” he said. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

'We found about 30% of patients could be labeled as aspirin resistant, and 90% of them were noncompliant.' DR. SCHWARTZ

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview alongside his poster.

Physicians should focus on compliance rather than resistance, he said, recommending that they test patients for aspirin use when they appear to be resistant. “In our studies, we found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant,” he said.

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After the 7 days, they removed 45 from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“These patients were very special because we were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing can reveal whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. A relatively new test, PPA-stimulated light aggregometry allowed the investigators to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's postaspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

While the seven low responders had a decrease that was less than one standard deviation, the investigators suggested they might not be a distinct population but the bottom of a normal bell-shape distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The 1 patient admitted to taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said that patients should be counseled about the importance of aspirin to their survival. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview alongside his poster.

Physicians should focus on compliance rather than resistance, he said, recommending that they test patients for aspirin use when they appear to be resistant. “In our studies, we found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant,” he said.

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After the 7 days, they removed 45 from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“These patients were very special because we were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing can reveal whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. A relatively new test, PPA-stimulated light aggregometry allowed the investigators to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's postaspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

While the seven low responders had a decrease that was less than one standard deviation, the investigators suggested they might not be a distinct population but the bottom of a normal bell-shape distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The 1 patient admitted to taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said that patients should be counseled about the importance of aspirin to their survival. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

ATLANTA — Noncompliance is the main cause of aspirin resistance, according to investigators who studied aspirin response in 230 people, most of whom had a history of myocardial infarction.

The study initially classified up to 30% of the participants as aspirin resistant, but in the end, only 4% of 185 people in whom aspirin response was measured met a conservative definition of aspirin resistance. These seven patients were determined to have a low response to aspirin. One person violated the study's protocols by taking a nonaspirin nonsteroidal anti-inflammatory drug (NANSAID) that would have interfered with aspirin's effects.

Among participants who complied with the protocol, aspirin responses were normally distributed, Dr. Kenneth A. Schwartz reported at the annual meeting of the American Society of Hematology. No difference was seen between those with a history of MI and those in a control group.

“In my way of thinking, there are no people other than NANSAID people that you can label as truly aspirin resistant based on genetics or some other prior inability to respond to aspirin,” Dr. Schwartz, professor of medicine, Michigan State University, East Lansing, said in an interview alongside his poster.

Physicians should focus on compliance rather than resistance, he said, recommending that they test patients for aspirin use when they appear to be resistant. “In our studies, we found about 30% of patients could be labeled as aspirin resistant, and 90% of them [62 of 69 patients] were noncompliant,” he said.

Dr. Schwartz and his colleagues started with 230 evaluable individuals, all of whom were told not to take aspirin for 7 days. After the 7 days, they removed 45 from the study because they were not compliant with the protocol during the withdrawal period.

This left 185 participants—146 with a history of MI and 39 normal controls—in whom aspirin response was measured with platelet prostaglandin agonist (PPA) stimulated light aggregometry. The participants' average age was 61 years, and 63% were men. Blood was drawn twice: immediately after the 7-day washout period, and then 2 hours after a nurse observed each participant ingesting 365 mg of aspirin.

“These patients were very special because we were sure they were off aspirin because we checked with arachidonic acid,” Dr. Schwartz said. “And we were sure that they were on aspirin … because we watched them take the aspirin. And that's why we got a nice normal curve.”

Arachidonic acid testing can reveal whether a patient is taking aspirin, which inhibits cyclo-oxygenase-1-mediated events leading to platelet aggregation. A relatively new test, PPA-stimulated light aggregometry allowed the investigators to measure the extent of aspirin-induced platelet inhibition. To define net aspirin response, they subtracted the slope of each patient's postaspirin PPA light aggregation curve from the curve recorded when the patient was aspirin free.

While the seven low responders had a decrease that was less than one standard deviation, the investigators suggested they might not be a distinct population but the bottom of a normal bell-shape distribution curve. “If there was a separate group of patients that were aspirin resistant, this would show a subgroup in which there was a poor response, and we don't see that,” he said.

In an earlier phase of the study, he said, arachidonic acid failed to show the expected aspirin inhibition in 17 of 192 heart attack patients who had been prescribed aspirin. All but one showed aspirin inhibition when they were retested 2 hours after being observed taking aspirin, however. The 1 patient admitted to taking a NANSAID in violation of the protocol, leaving the investigators to conclude that the other 16 were not aspirin resistant but rather were noncompliant with their prescribed aspirin use.

Dr. Schwartz said that patients should be counseled about the importance of aspirin to their survival. “Aspirin is one of the most effective drugs we have in terms of platelet inhibition.”

'[Referring physicians] say, “Does this patient have Factor V Leiden?” I talk them out of it.' DR. WEITZ

ATLANTA — An inherited mutation, Factor V Leiden, puts people at risk for life-threatening blood clots. Carriers can be identified with a simple blood test, so why not use it?

“Genetic testing is highly controversial. This is really not ready for prime time yet,” Dr. David Ginsberg advised during a special session on venous thromboembolism at the annual meeting of the American Society of Hematology.

Factor V Leiden has been associated with risk of miscarriage and possibly other complications, but most women with the mutation have normal pregnancies, he noted. Likewise, while Factor V Leiden has been linked to increased risk of venous thromboembolism in women taking oral contraceptives, they are not contraindicated.

The central issue for Dr. Ginsberg was not whether Factor V Leiden is a risk factor, but what that means and what, if anything, would be done differently when treating patients who test positive.

About 5% of people of European origin have Factor V Leiden, according to Dr. Ginsberg, the James V. Neel Distinguished University Professor of Internal Medicine and Human Genetics at the University of Michigan, Ann Arbor. It “clearly increases” relative risk, compared with no mutation in Factor V, but most people with the mutation do not develop blood clots.

“Nature would not allow this to be in 5% of the population, if it was really all that bad,” he said, speculating that Factor V Leiden might confer a benefit in some patients who develop venous thromboembolism. “Factor V Leiden might not always be 'bad' for you,” he said.

Dr. Ginsberg cited two human studies that found deep venous thrombosis (DVT) was less likely to progress to pulmonary embolism in people with Factor V Leiden. Also, he noted that in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial evaluating recombinant human activated protein C (rhAPC), or drotrecogin alfa activated, in patients with severe sepsis, 28-day all-cause mortality was lower in 65 patients with Factor V Leiden.

Based on current knowledge, a positive test for Factor V Leiden would not change any treatments, Dr. Ginsberg continued. Patients still would receive heparin or warfarin for acute thrombosis and be given warfarin for 31/2 months as prophylaxis after a first event. If patients have recurrent thromboses, warfarin prophylaxis would be extended, possibly becoming a lifelong intervention.

In the future, he suggested Factor V Leiden testing might be useful when choosing primary therapy and duration of therapy for thrombosis. Likewise, the presence of Factor V Leiden might indicate the need for thrombosis prophylaxis during pregnancy, postoperatively, and after a first thrombotic event. And women may be screened for Factor V Leiden before oral contraceptives are prescribed.

But none of this is done now, and he said more data are needed to support genotype-specific prophylaxis or therapy. Meanwhile, a positive finding could be cause for anxiety and hypervigilance. “My plea is that, until there is clear-cut evidence, testing should be used judiciously,” he said.

In an interview after the session, Dr. Jeffrey Weitz, another speaker at the special session, said he “very much agreed” with Dr. Ginsberg and does not test for Factor V Leiden unless a patient insists. Most patients requesting the test have thrombosis and are referred by primary care physicians, according to Dr. Weitz of Hamilton Civic Hospitals Research Centre in Ontario. “They say, 'Does this patient have Factor V Leiden?' “he said. “I talk them out of it.”

For another speaker, Melanie Bloom, a national patient spokeswoman for the Coalition to Prevent Deep Vein Thrombosis, the test is not so easy to rule out, however. Her husband, David Bloom, died of a DVT that led to pulmonary embolism while covering the Iraq war for NBC news. After his death at the age of 39, the family became aware that he had been at high risk for DVT.

When their three young daughters reach the age where pregnancy and contraception are an issue, Mrs. Bloom said she would want to know whether they have an inherited risk. “David's life could have been saved with awareness and knowledge,” she said. “Less than a quarter of physicians educate high-risk patients about DVT.”

'[Referring physicians] say, “Does this patient have Factor V Leiden?” I talk them out of it.' DR. WEITZ

ATLANTA — An inherited mutation, Factor V Leiden, puts people at risk for life-threatening blood clots. Carriers can be identified with a simple blood test, so why not use it?

“Genetic testing is highly controversial. This is really not ready for prime time yet,” Dr. David Ginsberg advised during a special session on venous thromboembolism at the annual meeting of the American Society of Hematology.

Factor V Leiden has been associated with risk of miscarriage and possibly other complications, but most women with the mutation have normal pregnancies, he noted. Likewise, while Factor V Leiden has been linked to increased risk of venous thromboembolism in women taking oral contraceptives, they are not contraindicated.

The central issue for Dr. Ginsberg was not whether Factor V Leiden is a risk factor, but what that means and what, if anything, would be done differently when treating patients who test positive.

About 5% of people of European origin have Factor V Leiden, according to Dr. Ginsberg, the James V. Neel Distinguished University Professor of Internal Medicine and Human Genetics at the University of Michigan, Ann Arbor. It “clearly increases” relative risk, compared with no mutation in Factor V, but most people with the mutation do not develop blood clots.

“Nature would not allow this to be in 5% of the population, if it was really all that bad,” he said, speculating that Factor V Leiden might confer a benefit in some patients who develop venous thromboembolism. “Factor V Leiden might not always be 'bad' for you,” he said.

Dr. Ginsberg cited two human studies that found deep venous thrombosis (DVT) was less likely to progress to pulmonary embolism in people with Factor V Leiden. Also, he noted that in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial evaluating recombinant human activated protein C (rhAPC), or drotrecogin alfa activated, in patients with severe sepsis, 28-day all-cause mortality was lower in 65 patients with Factor V Leiden.

Based on current knowledge, a positive test for Factor V Leiden would not change any treatments, Dr. Ginsberg continued. Patients still would receive heparin or warfarin for acute thrombosis and be given warfarin for 31/2 months as prophylaxis after a first event. If patients have recurrent thromboses, warfarin prophylaxis would be extended, possibly becoming a lifelong intervention.

In the future, he suggested Factor V Leiden testing might be useful when choosing primary therapy and duration of therapy for thrombosis. Likewise, the presence of Factor V Leiden might indicate the need for thrombosis prophylaxis during pregnancy, postoperatively, and after a first thrombotic event. And women may be screened for Factor V Leiden before oral contraceptives are prescribed.

But none of this is done now, and he said more data are needed to support genotype-specific prophylaxis or therapy. Meanwhile, a positive finding could be cause for anxiety and hypervigilance. “My plea is that, until there is clear-cut evidence, testing should be used judiciously,” he said.

In an interview after the session, Dr. Jeffrey Weitz, another speaker at the special session, said he “very much agreed” with Dr. Ginsberg and does not test for Factor V Leiden unless a patient insists. Most patients requesting the test have thrombosis and are referred by primary care physicians, according to Dr. Weitz of Hamilton Civic Hospitals Research Centre in Ontario. “They say, 'Does this patient have Factor V Leiden?' “he said. “I talk them out of it.”

For another speaker, Melanie Bloom, a national patient spokeswoman for the Coalition to Prevent Deep Vein Thrombosis, the test is not so easy to rule out, however. Her husband, David Bloom, died of a DVT that led to pulmonary embolism while covering the Iraq war for NBC news. After his death at the age of 39, the family became aware that he had been at high risk for DVT.

When their three young daughters reach the age where pregnancy and contraception are an issue, Mrs. Bloom said she would want to know whether they have an inherited risk. “David's life could have been saved with awareness and knowledge,” she said. “Less than a quarter of physicians educate high-risk patients about DVT.”

'[Referring physicians] say, “Does this patient have Factor V Leiden?” I talk them out of it.' DR. WEITZ

ATLANTA — An inherited mutation, Factor V Leiden, puts people at risk for life-threatening blood clots. Carriers can be identified with a simple blood test, so why not use it?

“Genetic testing is highly controversial. This is really not ready for prime time yet,” Dr. David Ginsberg advised during a special session on venous thromboembolism at the annual meeting of the American Society of Hematology.

Factor V Leiden has been associated with risk of miscarriage and possibly other complications, but most women with the mutation have normal pregnancies, he noted. Likewise, while Factor V Leiden has been linked to increased risk of venous thromboembolism in women taking oral contraceptives, they are not contraindicated.

The central issue for Dr. Ginsberg was not whether Factor V Leiden is a risk factor, but what that means and what, if anything, would be done differently when treating patients who test positive.

About 5% of people of European origin have Factor V Leiden, according to Dr. Ginsberg, the James V. Neel Distinguished University Professor of Internal Medicine and Human Genetics at the University of Michigan, Ann Arbor. It “clearly increases” relative risk, compared with no mutation in Factor V, but most people with the mutation do not develop blood clots.

“Nature would not allow this to be in 5% of the population, if it was really all that bad,” he said, speculating that Factor V Leiden might confer a benefit in some patients who develop venous thromboembolism. “Factor V Leiden might not always be 'bad' for you,” he said.

Dr. Ginsberg cited two human studies that found deep venous thrombosis (DVT) was less likely to progress to pulmonary embolism in people with Factor V Leiden. Also, he noted that in the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial evaluating recombinant human activated protein C (rhAPC), or drotrecogin alfa activated, in patients with severe sepsis, 28-day all-cause mortality was lower in 65 patients with Factor V Leiden.

Based on current knowledge, a positive test for Factor V Leiden would not change any treatments, Dr. Ginsberg continued. Patients still would receive heparin or warfarin for acute thrombosis and be given warfarin for 31/2 months as prophylaxis after a first event. If patients have recurrent thromboses, warfarin prophylaxis would be extended, possibly becoming a lifelong intervention.

In the future, he suggested Factor V Leiden testing might be useful when choosing primary therapy and duration of therapy for thrombosis. Likewise, the presence of Factor V Leiden might indicate the need for thrombosis prophylaxis during pregnancy, postoperatively, and after a first thrombotic event. And women may be screened for Factor V Leiden before oral contraceptives are prescribed.

But none of this is done now, and he said more data are needed to support genotype-specific prophylaxis or therapy. Meanwhile, a positive finding could be cause for anxiety and hypervigilance. “My plea is that, until there is clear-cut evidence, testing should be used judiciously,” he said.

In an interview after the session, Dr. Jeffrey Weitz, another speaker at the special session, said he “very much agreed” with Dr. Ginsberg and does not test for Factor V Leiden unless a patient insists. Most patients requesting the test have thrombosis and are referred by primary care physicians, according to Dr. Weitz of Hamilton Civic Hospitals Research Centre in Ontario. “They say, 'Does this patient have Factor V Leiden?' “he said. “I talk them out of it.”

For another speaker, Melanie Bloom, a national patient spokeswoman for the Coalition to Prevent Deep Vein Thrombosis, the test is not so easy to rule out, however. Her husband, David Bloom, died of a DVT that led to pulmonary embolism while covering the Iraq war for NBC news. After his death at the age of 39, the family became aware that he had been at high risk for DVT.

When their three young daughters reach the age where pregnancy and contraception are an issue, Mrs. Bloom said she would want to know whether they have an inherited risk. “David's life could have been saved with awareness and knowledge,” she said. “Less than a quarter of physicians educate high-risk patients about DVT.”

ATLANTA — Healthy blood donors with positive direct antiglobulin tests develop cancer more than twice as often as those who test negative, according to a provocative study that linked thousands of blood bank records to Israel's national cancer registry.

Absolute cancer risk was small in the study: Of people with positive direct antiglobulin tests (DATs), 2.9% developed cancer, compared with 1.2% of DAT-negative donors, Dr. Ora Paltiel reported in a poster at the annual meeting of the American Society of Hematology.

Relative cancer risk was high, however, with hazard ratios of 2.46 overall, 14.20 for hematopoietic cancers, and 8.02 for lymphomas. Even when the investigators excluded cases diagnosed within 12 months of blood donation, people with positive DAT tests had an eightfold higher risk of developing a hematopoietic cancer at an average follow-up of 66 months.

“In a small minority of people, a positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing,” said Dr. Paltiel, a hematologist and epidemiologist at the Hadassah University Medical Center, Jerusalem.

“Practically, you would not want to bring a panic because of this, but there are implications to a positive DAT,” she said, urging additional studies to confirm the finding and determine whether DAT testing could help detect early cancers in healthy people.

The DAT test (also known as a direct Coombs' test) has been used since the 1950s to see whether the donor has immunoglobulin antibodies attached to red blood cells, according to Dr. Paltiel. It is not universally required of blood donors, but a positive finding can suggest an immune reaction to a disease process.

The investigators identified 586 blood donors who had positive DAT screens during the years 1993–2003, and matched them by gender, age, and year of blood donation to 2,344 DAT-negative donors. Using unique identification numbers, the study was able to determine cancer incidence through July 30, 2006, in both cohorts. Men made up 63% of the population. The DAT-positive donors were slightly older (34.5 years vs. 32 years on average).

All told, 17 DAT-positive donors and 27 DAT-negative donors developed cancer by mid-2006. Dr. Paltiel said that DAT-positive patients tended to be diagnosed with cancer earlier than those who were DAT negative, perhaps because they had a physical exam after receiving letters notifying them of the DAT results. Three DAT-positive donors were diagnosed with hematopoietic cancers (Hodgkin's lymphoma, non-Hodgkin's lymphoma, and multiple myeloma) during the first year.

The investigators did a subset analysis excluding early diagnoses in people who may have had undiagnosed cancers at the time of blood donation. Looking just at DAT-positive donors diagnosed with cancers after 12 months, the most common malignancies (with two in each category) were lymphoma, multiple myeloma, and thyroid, prostate, and gastrointestinal tumors.

Comparisons of observed cases of cancer in blood donors with expected cases in the general population also found twice the incidence of cancer in DAT-positive donors, but no elevation of cancer rates in those who had tested DAT negative. Incidence of hematologic malignancies was 11-fold higher in the DAT-positive donors, according to the poster. This reflected somewhat increased rates of lymphomas and Hodgkin's lymphoma and a more than 40-fold hike in incidence of multiple myeloma, compared with expected rates.

The increase in a condition as rare as multiple myeloma cannot simply be attributed to more people being screened after a positive DAT test, Dr. Paltiel said. “Some of it has to do with health behavior, but you can't blame myeloma on health behavior.” If a positive DAT leads to earlier diagnosis, she added, the person could benefit from recent advances in treatment of multiple myeloma.

'A positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing.' DR. PALTIEL

ATLANTA — Healthy blood donors with positive direct antiglobulin tests develop cancer more than twice as often as those who test negative, according to a provocative study that linked thousands of blood bank records to Israel's national cancer registry.

Absolute cancer risk was small in the study: Of people with positive direct antiglobulin tests (DATs), 2.9% developed cancer, compared with 1.2% of DAT-negative donors, Dr. Ora Paltiel reported in a poster at the annual meeting of the American Society of Hematology.

Relative cancer risk was high, however, with hazard ratios of 2.46 overall, 14.20 for hematopoietic cancers, and 8.02 for lymphomas. Even when the investigators excluded cases diagnosed within 12 months of blood donation, people with positive DAT tests had an eightfold higher risk of developing a hematopoietic cancer at an average follow-up of 66 months.

“In a small minority of people, a positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing,” said Dr. Paltiel, a hematologist and epidemiologist at the Hadassah University Medical Center, Jerusalem.

“Practically, you would not want to bring a panic because of this, but there are implications to a positive DAT,” she said, urging additional studies to confirm the finding and determine whether DAT testing could help detect early cancers in healthy people.

The DAT test (also known as a direct Coombs' test) has been used since the 1950s to see whether the donor has immunoglobulin antibodies attached to red blood cells, according to Dr. Paltiel. It is not universally required of blood donors, but a positive finding can suggest an immune reaction to a disease process.

The investigators identified 586 blood donors who had positive DAT screens during the years 1993–2003, and matched them by gender, age, and year of blood donation to 2,344 DAT-negative donors. Using unique identification numbers, the study was able to determine cancer incidence through July 30, 2006, in both cohorts. Men made up 63% of the population. The DAT-positive donors were slightly older (34.5 years vs. 32 years on average).

All told, 17 DAT-positive donors and 27 DAT-negative donors developed cancer by mid-2006. Dr. Paltiel said that DAT-positive patients tended to be diagnosed with cancer earlier than those who were DAT negative, perhaps because they had a physical exam after receiving letters notifying them of the DAT results. Three DAT-positive donors were diagnosed with hematopoietic cancers (Hodgkin's lymphoma, non-Hodgkin's lymphoma, and multiple myeloma) during the first year.

The investigators did a subset analysis excluding early diagnoses in people who may have had undiagnosed cancers at the time of blood donation. Looking just at DAT-positive donors diagnosed with cancers after 12 months, the most common malignancies (with two in each category) were lymphoma, multiple myeloma, and thyroid, prostate, and gastrointestinal tumors.

Comparisons of observed cases of cancer in blood donors with expected cases in the general population also found twice the incidence of cancer in DAT-positive donors, but no elevation of cancer rates in those who had tested DAT negative. Incidence of hematologic malignancies was 11-fold higher in the DAT-positive donors, according to the poster. This reflected somewhat increased rates of lymphomas and Hodgkin's lymphoma and a more than 40-fold hike in incidence of multiple myeloma, compared with expected rates.

The increase in a condition as rare as multiple myeloma cannot simply be attributed to more people being screened after a positive DAT test, Dr. Paltiel said. “Some of it has to do with health behavior, but you can't blame myeloma on health behavior.” If a positive DAT leads to earlier diagnosis, she added, the person could benefit from recent advances in treatment of multiple myeloma.

'A positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing.' DR. PALTIEL

ATLANTA — Healthy blood donors with positive direct antiglobulin tests develop cancer more than twice as often as those who test negative, according to a provocative study that linked thousands of blood bank records to Israel's national cancer registry.

Absolute cancer risk was small in the study: Of people with positive direct antiglobulin tests (DATs), 2.9% developed cancer, compared with 1.2% of DAT-negative donors, Dr. Ora Paltiel reported in a poster at the annual meeting of the American Society of Hematology.

Relative cancer risk was high, however, with hazard ratios of 2.46 overall, 14.20 for hematopoietic cancers, and 8.02 for lymphomas. Even when the investigators excluded cases diagnosed within 12 months of blood donation, people with positive DAT tests had an eightfold higher risk of developing a hematopoietic cancer at an average follow-up of 66 months.

“In a small minority of people, a positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing,” said Dr. Paltiel, a hematologist and epidemiologist at the Hadassah University Medical Center, Jerusalem.

“Practically, you would not want to bring a panic because of this, but there are implications to a positive DAT,” she said, urging additional studies to confirm the finding and determine whether DAT testing could help detect early cancers in healthy people.

The DAT test (also known as a direct Coombs' test) has been used since the 1950s to see whether the donor has immunoglobulin antibodies attached to red blood cells, according to Dr. Paltiel. It is not universally required of blood donors, but a positive finding can suggest an immune reaction to a disease process.

The investigators identified 586 blood donors who had positive DAT screens during the years 1993–2003, and matched them by gender, age, and year of blood donation to 2,344 DAT-negative donors. Using unique identification numbers, the study was able to determine cancer incidence through July 30, 2006, in both cohorts. Men made up 63% of the population. The DAT-positive donors were slightly older (34.5 years vs. 32 years on average).

All told, 17 DAT-positive donors and 27 DAT-negative donors developed cancer by mid-2006. Dr. Paltiel said that DAT-positive patients tended to be diagnosed with cancer earlier than those who were DAT negative, perhaps because they had a physical exam after receiving letters notifying them of the DAT results. Three DAT-positive donors were diagnosed with hematopoietic cancers (Hodgkin's lymphoma, non-Hodgkin's lymphoma, and multiple myeloma) during the first year.

The investigators did a subset analysis excluding early diagnoses in people who may have had undiagnosed cancers at the time of blood donation. Looking just at DAT-positive donors diagnosed with cancers after 12 months, the most common malignancies (with two in each category) were lymphoma, multiple myeloma, and thyroid, prostate, and gastrointestinal tumors.

Comparisons of observed cases of cancer in blood donors with expected cases in the general population also found twice the incidence of cancer in DAT-positive donors, but no elevation of cancer rates in those who had tested DAT negative. Incidence of hematologic malignancies was 11-fold higher in the DAT-positive donors, according to the poster. This reflected somewhat increased rates of lymphomas and Hodgkin's lymphoma and a more than 40-fold hike in incidence of multiple myeloma, compared with expected rates.

The increase in a condition as rare as multiple myeloma cannot simply be attributed to more people being screened after a positive DAT test, Dr. Paltiel said. “Some of it has to do with health behavior, but you can't blame myeloma on health behavior.” If a positive DAT leads to earlier diagnosis, she added, the person could benefit from recent advances in treatment of multiple myeloma.

'A positive DAT is actually a marker—not a risk factor, a marker—that they have some cancer growing.' DR. PALTIEL

LOS ANGELES — For men with low-risk prostate cancer, skipping more than two sessions of radiotherapy beyond their scheduled weekends off can have long-term consequences, investigators found when they reviewed nearly 1,800 patients treated from 1989 to 2004 at a single cancer center.

Biochemical control at 5 and 10 years was significantly worse for men who skipped more than 2 days even though they ultimately completed their treatments, Dr. David J. D'Ambrosio reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The impact of treatment interruptions was significant for the population as a whole, but the disparity was driven by a highly significant difference within the low-risk group. Interruptions had little to no impact in men with medium- or high-risk disease.

At 5 years the freedom-from-biochemical-failure (FFBF) rate was 90% in patients who skipped the equivalent of more than 2 days for low-risk prostate cancer versus 95% in those who took shorter breaks or no breaks. At 10 years, the FFBF rates were 57% and 82%, respectively.

“Our hypothesis for why this was seen in the low-risk group is that the low-risk patients are the ones most likely to have cancer just confined to the prostate. So … they are the ones who have the most to gain and lose from the local treatment,” Dr. D'Ambrosio, a radiation oncology resident at Fox Chase Cancer Center in Philadelphia, said during an interview.

Findings of previous studies have conflicted on the question of whether small interruptions in prostate cancer treatment can be harmful, Dr. D'Ambrosio said.

The new study identified 1,796 men who received 3-D conformal radiation therapy (76%) or intensity-modulated radiation therapy (24%) between April 1989 and November 2004 at Fox Chase. None had androgen deprivation therapy.

The median dose was 76 Gy, median patient age was 69 years, and median follow-up was 62 months. On the basis of a Gleason score, pretreatment prostate-specific antigen (PSA) levels, and tumor stage, the patients were stratified into three groups: high risk (209 patients, 12%), medium risk (798 patients, 44%), and low risk (789 patients, 44%). The investigators created a nontreatment days ratio (NTDR). They calculated each patient's NTDR by dividing the total elapsed days during treatment into the number of nontreatment days during a course of treatment.

The investigators determined that patients with a ratio of 33% or higher were less likely to maintain long-term biochemical control. “This is the first time [the impact of skipped treatment days] has been shown, and it needs to be repeated before it is taken as dogma,” Dr. D'Ambrosio said.

LOS ANGELES — For men with low-risk prostate cancer, skipping more than two sessions of radiotherapy beyond their scheduled weekends off can have long-term consequences, investigators found when they reviewed nearly 1,800 patients treated from 1989 to 2004 at a single cancer center.

Biochemical control at 5 and 10 years was significantly worse for men who skipped more than 2 days even though they ultimately completed their treatments, Dr. David J. D'Ambrosio reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The impact of treatment interruptions was significant for the population as a whole, but the disparity was driven by a highly significant difference within the low-risk group. Interruptions had little to no impact in men with medium- or high-risk disease.

At 5 years the freedom-from-biochemical-failure (FFBF) rate was 90% in patients who skipped the equivalent of more than 2 days for low-risk prostate cancer versus 95% in those who took shorter breaks or no breaks. At 10 years, the FFBF rates were 57% and 82%, respectively.

“Our hypothesis for why this was seen in the low-risk group is that the low-risk patients are the ones most likely to have cancer just confined to the prostate. So … they are the ones who have the most to gain and lose from the local treatment,” Dr. D'Ambrosio, a radiation oncology resident at Fox Chase Cancer Center in Philadelphia, said during an interview.

Findings of previous studies have conflicted on the question of whether small interruptions in prostate cancer treatment can be harmful, Dr. D'Ambrosio said.

The new study identified 1,796 men who received 3-D conformal radiation therapy (76%) or intensity-modulated radiation therapy (24%) between April 1989 and November 2004 at Fox Chase. None had androgen deprivation therapy.

The median dose was 76 Gy, median patient age was 69 years, and median follow-up was 62 months. On the basis of a Gleason score, pretreatment prostate-specific antigen (PSA) levels, and tumor stage, the patients were stratified into three groups: high risk (209 patients, 12%), medium risk (798 patients, 44%), and low risk (789 patients, 44%). The investigators created a nontreatment days ratio (NTDR). They calculated each patient's NTDR by dividing the total elapsed days during treatment into the number of nontreatment days during a course of treatment.

The investigators determined that patients with a ratio of 33% or higher were less likely to maintain long-term biochemical control. “This is the first time [the impact of skipped treatment days] has been shown, and it needs to be repeated before it is taken as dogma,” Dr. D'Ambrosio said.

LOS ANGELES — For men with low-risk prostate cancer, skipping more than two sessions of radiotherapy beyond their scheduled weekends off can have long-term consequences, investigators found when they reviewed nearly 1,800 patients treated from 1989 to 2004 at a single cancer center.

Biochemical control at 5 and 10 years was significantly worse for men who skipped more than 2 days even though they ultimately completed their treatments, Dr. David J. D'Ambrosio reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The impact of treatment interruptions was significant for the population as a whole, but the disparity was driven by a highly significant difference within the low-risk group. Interruptions had little to no impact in men with medium- or high-risk disease.

At 5 years the freedom-from-biochemical-failure (FFBF) rate was 90% in patients who skipped the equivalent of more than 2 days for low-risk prostate cancer versus 95% in those who took shorter breaks or no breaks. At 10 years, the FFBF rates were 57% and 82%, respectively.

“Our hypothesis for why this was seen in the low-risk group is that the low-risk patients are the ones most likely to have cancer just confined to the prostate. So … they are the ones who have the most to gain and lose from the local treatment,” Dr. D'Ambrosio, a radiation oncology resident at Fox Chase Cancer Center in Philadelphia, said during an interview.

Findings of previous studies have conflicted on the question of whether small interruptions in prostate cancer treatment can be harmful, Dr. D'Ambrosio said.

The new study identified 1,796 men who received 3-D conformal radiation therapy (76%) or intensity-modulated radiation therapy (24%) between April 1989 and November 2004 at Fox Chase. None had androgen deprivation therapy.

The median dose was 76 Gy, median patient age was 69 years, and median follow-up was 62 months. On the basis of a Gleason score, pretreatment prostate-specific antigen (PSA) levels, and tumor stage, the patients were stratified into three groups: high risk (209 patients, 12%), medium risk (798 patients, 44%), and low risk (789 patients, 44%). The investigators created a nontreatment days ratio (NTDR). They calculated each patient's NTDR by dividing the total elapsed days during treatment into the number of nontreatment days during a course of treatment.

The investigators determined that patients with a ratio of 33% or higher were less likely to maintain long-term biochemical control. “This is the first time [the impact of skipped treatment days] has been shown, and it needs to be repeated before it is taken as dogma,” Dr. D'Ambrosio said.

LOS ANGELES – Men who were on statins when given radiotherapy for prostate cancer were significantly more likely to be disease free 10 years later, said researchers who reviewed 871 patients treated from 1994 to 2000 at a New York City cancer center.

Based on prostate-specific antigen levels, 76% of statin users, but only 66% of men who did not take the cholesterol-lowering drugs, were relapse free, Dr. Michael J. Zelefsky, lead author, reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The greatest benefit was seen in 221 men with high-risk disease, who were threefold more likely to have long-term biochemical control and to be free of distant metastases if they used statins.

“These results … will have to be tested carefully,” cautioned Dr. Zelefsky, a radiation oncologist at Memorial Sloan-Kettering Cancer Center, where the study was conducted. “We still don't know … the appropriate duration of taking these medications, or the appropriate dose, or which particular statin is more beneficial.”

That statins can lower risk of heart disease is well established. Dr. Zelefsky said the team conducted the retrospective study because published studies had suggested statins also may have an apoptotic effect, may act as a radiation sensitizer, and may reduce cancer risk.

They selected patients with T1c-T3 prostate cancer who received high-dose radiotherapy, 75.6-86.4 Gy, at Memorial Sloan-Kettering during the study period. A records review determined that 168 men, 19%, used statins and 703 men, 81%, did not. The population had been followed for a median of 7 years. PSA relapse was defined as nadir +2.

Overall survival was not significantly different at 10 years, with 78% of the statin users and 71% of the nonusers still alive. All told, 72% of the entire population lived 10 years.

Introducing Dr. Zelefsky at a press briefing, Dr. Anthony Zietman, professor of radiation oncology at Harvard Medical School, Boston, said cancer treatment is “not just about the therapy and the cancer–it's about the environment. … We are treating the patients with whatever they are putting inside their body. By the time a man gets to 70 years of age, he is almost certainly taking at least one prescription medication. That prescription medication interacts with our therapy.”

ELSEVIER GLOBAL MEDICAL NEWS

LOS ANGELES – Men who were on statins when given radiotherapy for prostate cancer were significantly more likely to be disease free 10 years later, said researchers who reviewed 871 patients treated from 1994 to 2000 at a New York City cancer center.

Based on prostate-specific antigen levels, 76% of statin users, but only 66% of men who did not take the cholesterol-lowering drugs, were relapse free, Dr. Michael J. Zelefsky, lead author, reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The greatest benefit was seen in 221 men with high-risk disease, who were threefold more likely to have long-term biochemical control and to be free of distant metastases if they used statins.

“These results … will have to be tested carefully,” cautioned Dr. Zelefsky, a radiation oncologist at Memorial Sloan-Kettering Cancer Center, where the study was conducted. “We still don't know … the appropriate duration of taking these medications, or the appropriate dose, or which particular statin is more beneficial.”

That statins can lower risk of heart disease is well established. Dr. Zelefsky said the team conducted the retrospective study because published studies had suggested statins also may have an apoptotic effect, may act as a radiation sensitizer, and may reduce cancer risk.

They selected patients with T1c-T3 prostate cancer who received high-dose radiotherapy, 75.6-86.4 Gy, at Memorial Sloan-Kettering during the study period. A records review determined that 168 men, 19%, used statins and 703 men, 81%, did not. The population had been followed for a median of 7 years. PSA relapse was defined as nadir +2.

Overall survival was not significantly different at 10 years, with 78% of the statin users and 71% of the nonusers still alive. All told, 72% of the entire population lived 10 years.

Introducing Dr. Zelefsky at a press briefing, Dr. Anthony Zietman, professor of radiation oncology at Harvard Medical School, Boston, said cancer treatment is “not just about the therapy and the cancer–it's about the environment. … We are treating the patients with whatever they are putting inside their body. By the time a man gets to 70 years of age, he is almost certainly taking at least one prescription medication. That prescription medication interacts with our therapy.”

ELSEVIER GLOBAL MEDICAL NEWS

LOS ANGELES – Men who were on statins when given radiotherapy for prostate cancer were significantly more likely to be disease free 10 years later, said researchers who reviewed 871 patients treated from 1994 to 2000 at a New York City cancer center.

Based on prostate-specific antigen levels, 76% of statin users, but only 66% of men who did not take the cholesterol-lowering drugs, were relapse free, Dr. Michael J. Zelefsky, lead author, reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

The greatest benefit was seen in 221 men with high-risk disease, who were threefold more likely to have long-term biochemical control and to be free of distant metastases if they used statins.

“These results … will have to be tested carefully,” cautioned Dr. Zelefsky, a radiation oncologist at Memorial Sloan-Kettering Cancer Center, where the study was conducted. “We still don't know … the appropriate duration of taking these medications, or the appropriate dose, or which particular statin is more beneficial.”

That statins can lower risk of heart disease is well established. Dr. Zelefsky said the team conducted the retrospective study because published studies had suggested statins also may have an apoptotic effect, may act as a radiation sensitizer, and may reduce cancer risk.

They selected patients with T1c-T3 prostate cancer who received high-dose radiotherapy, 75.6-86.4 Gy, at Memorial Sloan-Kettering during the study period. A records review determined that 168 men, 19%, used statins and 703 men, 81%, did not. The population had been followed for a median of 7 years. PSA relapse was defined as nadir +2.

Overall survival was not significantly different at 10 years, with 78% of the statin users and 71% of the nonusers still alive. All told, 72% of the entire population lived 10 years.

Introducing Dr. Zelefsky at a press briefing, Dr. Anthony Zietman, professor of radiation oncology at Harvard Medical School, Boston, said cancer treatment is “not just about the therapy and the cancer–it's about the environment. … We are treating the patients with whatever they are putting inside their body. By the time a man gets to 70 years of age, he is almost certainly taking at least one prescription medication. That prescription medication interacts with our therapy.”

ELSEVIER GLOBAL MEDICAL NEWS

LOS ANGELES – A study of 11,453 men diagnosed with local prostate cancer from 1999 to 2001 found that brachytherapy reduced their relative risk of dying from the disease by 55%, compared with watchful waiting.

Radical prostatectomy was the best option and hormone therapy was the worst in the complex analysis reported by Dr. Esther H. Zhou at the annual meeting of the American Society for Therapeutic Radiology and Oncology. External beam radiation therapy also was better than watchful waiting (sometimes known as active surveillance), but the difference was not statistically significant.

“The results indicate brachytherapy is better than watchful waiting for the patient, even after we adjust for age, comorbidity, and… Gleason score,” Dr. Zhou, an epidemiologist at Case Western Reserve University, Cleveland, told reporters at a press briefing. “We want to emphasize that brachytherapy is as good as radical prostatectomy and better than watchful waiting.”

She described the study as the first large, population-based comparison of brachytherapy with watchful waiting, and said the researchers were surprised to find that brachytherapy produced a higher rate of disease-specific survival. The best choice among prostate cancer treatments is highly controversial, with options ranging from surgically removing the prostate to doing nothing while monitoring the slow-moving disease for signs of progression.

Brachytherapy involves small radioactive seeds that are placed into the prostate by a radiation oncologist. Unlike external beam radiation therapy, the procedure can be done in one visit. It also is less arduous and has a faster recovery than does radical prostatectomy, which is often reserved for patients who are relatively young and physically fit.

Dr. Zhou and her colleagues examined the records of newly diagnosed prostate cancer patients aged 65 years and older in the Ohio Cancer Incidence Surveillance System and linked them with Medicare and death certificate files. She said that the Ohio database is comparable to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. The investigators assigned patients who did not receive a curative therapy within 6 months of diagnosis to the watchful waiting category.

At 7 years, disease-specific survival–the percentage of patients who didn't die of the disease–was highest for radical prostatectomy (97.9%), followed closely by brachytherapy (96.6%) and external beam radiation (94.2%). Watchful waiting (89.8%) and androgen deprivation therapy (88.1%) were not as effective, according to Dr. Zhou.

When the investigators conducted a multivariate analysis taking into account age, disease stage, comorbidities, and Gleason score, they found that radical prostatectomy (hazard ratio 0.25) and brachytherapy (HR 0.45) were significantly better than watchful waiting, which was assigned a hazard ratio of 1. “For the same age of patient with the same Gleason score with the same stage, [those who receive brachytherapy] tend to have better survival” than do those treated with watchful waiting, Dr. Zhou said.

External beam radiation therapy also was better than watchful waiting (HR 0.66), she added, but the difference was not statistically significant. Again, androgen-deprivation therapy produced the worst results (HR 1.32), compared with watchful waiting.

Dr. Zhou noted, however, that the database did not include information on prostate-specific antigen levels, which would be a factor in the choice of treatment.

The investigators had no disclosures.

LOS ANGELES – A study of 11,453 men diagnosed with local prostate cancer from 1999 to 2001 found that brachytherapy reduced their relative risk of dying from the disease by 55%, compared with watchful waiting.

Radical prostatectomy was the best option and hormone therapy was the worst in the complex analysis reported by Dr. Esther H. Zhou at the annual meeting of the American Society for Therapeutic Radiology and Oncology. External beam radiation therapy also was better than watchful waiting (sometimes known as active surveillance), but the difference was not statistically significant.

“The results indicate brachytherapy is better than watchful waiting for the patient, even after we adjust for age, comorbidity, and… Gleason score,” Dr. Zhou, an epidemiologist at Case Western Reserve University, Cleveland, told reporters at a press briefing. “We want to emphasize that brachytherapy is as good as radical prostatectomy and better than watchful waiting.”

She described the study as the first large, population-based comparison of brachytherapy with watchful waiting, and said the researchers were surprised to find that brachytherapy produced a higher rate of disease-specific survival. The best choice among prostate cancer treatments is highly controversial, with options ranging from surgically removing the prostate to doing nothing while monitoring the slow-moving disease for signs of progression.

Brachytherapy involves small radioactive seeds that are placed into the prostate by a radiation oncologist. Unlike external beam radiation therapy, the procedure can be done in one visit. It also is less arduous and has a faster recovery than does radical prostatectomy, which is often reserved for patients who are relatively young and physically fit.

Dr. Zhou and her colleagues examined the records of newly diagnosed prostate cancer patients aged 65 years and older in the Ohio Cancer Incidence Surveillance System and linked them with Medicare and death certificate files. She said that the Ohio database is comparable to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. The investigators assigned patients who did not receive a curative therapy within 6 months of diagnosis to the watchful waiting category.

At 7 years, disease-specific survival–the percentage of patients who didn't die of the disease–was highest for radical prostatectomy (97.9%), followed closely by brachytherapy (96.6%) and external beam radiation (94.2%). Watchful waiting (89.8%) and androgen deprivation therapy (88.1%) were not as effective, according to Dr. Zhou.

When the investigators conducted a multivariate analysis taking into account age, disease stage, comorbidities, and Gleason score, they found that radical prostatectomy (hazard ratio 0.25) and brachytherapy (HR 0.45) were significantly better than watchful waiting, which was assigned a hazard ratio of 1. “For the same age of patient with the same Gleason score with the same stage, [those who receive brachytherapy] tend to have better survival” than do those treated with watchful waiting, Dr. Zhou said.

External beam radiation therapy also was better than watchful waiting (HR 0.66), she added, but the difference was not statistically significant. Again, androgen-deprivation therapy produced the worst results (HR 1.32), compared with watchful waiting.

Dr. Zhou noted, however, that the database did not include information on prostate-specific antigen levels, which would be a factor in the choice of treatment.

The investigators had no disclosures.

LOS ANGELES – A study of 11,453 men diagnosed with local prostate cancer from 1999 to 2001 found that brachytherapy reduced their relative risk of dying from the disease by 55%, compared with watchful waiting.

Radical prostatectomy was the best option and hormone therapy was the worst in the complex analysis reported by Dr. Esther H. Zhou at the annual meeting of the American Society for Therapeutic Radiology and Oncology. External beam radiation therapy also was better than watchful waiting (sometimes known as active surveillance), but the difference was not statistically significant.

“The results indicate brachytherapy is better than watchful waiting for the patient, even after we adjust for age, comorbidity, and… Gleason score,” Dr. Zhou, an epidemiologist at Case Western Reserve University, Cleveland, told reporters at a press briefing. “We want to emphasize that brachytherapy is as good as radical prostatectomy and better than watchful waiting.”

She described the study as the first large, population-based comparison of brachytherapy with watchful waiting, and said the researchers were surprised to find that brachytherapy produced a higher rate of disease-specific survival. The best choice among prostate cancer treatments is highly controversial, with options ranging from surgically removing the prostate to doing nothing while monitoring the slow-moving disease for signs of progression.

Brachytherapy involves small radioactive seeds that are placed into the prostate by a radiation oncologist. Unlike external beam radiation therapy, the procedure can be done in one visit. It also is less arduous and has a faster recovery than does radical prostatectomy, which is often reserved for patients who are relatively young and physically fit.

Dr. Zhou and her colleagues examined the records of newly diagnosed prostate cancer patients aged 65 years and older in the Ohio Cancer Incidence Surveillance System and linked them with Medicare and death certificate files. She said that the Ohio database is comparable to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry. The investigators assigned patients who did not receive a curative therapy within 6 months of diagnosis to the watchful waiting category.

At 7 years, disease-specific survival–the percentage of patients who didn't die of the disease–was highest for radical prostatectomy (97.9%), followed closely by brachytherapy (96.6%) and external beam radiation (94.2%). Watchful waiting (89.8%) and androgen deprivation therapy (88.1%) were not as effective, according to Dr. Zhou.

When the investigators conducted a multivariate analysis taking into account age, disease stage, comorbidities, and Gleason score, they found that radical prostatectomy (hazard ratio 0.25) and brachytherapy (HR 0.45) were significantly better than watchful waiting, which was assigned a hazard ratio of 1. “For the same age of patient with the same Gleason score with the same stage, [those who receive brachytherapy] tend to have better survival” than do those treated with watchful waiting, Dr. Zhou said.

External beam radiation therapy also was better than watchful waiting (HR 0.66), she added, but the difference was not statistically significant. Again, androgen-deprivation therapy produced the worst results (HR 1.32), compared with watchful waiting.

Dr. Zhou noted, however, that the database did not include information on prostate-specific antigen levels, which would be a factor in the choice of treatment.

The investigators had no disclosures.

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA

LOS ANGELES — Primary care physicians cannot assume that cancer patients are receiving influenza or pneumonia vaccinations while in the care of oncology specialists.

When surveyed at the University of Pennsylvania in Philadelphia, a third of radiotherapy patients aged 50 years and older reported they never had an annual flu shot. Among those aged 65 years and older, 30% said they never were vaccinated against pneumococcal pneumonia.

National guidelines call for vaccination of persons in these age groups. Moreover, by dint of their cancers and the treatments they were receiving, the patients surveyed were susceptible to life-threatening infections. Yet many said they did not know about the vaccines, did not need them, or that the vaccinations were not recommended by a physician.

Such patients are falling into a gray zone, according to Dr. Neha Vapiwala, who presented results of the 214-person survey in a poster at the annual meeting of the American Society for Therapeutic Radiation and Oncology. Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance measures, she said.

Although primary care physicians were more likely to recommend vaccinations than oncologists were, they did not do so routinely, according to the subgroup of patients who were vaccinated. Only 7% said a cancer specialist discussed vaccinations with them; 44% cited conversations with their primary care physicians.

“If there is ever a question about that cancer patient sitting in your office—a question about which routine health maintenance and prevention measures should or shouldn't be recommended—pick up the phone, send that e-mail, communicate with the oncologist,” Dr. Vapiwala urged primary care physicians during a press briefing at the meeting.

Clearer mandates are needed on vaccinations for cancer patients and “which physician is responsible for what,” she said. “Until that happens, we have patients now every single day in our clinic where assumptions are being made that specialist X is taking care of this item and primary care physician Y is taking care of that.”

Though the study relied on patient responses, Dr. Vapiwala, a radiation oncologist at the university, said anecdotal experience supports the finding that vaccinations are being overlooked by oncologists. “We only have to survey the 12 physicians in our department to find the overwhelming majority are guilty. I include myself in that group,” she said.

Patients with a wide range of cancers were surveyed in outpatient clinics at the University of Pennsylvania. An unusually high proportion, 98%, completed usable questionnaires. Overall, 28% of patients reported having received one or two doses of the pneumococcal vaccine. More than half, 58%, said they had yearly flu shots. The median age was 56 years.

The investigators reported no difference among cancer types or treatment regimens with respect to inadequate vaccinations. “Somebody has to bring it up,” Dr. Vapiwala noted.

Cancer patients see multiple physicians, none of whom is taking responsibility for routine prevention and maintenance. DR. VAPIWALA

LOS ANGELES — A small pilot study at a community hospital in the Midwest challenges the common wisdom that breast cancer patients should shun aluminum-based deodorant when being treated with external radiation.

Radiation oncology nurses Juli Aistars and Kathleen Vehlow told 30 women to use their aluminum-based deodorants without regard to their scheduled treatments at Northwest Community Hospital in Arlington Heights, Ill.

The patients also applied a soothing 100% aloe vera gel from one to three times each day, with one application occurring within a half-hour of radiotherapy.

The researchers then used the Skin Toxicity Assessment Tool (Am. J. Clin. Oncol. 2004;27:626–31) to evaluate the patients' skin reactions twice each week during treatment and up to 6 weeks afterward.

Results were compared with those in 30 women who happened to be undergoing radiation treatments during the same time period and received the hospital's standard instruction: no aluminum-based deodorant on the treated side and no skin care products in the radiation field 4 hours before treatment.

The control group was younger—an average of 58 years vs. 64 years—but there was “no major clinical difference,” Ms. Aistars and Ms. Vehlow reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

In both groups, the average time to onset of erythema was about 13 days, with a median of 12 days in the control group and 13 days in the experimental cohort.

The only patient to have no erythema was a woman allowed to use her personal deodorant at will.

Whereas slightly more experimental arm patients had faint, transient grade I erythema (17 patients vs. 15 in the control group), bright grade 2 erythema occurred more often in women told to eschew skin-care products (15 patients vs. 12 in the experimental group).

Common symptoms were not measured in the control group, but these women's charts showed similar reactions to those in the deodorant of choice group, according to the investigators. Among women allowed free use of their deodorants, the leading symptoms were itching (63%), tenderness (47%), pulling (30%), and burning (20%).

Aluminum-based deodorants usually are banned during treatment and other skin care products are likewise discouraged for fear that the metal content will increase the dose of radiation delivered to the skin.

The consequence if that were to happen—an increase in skin toxicity—not only can cause discomfort but also lead to interruptions to treatment in severe cases.

This common practice and the reasoning behind it are not supported by scientific evidence, according to the two investigators.

“It's one of those things handed down through the years that really hasn't changed,” Ms. Vehlow said in an interview at the poster session, where the data were presented.

Giving up the use of their customary personal deodorant temporarily can seem only a minor inconvenience for patients, she acknowledged, but it adds “one more burden in terms of body image” at a time when women are anxious and under “extreme stress.”

Indeed, when the women in the experimental group were surveyed at the conclusion of the experiment, 77% said they felt using their own deodorant was important.

Among the reasons given were “can't go to work without deodorant,” “social reasons,” and “it's the only one that works for me.”

Ms. Aistars and Ms. Vehlow urged further research with larger numbers of women and randomization at more than one site.

'It's one of those things handed down through the years that really hasn't changed.' MS. VEHLOW

LOS ANGELES — A small pilot study at a community hospital in the Midwest challenges the common wisdom that breast cancer patients should shun aluminum-based deodorant when being treated with external radiation.

Radiation oncology nurses Juli Aistars and Kathleen Vehlow told 30 women to use their aluminum-based deodorants without regard to their scheduled treatments at Northwest Community Hospital in Arlington Heights, Ill.

The patients also applied a soothing 100% aloe vera gel from one to three times each day, with one application occurring within a half-hour of radiotherapy.

The researchers then used the Skin Toxicity Assessment Tool (Am. J. Clin. Oncol. 2004;27:626–31) to evaluate the patients' skin reactions twice each week during treatment and up to 6 weeks afterward.

Results were compared with those in 30 women who happened to be undergoing radiation treatments during the same time period and received the hospital's standard instruction: no aluminum-based deodorant on the treated side and no skin care products in the radiation field 4 hours before treatment.

The control group was younger—an average of 58 years vs. 64 years—but there was “no major clinical difference,” Ms. Aistars and Ms. Vehlow reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

In both groups, the average time to onset of erythema was about 13 days, with a median of 12 days in the control group and 13 days in the experimental cohort.

The only patient to have no erythema was a woman allowed to use her personal deodorant at will.

Whereas slightly more experimental arm patients had faint, transient grade I erythema (17 patients vs. 15 in the control group), bright grade 2 erythema occurred more often in women told to eschew skin-care products (15 patients vs. 12 in the experimental group).

Common symptoms were not measured in the control group, but these women's charts showed similar reactions to those in the deodorant of choice group, according to the investigators. Among women allowed free use of their deodorants, the leading symptoms were itching (63%), tenderness (47%), pulling (30%), and burning (20%).

Aluminum-based deodorants usually are banned during treatment and other skin care products are likewise discouraged for fear that the metal content will increase the dose of radiation delivered to the skin.

The consequence if that were to happen—an increase in skin toxicity—not only can cause discomfort but also lead to interruptions to treatment in severe cases.

This common practice and the reasoning behind it are not supported by scientific evidence, according to the two investigators.

“It's one of those things handed down through the years that really hasn't changed,” Ms. Vehlow said in an interview at the poster session, where the data were presented.

Giving up the use of their customary personal deodorant temporarily can seem only a minor inconvenience for patients, she acknowledged, but it adds “one more burden in terms of body image” at a time when women are anxious and under “extreme stress.”

Indeed, when the women in the experimental group were surveyed at the conclusion of the experiment, 77% said they felt using their own deodorant was important.

Among the reasons given were “can't go to work without deodorant,” “social reasons,” and “it's the only one that works for me.”

Ms. Aistars and Ms. Vehlow urged further research with larger numbers of women and randomization at more than one site.

'It's one of those things handed down through the years that really hasn't changed.' MS. VEHLOW

LOS ANGELES — A small pilot study at a community hospital in the Midwest challenges the common wisdom that breast cancer patients should shun aluminum-based deodorant when being treated with external radiation.

Radiation oncology nurses Juli Aistars and Kathleen Vehlow told 30 women to use their aluminum-based deodorants without regard to their scheduled treatments at Northwest Community Hospital in Arlington Heights, Ill.

The patients also applied a soothing 100% aloe vera gel from one to three times each day, with one application occurring within a half-hour of radiotherapy.

The researchers then used the Skin Toxicity Assessment Tool (Am. J. Clin. Oncol. 2004;27:626–31) to evaluate the patients' skin reactions twice each week during treatment and up to 6 weeks afterward.

Results were compared with those in 30 women who happened to be undergoing radiation treatments during the same time period and received the hospital's standard instruction: no aluminum-based deodorant on the treated side and no skin care products in the radiation field 4 hours before treatment.

The control group was younger—an average of 58 years vs. 64 years—but there was “no major clinical difference,” Ms. Aistars and Ms. Vehlow reported at the annual meeting of the American Society for Therapeutic Radiation and Oncology.

In both groups, the average time to onset of erythema was about 13 days, with a median of 12 days in the control group and 13 days in the experimental cohort.

The only patient to have no erythema was a woman allowed to use her personal deodorant at will.

Whereas slightly more experimental arm patients had faint, transient grade I erythema (17 patients vs. 15 in the control group), bright grade 2 erythema occurred more often in women told to eschew skin-care products (15 patients vs. 12 in the experimental group).

Common symptoms were not measured in the control group, but these women's charts showed similar reactions to those in the deodorant of choice group, according to the investigators. Among women allowed free use of their deodorants, the leading symptoms were itching (63%), tenderness (47%), pulling (30%), and burning (20%).

Aluminum-based deodorants usually are banned during treatment and other skin care products are likewise discouraged for fear that the metal content will increase the dose of radiation delivered to the skin.

The consequence if that were to happen—an increase in skin toxicity—not only can cause discomfort but also lead to interruptions to treatment in severe cases.

This common practice and the reasoning behind it are not supported by scientific evidence, according to the two investigators.

“It's one of those things handed down through the years that really hasn't changed,” Ms. Vehlow said in an interview at the poster session, where the data were presented.

Giving up the use of their customary personal deodorant temporarily can seem only a minor inconvenience for patients, she acknowledged, but it adds “one more burden in terms of body image” at a time when women are anxious and under “extreme stress.”

Indeed, when the women in the experimental group were surveyed at the conclusion of the experiment, 77% said they felt using their own deodorant was important.

Among the reasons given were “can't go to work without deodorant,” “social reasons,” and “it's the only one that works for me.”

Ms. Aistars and Ms. Vehlow urged further research with larger numbers of women and randomization at more than one site.

'It's one of those things handed down through the years that really hasn't changed.' MS. VEHLOW