Related Issues

Doctor and patient

Photo courtesy of NIH

The American Society of Clinical Oncology (ASCO) has issued a new clinical practice guideline on the management of chronic pain in adult cancer survivors.

ASCO’s recommendations comprise both long-standing and new approaches, including routine screening for chronic pain, the use of alternative pain management approaches, the use of medical cannabis in certain settings where it is legal, and assessing the potential for opioid overuse.

“Many oncologists and primary care physicians are not trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, PhD, RN, a co-chair of the ASCO expert panel that developed the guideline.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans, using a broad range of approaches.”

The guideline recommendations were developed by a multidisciplinary panel of experts in medical oncology, hematology/oncology, pain medicine, palliative care, hospice, radiation oncology, social work, symptom management research, rehabilitation, psychology, and anesthesiology, as well as a patient representative.

The panel conducted a systematic review of the medical literature published from 1996 to 2015. The resulting guideline includes the following key recommendations.

Clinicians should screen for pain at each encounter with a patient. Recurrent disease, second malignancy, or late-onset treatment effects should be evaluated, treated, and monitored.

Clinicians may prescribe non-pharmacologic interventions such as physical medicine and rehabilitation, integrative therapies (eg, acupuncture and massage), interventional therapies, and psychological approaches (eg, guided imagery, hypnosis, and meditation).

Systemic non-opioid analgesics (NSAIDS, acetaminophen) and adjuvant analgesics (selected antidepressants and anticonvulsants) may be prescribed to relieve chronic pain and/or improve physical function.

Clinicians may follow specific state regulations that allow access to medical cannabis or cannabinoids for patients with chronic pain after considering the potential benefits and risks of the available formulations.

Clinicians may prescribe a trial of opioids in carefully selected cancer patients who do not respond to more conservative pain management and who continue to experience pain-related distress or impairment of physical function.

Clinicians should assess the risk of adverse effects of opioids used in pain management and incorporate universal precautions to minimize abuse, addiction, and adverse consequences.

“Of great importance is the attention to appropriate assessment, not only of the individual’s pain, but also of their potential for over-reliance on opioids,” Dr Paice said. “This guideline outlines precautions that help ensure cancer survivors with persistent pain use opioids safely and effectively, while limiting access to those who are struggling with addiction.”

Doctor and patient

Photo courtesy of NIH

The American Society of Clinical Oncology (ASCO) has issued a new clinical practice guideline on the management of chronic pain in adult cancer survivors.

ASCO’s recommendations comprise both long-standing and new approaches, including routine screening for chronic pain, the use of alternative pain management approaches, the use of medical cannabis in certain settings where it is legal, and assessing the potential for opioid overuse.

“Many oncologists and primary care physicians are not trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, PhD, RN, a co-chair of the ASCO expert panel that developed the guideline.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans, using a broad range of approaches.”

The guideline recommendations were developed by a multidisciplinary panel of experts in medical oncology, hematology/oncology, pain medicine, palliative care, hospice, radiation oncology, social work, symptom management research, rehabilitation, psychology, and anesthesiology, as well as a patient representative.

The panel conducted a systematic review of the medical literature published from 1996 to 2015. The resulting guideline includes the following key recommendations.

Clinicians should screen for pain at each encounter with a patient. Recurrent disease, second malignancy, or late-onset treatment effects should be evaluated, treated, and monitored.

Clinicians may prescribe non-pharmacologic interventions such as physical medicine and rehabilitation, integrative therapies (eg, acupuncture and massage), interventional therapies, and psychological approaches (eg, guided imagery, hypnosis, and meditation).

Systemic non-opioid analgesics (NSAIDS, acetaminophen) and adjuvant analgesics (selected antidepressants and anticonvulsants) may be prescribed to relieve chronic pain and/or improve physical function.

Clinicians may follow specific state regulations that allow access to medical cannabis or cannabinoids for patients with chronic pain after considering the potential benefits and risks of the available formulations.

Clinicians may prescribe a trial of opioids in carefully selected cancer patients who do not respond to more conservative pain management and who continue to experience pain-related distress or impairment of physical function.

Clinicians should assess the risk of adverse effects of opioids used in pain management and incorporate universal precautions to minimize abuse, addiction, and adverse consequences.

“Of great importance is the attention to appropriate assessment, not only of the individual’s pain, but also of their potential for over-reliance on opioids,” Dr Paice said. “This guideline outlines precautions that help ensure cancer survivors with persistent pain use opioids safely and effectively, while limiting access to those who are struggling with addiction.”

Doctor and patient

Photo courtesy of NIH

The American Society of Clinical Oncology (ASCO) has issued a new clinical practice guideline on the management of chronic pain in adult cancer survivors.

ASCO’s recommendations comprise both long-standing and new approaches, including routine screening for chronic pain, the use of alternative pain management approaches, the use of medical cannabis in certain settings where it is legal, and assessing the potential for opioid overuse.

“Many oncologists and primary care physicians are not trained to recognize or treat long-term pain associated with cancer,” said Judith A. Paice, PhD, RN, a co-chair of the ASCO expert panel that developed the guideline.

“This guideline will help clinicians identify pain early and develop comprehensive treatment plans, using a broad range of approaches.”

The guideline recommendations were developed by a multidisciplinary panel of experts in medical oncology, hematology/oncology, pain medicine, palliative care, hospice, radiation oncology, social work, symptom management research, rehabilitation, psychology, and anesthesiology, as well as a patient representative.

The panel conducted a systematic review of the medical literature published from 1996 to 2015. The resulting guideline includes the following key recommendations.

Clinicians should screen for pain at each encounter with a patient. Recurrent disease, second malignancy, or late-onset treatment effects should be evaluated, treated, and monitored.

Clinicians may prescribe non-pharmacologic interventions such as physical medicine and rehabilitation, integrative therapies (eg, acupuncture and massage), interventional therapies, and psychological approaches (eg, guided imagery, hypnosis, and meditation).

Systemic non-opioid analgesics (NSAIDS, acetaminophen) and adjuvant analgesics (selected antidepressants and anticonvulsants) may be prescribed to relieve chronic pain and/or improve physical function.

Clinicians may follow specific state regulations that allow access to medical cannabis or cannabinoids for patients with chronic pain after considering the potential benefits and risks of the available formulations.

Clinicians may prescribe a trial of opioids in carefully selected cancer patients who do not respond to more conservative pain management and who continue to experience pain-related distress or impairment of physical function.

Clinicians should assess the risk of adverse effects of opioids used in pain management and incorporate universal precautions to minimize abuse, addiction, and adverse consequences.

“Of great importance is the attention to appropriate assessment, not only of the individual’s pain, but also of their potential for over-reliance on opioids,” Dr Paice said. “This guideline outlines precautions that help ensure cancer survivors with persistent pain use opioids safely and effectively, while limiting access to those who are struggling with addiction.”

White leghorn chickens

Photo by Geri Glastra

Research published in Malaria Journal indicates that malaria-transmitting mosquitoes use their sense of smell to avoid feeding on chickens.

Investigators therefore believe that odors emitted by chickens and other animals could provide protection for humans at risk of mosquito-transmitted diseases.

The study showed that Anopheles arabiensis, one of the predominant species of mosquitoes transmitting malaria in sub-Saharan Africa, avoids chickens when looking for hosts to feed on.

And the mosquitoes can distinguish chickens from other animals using their sense of smell.

“We were surprised to find that malaria mosquitoes are repelled by the odors emitted by chickens,” said study author Rickard Ignell, PhD, of the Swedish University of Agricultural Sciences in Alnarp, Sweden.

“This study shows, for the first time, that malaria mosquitoes actively avoid feeding on certain animal species and that this behavior is regulated through odor cues.”

To find out which species the mosquitoes prefer, Dr Ignell and his colleagues collected data on the population of human and domestic animals in 3 Ethiopian villages. People living in these villages share their living quarters with their livestock.

The investigators also collected blood-fed mosquitoes to test for the source of the blood the mosquitoes had consumed.

The team found that An arabiensis strongly prefers human over animal blood when seeking hosts indoors and randomly feeds on cattle, goats, and sheep when outdoors. However, the mosquitoes avoid chickens in both settings, despite their relatively high abundance.

Since mosquitoes select and discriminate between their hosts mainly based on their sense of smell, the investigators collected hair, wool, and feathers from potential host and non-host species to analyze the odor compounds present in them.

Identifying certain compounds that were only present in chicken feathers, the team used these and other compounds obtained from all species to test their ability to repel mosquitoes from mosquito traps.

The traps were set up in 11 thatched houses in one of the villages for a total of 11 days. In each of the houses, a single volunteer between ages 27 and 36 slept under an untreated bed net.

The investigators found that significantly fewer mosquitoes were caught in traps baited with chicken compounds than in control traps. Suspending a living chicken in a cage next to a trap had a similar repellent effect.

Because it feeds indoors and outdoors on various host species, An arabiensis is difficult to control with existing methods, previous research has shown. The results of the current study suggest that, in combination with established control methods, the odors emitted by chickens and other non-host species could prove useful in controlling An arabiensis.

“People in sub-Saharan Africa have suffered considerably under the burden of malaria over an extended period of time, and mosquitoes are becoming increasingly physiologically resistant to pesticides, while also changing their feeding habits, for example, by moving from indoors to outdoors,” Dr Ignell said.

“For this reason, there is a need to develop novel control methods. In our study, we have been able to identify a number of natural odor compounds which could repel host-seeking malaria mosquitoes and prevent them from getting in contact with people.”

White leghorn chickens

Photo by Geri Glastra

Research published in Malaria Journal indicates that malaria-transmitting mosquitoes use their sense of smell to avoid feeding on chickens.

Investigators therefore believe that odors emitted by chickens and other animals could provide protection for humans at risk of mosquito-transmitted diseases.

The study showed that Anopheles arabiensis, one of the predominant species of mosquitoes transmitting malaria in sub-Saharan Africa, avoids chickens when looking for hosts to feed on.

And the mosquitoes can distinguish chickens from other animals using their sense of smell.

“We were surprised to find that malaria mosquitoes are repelled by the odors emitted by chickens,” said study author Rickard Ignell, PhD, of the Swedish University of Agricultural Sciences in Alnarp, Sweden.

“This study shows, for the first time, that malaria mosquitoes actively avoid feeding on certain animal species and that this behavior is regulated through odor cues.”

To find out which species the mosquitoes prefer, Dr Ignell and his colleagues collected data on the population of human and domestic animals in 3 Ethiopian villages. People living in these villages share their living quarters with their livestock.

The investigators also collected blood-fed mosquitoes to test for the source of the blood the mosquitoes had consumed.

The team found that An arabiensis strongly prefers human over animal blood when seeking hosts indoors and randomly feeds on cattle, goats, and sheep when outdoors. However, the mosquitoes avoid chickens in both settings, despite their relatively high abundance.

Since mosquitoes select and discriminate between their hosts mainly based on their sense of smell, the investigators collected hair, wool, and feathers from potential host and non-host species to analyze the odor compounds present in them.

Identifying certain compounds that were only present in chicken feathers, the team used these and other compounds obtained from all species to test their ability to repel mosquitoes from mosquito traps.

The traps were set up in 11 thatched houses in one of the villages for a total of 11 days. In each of the houses, a single volunteer between ages 27 and 36 slept under an untreated bed net.

The investigators found that significantly fewer mosquitoes were caught in traps baited with chicken compounds than in control traps. Suspending a living chicken in a cage next to a trap had a similar repellent effect.

Because it feeds indoors and outdoors on various host species, An arabiensis is difficult to control with existing methods, previous research has shown. The results of the current study suggest that, in combination with established control methods, the odors emitted by chickens and other non-host species could prove useful in controlling An arabiensis.

“People in sub-Saharan Africa have suffered considerably under the burden of malaria over an extended period of time, and mosquitoes are becoming increasingly physiologically resistant to pesticides, while also changing their feeding habits, for example, by moving from indoors to outdoors,” Dr Ignell said.

“For this reason, there is a need to develop novel control methods. In our study, we have been able to identify a number of natural odor compounds which could repel host-seeking malaria mosquitoes and prevent them from getting in contact with people.”

White leghorn chickens

Photo by Geri Glastra

Research published in Malaria Journal indicates that malaria-transmitting mosquitoes use their sense of smell to avoid feeding on chickens.

Investigators therefore believe that odors emitted by chickens and other animals could provide protection for humans at risk of mosquito-transmitted diseases.

The study showed that Anopheles arabiensis, one of the predominant species of mosquitoes transmitting malaria in sub-Saharan Africa, avoids chickens when looking for hosts to feed on.

And the mosquitoes can distinguish chickens from other animals using their sense of smell.

“We were surprised to find that malaria mosquitoes are repelled by the odors emitted by chickens,” said study author Rickard Ignell, PhD, of the Swedish University of Agricultural Sciences in Alnarp, Sweden.

“This study shows, for the first time, that malaria mosquitoes actively avoid feeding on certain animal species and that this behavior is regulated through odor cues.”

To find out which species the mosquitoes prefer, Dr Ignell and his colleagues collected data on the population of human and domestic animals in 3 Ethiopian villages. People living in these villages share their living quarters with their livestock.

The investigators also collected blood-fed mosquitoes to test for the source of the blood the mosquitoes had consumed.

The team found that An arabiensis strongly prefers human over animal blood when seeking hosts indoors and randomly feeds on cattle, goats, and sheep when outdoors. However, the mosquitoes avoid chickens in both settings, despite their relatively high abundance.

Since mosquitoes select and discriminate between their hosts mainly based on their sense of smell, the investigators collected hair, wool, and feathers from potential host and non-host species to analyze the odor compounds present in them.

Identifying certain compounds that were only present in chicken feathers, the team used these and other compounds obtained from all species to test their ability to repel mosquitoes from mosquito traps.

The traps were set up in 11 thatched houses in one of the villages for a total of 11 days. In each of the houses, a single volunteer between ages 27 and 36 slept under an untreated bed net.

The investigators found that significantly fewer mosquitoes were caught in traps baited with chicken compounds than in control traps. Suspending a living chicken in a cage next to a trap had a similar repellent effect.

Because it feeds indoors and outdoors on various host species, An arabiensis is difficult to control with existing methods, previous research has shown. The results of the current study suggest that, in combination with established control methods, the odors emitted by chickens and other non-host species could prove useful in controlling An arabiensis.

“People in sub-Saharan Africa have suffered considerably under the burden of malaria over an extended period of time, and mosquitoes are becoming increasingly physiologically resistant to pesticides, while also changing their feeding habits, for example, by moving from indoors to outdoors,” Dr Ignell said.

“For this reason, there is a need to develop novel control methods. In our study, we have been able to identify a number of natural odor compounds which could repel host-seeking malaria mosquitoes and prevent them from getting in contact with people.”

Pregnant woman

Photo by Nina Matthews

The US Centers for Disease Control and Prevention (CDC) has updated some of its recommendations regarding the Zika virus.

The agency issued an updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus and an updated interim guidance on preventing sexual transmission of the virus.

The CDC issued these updates based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. The CDC said it will continue to make updates as new information becomes available.

Guidance for pregnant women

This updated guidance expands the timeframe during which pregnant women can be tested for Zika virus—with an rRT-PCR test—from 7 days to 14 days after symptoms start. The CDC said this expansion will provide a definite diagnosis for more pregnant women infected with the Zika virus.

Scientists previously thought the virus stays in the blood for about a week after symptoms start. So the first week of illness was thought to be the best time to find evidence of the virus in blood using a Zika-specific test (rRT-PCR).

For patients who visited a healthcare provider more than a week after symptoms started and those who were possibly exposed to Zika but never developed symptoms, healthcare providers could perform Zika virus IgM testing. However, this test might not provide a definite diagnosis, as it can also detect related viruses.

New information has indicated that some infected pregnant women can have evidence of the Zika virus in their blood for longer than 7 days after symptoms begin, and even pregnant women without symptoms can have evidence of the virus in their blood and urine.

Therefore, the updated guidance expands the use of Zika-specific blood testing for a longer period, up to 14 days, in pregnant women with symptoms and advises that pregnant women with possible Zika exposure but no symptoms receive this testing as well.

In addition, if pregnant women visit their healthcare provider after the 14-day testing window and test positive with the IgM test, rRT-PCR testing can now be offered to potentially provide a definite diagnosis.

The CDC’s new guidance also includes recommendations to help healthcare providers better care for their pregnant patients with confirmed or possible Zika infection.

Guidance for sexual transmission

This updated guidance is based on a recently reported case of female-to-male sexual transmission of the Zika virus in New York City and limited human and non-human primate data indicating that Zika virus RNA can be detected in vaginal secretions.

The guidance expands the CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person—male or female—who has traveled to or lives in an area with active Zika virus transmission.

The updated recommendations for pregnant couples include pregnant women with female sex partners who are potentially infected with Zika. The recommendations also provide advice for potentially infected women on how to reduce their risk of sexually transmitting the virus to partners.

Specifically, the CDC recommends that all pregnant women with sex partners who live in or traveled to an area with active Zika virus transmission use condoms during sex or abstain from sex for the remainder of their pregnancy.

All other couples in which a partner has been in an area with active Zika virus transmission can also reduce the risk of sexual transmission by using condoms or abstaining from sex. Sex includes vaginal, anal, and oral sex, and may also include the sharing of sex toys.

Healthcare providers should test all pregnant women who may have been exposed to Zika sexually. Providers should also test patients if they develop symptoms of the Zika virus and report potential sexual exposure to a partner who lives in or traveled to an area with active Zika virus transmission.

The CDC encourages local and state health departments to report potential cases of sexually transmitted Zika virus infection.

Pregnant woman

Photo by Nina Matthews

The US Centers for Disease Control and Prevention (CDC) has updated some of its recommendations regarding the Zika virus.

The agency issued an updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus and an updated interim guidance on preventing sexual transmission of the virus.

The CDC issued these updates based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. The CDC said it will continue to make updates as new information becomes available.

Guidance for pregnant women

This updated guidance expands the timeframe during which pregnant women can be tested for Zika virus—with an rRT-PCR test—from 7 days to 14 days after symptoms start. The CDC said this expansion will provide a definite diagnosis for more pregnant women infected with the Zika virus.

Scientists previously thought the virus stays in the blood for about a week after symptoms start. So the first week of illness was thought to be the best time to find evidence of the virus in blood using a Zika-specific test (rRT-PCR).

For patients who visited a healthcare provider more than a week after symptoms started and those who were possibly exposed to Zika but never developed symptoms, healthcare providers could perform Zika virus IgM testing. However, this test might not provide a definite diagnosis, as it can also detect related viruses.

New information has indicated that some infected pregnant women can have evidence of the Zika virus in their blood for longer than 7 days after symptoms begin, and even pregnant women without symptoms can have evidence of the virus in their blood and urine.

Therefore, the updated guidance expands the use of Zika-specific blood testing for a longer period, up to 14 days, in pregnant women with symptoms and advises that pregnant women with possible Zika exposure but no symptoms receive this testing as well.

In addition, if pregnant women visit their healthcare provider after the 14-day testing window and test positive with the IgM test, rRT-PCR testing can now be offered to potentially provide a definite diagnosis.

The CDC’s new guidance also includes recommendations to help healthcare providers better care for their pregnant patients with confirmed or possible Zika infection.

Guidance for sexual transmission

This updated guidance is based on a recently reported case of female-to-male sexual transmission of the Zika virus in New York City and limited human and non-human primate data indicating that Zika virus RNA can be detected in vaginal secretions.

The guidance expands the CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person—male or female—who has traveled to or lives in an area with active Zika virus transmission.

The updated recommendations for pregnant couples include pregnant women with female sex partners who are potentially infected with Zika. The recommendations also provide advice for potentially infected women on how to reduce their risk of sexually transmitting the virus to partners.

Specifically, the CDC recommends that all pregnant women with sex partners who live in or traveled to an area with active Zika virus transmission use condoms during sex or abstain from sex for the remainder of their pregnancy.

All other couples in which a partner has been in an area with active Zika virus transmission can also reduce the risk of sexual transmission by using condoms or abstaining from sex. Sex includes vaginal, anal, and oral sex, and may also include the sharing of sex toys.

Healthcare providers should test all pregnant women who may have been exposed to Zika sexually. Providers should also test patients if they develop symptoms of the Zika virus and report potential sexual exposure to a partner who lives in or traveled to an area with active Zika virus transmission.

The CDC encourages local and state health departments to report potential cases of sexually transmitted Zika virus infection.

Pregnant woman

Photo by Nina Matthews

The US Centers for Disease Control and Prevention (CDC) has updated some of its recommendations regarding the Zika virus.

The agency issued an updated interim guidance for healthcare providers caring for pregnant women with possible exposure to Zika virus and an updated interim guidance on preventing sexual transmission of the virus.

The CDC issued these updates based on the accumulating evidence, expert opinion, and knowledge about the risk associated with other viral infections. The CDC said it will continue to make updates as new information becomes available.

Guidance for pregnant women

This updated guidance expands the timeframe during which pregnant women can be tested for Zika virus—with an rRT-PCR test—from 7 days to 14 days after symptoms start. The CDC said this expansion will provide a definite diagnosis for more pregnant women infected with the Zika virus.

Scientists previously thought the virus stays in the blood for about a week after symptoms start. So the first week of illness was thought to be the best time to find evidence of the virus in blood using a Zika-specific test (rRT-PCR).

For patients who visited a healthcare provider more than a week after symptoms started and those who were possibly exposed to Zika but never developed symptoms, healthcare providers could perform Zika virus IgM testing. However, this test might not provide a definite diagnosis, as it can also detect related viruses.

New information has indicated that some infected pregnant women can have evidence of the Zika virus in their blood for longer than 7 days after symptoms begin, and even pregnant women without symptoms can have evidence of the virus in their blood and urine.

Therefore, the updated guidance expands the use of Zika-specific blood testing for a longer period, up to 14 days, in pregnant women with symptoms and advises that pregnant women with possible Zika exposure but no symptoms receive this testing as well.

In addition, if pregnant women visit their healthcare provider after the 14-day testing window and test positive with the IgM test, rRT-PCR testing can now be offered to potentially provide a definite diagnosis.

The CDC’s new guidance also includes recommendations to help healthcare providers better care for their pregnant patients with confirmed or possible Zika infection.

Guidance for sexual transmission

This updated guidance is based on a recently reported case of female-to-male sexual transmission of the Zika virus in New York City and limited human and non-human primate data indicating that Zika virus RNA can be detected in vaginal secretions.

The guidance expands the CDC’s definition of sexual exposure to Zika to include sex without a barrier method (including male or female condoms, among other methods) with any person—male or female—who has traveled to or lives in an area with active Zika virus transmission.

The updated recommendations for pregnant couples include pregnant women with female sex partners who are potentially infected with Zika. The recommendations also provide advice for potentially infected women on how to reduce their risk of sexually transmitting the virus to partners.

Specifically, the CDC recommends that all pregnant women with sex partners who live in or traveled to an area with active Zika virus transmission use condoms during sex or abstain from sex for the remainder of their pregnancy.

All other couples in which a partner has been in an area with active Zika virus transmission can also reduce the risk of sexual transmission by using condoms or abstaining from sex. Sex includes vaginal, anal, and oral sex, and may also include the sharing of sex toys.

Healthcare providers should test all pregnant women who may have been exposed to Zika sexually. Providers should also test patients if they develop symptoms of the Zika virus and report potential sexual exposure to a partner who lives in or traveled to an area with active Zika virus transmission.

The CDC encourages local and state health departments to report potential cases of sexually transmitted Zika virus infection.

Child in Senegal

Photo by Sarah Mattison

Combination therapy with artesunate and mefloquine can safely and effectively treat children younger than 5 years of age with uncomplicated, Plasmodium falciparum malaria, according to a phase 4 study.

Researchers compared the artesunate-mefloquine combination with artemether-lumefantrine in a group of malaria-infected children in Africa.

Both combinations produced a cure rate of about 90%, and the rates of side effects such as vomiting and neurologic events were similar.

These results were published in The Lancet Infectious Diseases.

The study included 944 African children, ages 6 months to 5 years, who tested positive for malaria.

Roughly half the children were assigned to treatment with artemether-lumefantrine (n=472), and the other half were assigned to artesunate-mefloquine (n=473). Both groups were treated for 2 or 3 days, with doses adjusted for age, not weight.

At 63 days of follow-up, the cure rates were similar between the treatment groups—89.7% for artemether-lumefantrine and 90.9% for artesunate-mefloquine. For both groups, no parasites were found in the blood at 72 hours after the start of treatment.

The rates of malaria recurrence were similar between the groups. Reinfection occurred in 43.8% of patients in the artesunate–mefloquine group and 43.0% in the artemether–lumefantrine group. Recrudescence occurred in 3.9% and 4.4%, respectively.

There were no psychiatric events in either treatment group, and the rates of neurologic events were low—2.1% in the artesunate-mefloquine group and 1.1% in the artemether-lumefantrine group.

The incidence of vomiting was 15.3% in the artesunate-mefloquine group and 16.8% in the artemether-lumefantrine group. Vomiting was a focus because it lowers patient adherence and limits how much of the medicine is absorbed.

The researchers noted that artesunate-mefloquine is not used in Africa at present, even though it’s 1 of the 5 artemisinin-based combination therapies approved for malaria treatment by the World Health Organization.

The team said the results of this study support the deployment of fixed-dose artesunate–mefloquine in young children in Africa. And the findings should have important implications for health policy in sub-Saharan Africa.

Child in Senegal

Photo by Sarah Mattison

Combination therapy with artesunate and mefloquine can safely and effectively treat children younger than 5 years of age with uncomplicated, Plasmodium falciparum malaria, according to a phase 4 study.

Researchers compared the artesunate-mefloquine combination with artemether-lumefantrine in a group of malaria-infected children in Africa.

Both combinations produced a cure rate of about 90%, and the rates of side effects such as vomiting and neurologic events were similar.

These results were published in The Lancet Infectious Diseases.

The study included 944 African children, ages 6 months to 5 years, who tested positive for malaria.

Roughly half the children were assigned to treatment with artemether-lumefantrine (n=472), and the other half were assigned to artesunate-mefloquine (n=473). Both groups were treated for 2 or 3 days, with doses adjusted for age, not weight.

At 63 days of follow-up, the cure rates were similar between the treatment groups—89.7% for artemether-lumefantrine and 90.9% for artesunate-mefloquine. For both groups, no parasites were found in the blood at 72 hours after the start of treatment.

The rates of malaria recurrence were similar between the groups. Reinfection occurred in 43.8% of patients in the artesunate–mefloquine group and 43.0% in the artemether–lumefantrine group. Recrudescence occurred in 3.9% and 4.4%, respectively.

There were no psychiatric events in either treatment group, and the rates of neurologic events were low—2.1% in the artesunate-mefloquine group and 1.1% in the artemether-lumefantrine group.

The incidence of vomiting was 15.3% in the artesunate-mefloquine group and 16.8% in the artemether-lumefantrine group. Vomiting was a focus because it lowers patient adherence and limits how much of the medicine is absorbed.

The researchers noted that artesunate-mefloquine is not used in Africa at present, even though it’s 1 of the 5 artemisinin-based combination therapies approved for malaria treatment by the World Health Organization.

The team said the results of this study support the deployment of fixed-dose artesunate–mefloquine in young children in Africa. And the findings should have important implications for health policy in sub-Saharan Africa.

Child in Senegal

Photo by Sarah Mattison

Combination therapy with artesunate and mefloquine can safely and effectively treat children younger than 5 years of age with uncomplicated, Plasmodium falciparum malaria, according to a phase 4 study.

Researchers compared the artesunate-mefloquine combination with artemether-lumefantrine in a group of malaria-infected children in Africa.

Both combinations produced a cure rate of about 90%, and the rates of side effects such as vomiting and neurologic events were similar.

These results were published in The Lancet Infectious Diseases.

The study included 944 African children, ages 6 months to 5 years, who tested positive for malaria.

Roughly half the children were assigned to treatment with artemether-lumefantrine (n=472), and the other half were assigned to artesunate-mefloquine (n=473). Both groups were treated for 2 or 3 days, with doses adjusted for age, not weight.

At 63 days of follow-up, the cure rates were similar between the treatment groups—89.7% for artemether-lumefantrine and 90.9% for artesunate-mefloquine. For both groups, no parasites were found in the blood at 72 hours after the start of treatment.

The rates of malaria recurrence were similar between the groups. Reinfection occurred in 43.8% of patients in the artesunate–mefloquine group and 43.0% in the artemether–lumefantrine group. Recrudescence occurred in 3.9% and 4.4%, respectively.

There were no psychiatric events in either treatment group, and the rates of neurologic events were low—2.1% in the artesunate-mefloquine group and 1.1% in the artemether-lumefantrine group.

The incidence of vomiting was 15.3% in the artesunate-mefloquine group and 16.8% in the artemether-lumefantrine group. Vomiting was a focus because it lowers patient adherence and limits how much of the medicine is absorbed.

The researchers noted that artesunate-mefloquine is not used in Africa at present, even though it’s 1 of the 5 artemisinin-based combination therapies approved for malaria treatment by the World Health Organization.

The team said the results of this study support the deployment of fixed-dose artesunate–mefloquine in young children in Africa. And the findings should have important implications for health policy in sub-Saharan Africa.

Chemotherapy drugs

Photo by Bill Branson

Results of a phase 3 study suggest the antipsychotic agent olanzapine can also be used to reduce nausea and vomiting caused by chemotherapy.

In this study, cancer patients receiving highly emetogenic chemotherapy also received combination anti-emetic therapy including olanzapine or placebo.

Those patients who received olanzapine were significantly less likely to experience nausea and vomiting in the 120 hours after starting chemotherapy.

These results were published in NEJM.

“We’ve long known the nausea and vomiting that come along with chemotherapy are a major problem and affect the quality of life of our patients,” said study author Steven Powell, MD, of Sanford Cancer Center in Sioux Falls, South Dakota.

“The findings of this study, fortunately, provide physicians with a tool to better address the needs of those they are treating for cancer.”

Dr Powell and his colleagues evaluated cancer patients who had received no previous chemotherapy but were receiving cisplatin or cyclophosphamide and doxorubicin during the study period.

To prevent nausea and vomiting, all of the patients received a 5-HT3–receptor antagonist, dexamethasone, and an NK1-receptor antagonist. Roughly half also received olanzapine, and the other half received placebo.

Overall, 380 patients were evaluable—192 assigned to olanzapine and 188 to placebo.

In the first 24 hours after starting chemotherapy, the proportion of patients who did not have chemotherapy-induced nausea was significantly greater in the olanzapine arm than the placebo arm—74% and 45%, respectively (P=0.002).

The same was true at 25 hours to 120 hours after the start of chemotherapy—42% and 25%, respectively (P=0.002)—and for the overall 120-hour period—37% and 22%, respectively (P=0.002).

The complete response rate—defined as no vomiting and no rescue therapy—was significantly higher in the olanzapine arm than the placebo arm in the first 24 hours—86% and 65% (P<0.001)—at 25 hours to 120 hours—67% and 52%, respectively (P=0.007)—and overall—64% and 41%, respectively (P<0.001).

There were two grade 3 adverse events and three grade 4 adverse events in the olanzapine arm, but none of these were attributed to olanzapine.

Patients in the olanzapine arm had significantly increased sedation on day 2 compared with baseline, but this resolved on days 3, 4, and 5, although the patients were still receiving olanzapine on days 3 and 4.

Chemotherapy drugs

Photo by Bill Branson

Results of a phase 3 study suggest the antipsychotic agent olanzapine can also be used to reduce nausea and vomiting caused by chemotherapy.

In this study, cancer patients receiving highly emetogenic chemotherapy also received combination anti-emetic therapy including olanzapine or placebo.

Those patients who received olanzapine were significantly less likely to experience nausea and vomiting in the 120 hours after starting chemotherapy.

These results were published in NEJM.

“We’ve long known the nausea and vomiting that come along with chemotherapy are a major problem and affect the quality of life of our patients,” said study author Steven Powell, MD, of Sanford Cancer Center in Sioux Falls, South Dakota.

“The findings of this study, fortunately, provide physicians with a tool to better address the needs of those they are treating for cancer.”

Dr Powell and his colleagues evaluated cancer patients who had received no previous chemotherapy but were receiving cisplatin or cyclophosphamide and doxorubicin during the study period.

To prevent nausea and vomiting, all of the patients received a 5-HT3–receptor antagonist, dexamethasone, and an NK1-receptor antagonist. Roughly half also received olanzapine, and the other half received placebo.

Overall, 380 patients were evaluable—192 assigned to olanzapine and 188 to placebo.

In the first 24 hours after starting chemotherapy, the proportion of patients who did not have chemotherapy-induced nausea was significantly greater in the olanzapine arm than the placebo arm—74% and 45%, respectively (P=0.002).

The same was true at 25 hours to 120 hours after the start of chemotherapy—42% and 25%, respectively (P=0.002)—and for the overall 120-hour period—37% and 22%, respectively (P=0.002).

The complete response rate—defined as no vomiting and no rescue therapy—was significantly higher in the olanzapine arm than the placebo arm in the first 24 hours—86% and 65% (P<0.001)—at 25 hours to 120 hours—67% and 52%, respectively (P=0.007)—and overall—64% and 41%, respectively (P<0.001).

There were two grade 3 adverse events and three grade 4 adverse events in the olanzapine arm, but none of these were attributed to olanzapine.

Patients in the olanzapine arm had significantly increased sedation on day 2 compared with baseline, but this resolved on days 3, 4, and 5, although the patients were still receiving olanzapine on days 3 and 4.

Chemotherapy drugs

Photo by Bill Branson

Results of a phase 3 study suggest the antipsychotic agent olanzapine can also be used to reduce nausea and vomiting caused by chemotherapy.

In this study, cancer patients receiving highly emetogenic chemotherapy also received combination anti-emetic therapy including olanzapine or placebo.

Those patients who received olanzapine were significantly less likely to experience nausea and vomiting in the 120 hours after starting chemotherapy.

These results were published in NEJM.

“We’ve long known the nausea and vomiting that come along with chemotherapy are a major problem and affect the quality of life of our patients,” said study author Steven Powell, MD, of Sanford Cancer Center in Sioux Falls, South Dakota.

“The findings of this study, fortunately, provide physicians with a tool to better address the needs of those they are treating for cancer.”

Dr Powell and his colleagues evaluated cancer patients who had received no previous chemotherapy but were receiving cisplatin or cyclophosphamide and doxorubicin during the study period.

To prevent nausea and vomiting, all of the patients received a 5-HT3–receptor antagonist, dexamethasone, and an NK1-receptor antagonist. Roughly half also received olanzapine, and the other half received placebo.

Overall, 380 patients were evaluable—192 assigned to olanzapine and 188 to placebo.

In the first 24 hours after starting chemotherapy, the proportion of patients who did not have chemotherapy-induced nausea was significantly greater in the olanzapine arm than the placebo arm—74% and 45%, respectively (P=0.002).

The same was true at 25 hours to 120 hours after the start of chemotherapy—42% and 25%, respectively (P=0.002)—and for the overall 120-hour period—37% and 22%, respectively (P=0.002).

The complete response rate—defined as no vomiting and no rescue therapy—was significantly higher in the olanzapine arm than the placebo arm in the first 24 hours—86% and 65% (P<0.001)—at 25 hours to 120 hours—67% and 52%, respectively (P=0.007)—and overall—64% and 41%, respectively (P<0.001).

There were two grade 3 adverse events and three grade 4 adverse events in the olanzapine arm, but none of these were attributed to olanzapine.

Patients in the olanzapine arm had significantly increased sedation on day 2 compared with baseline, but this resolved on days 3, 4, and 5, although the patients were still receiving olanzapine on days 3 and 4.

Scanning electron

micrograph of a T cell

Image from NIAID

The “asymmetric division” of T cells could provide new ways to enhance cancer immunotherapy, according to researchers.

When a T cell divides, the activity of the enzyme mTORC1, which controls protein production, splits unevenly between the progeny.

Results of a new study suggest this uneven division reprograms the daughter cells so that one goes on to become an effector T cell and the other becomes a memory T cell.

This study was published in Nature Immunology.

“One of the critical steps needed to improve cancer immunotherapy, in general, is finding out ways to make antitumor T cells persist or hang around in the body longer,” said study author Jonathan Powell, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland.

With that in mind, Dr Powell and his colleagues analyzed murine T cells. They found that when a “mother” T cell that is naïve to immune threats encounters such a threat and divides, one of its daughter cells inherits far more mTORC1 activity than the other daughter cell.

The researchers activated mouse T cells using a virus. Once the T cells divided, the team used antibodies to detect mTORC1 activity in each of the daughter cells.

Then, the researchers sorted the daughter cells and examined their function by injecting them into mice given two identical infections and tracking the cells’ activity.

The team found the difference in mTORC1 activity levels between the daughter cells varied depending on the population of cells studied.

And the lopsided distribution of mTORC1 activity appeared to reprogram the use of energy and other metabolic activities of each daughter cell.

The cells with high levels of mTORC1 activity were found to be potently activated, killer/effector T cells, while the cells with low mTORC1 levels behaved like memory T cells, persisting for long periods of time and rapidly activating upon reinfection.

The researchers said this finding could be used to improve immunotherapy, but another aspect of this discovery is the prospect that asymmetric partitioning of mTORC1 might be widespread across cells in many biological systems.

Dr Powell said it’s possible the mechanism may help explain how stem cells develop into more specialized cells in the bone marrow, for instance, or how cells differentiate to become hair, skin, or brain cells in a growing embryo.

“We think there will be implications for biology well beyond the immune system,” he concluded.

Scanning electron

micrograph of a T cell

Image from NIAID

The “asymmetric division” of T cells could provide new ways to enhance cancer immunotherapy, according to researchers.

When a T cell divides, the activity of the enzyme mTORC1, which controls protein production, splits unevenly between the progeny.

Results of a new study suggest this uneven division reprograms the daughter cells so that one goes on to become an effector T cell and the other becomes a memory T cell.

This study was published in Nature Immunology.

“One of the critical steps needed to improve cancer immunotherapy, in general, is finding out ways to make antitumor T cells persist or hang around in the body longer,” said study author Jonathan Powell, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland.

With that in mind, Dr Powell and his colleagues analyzed murine T cells. They found that when a “mother” T cell that is naïve to immune threats encounters such a threat and divides, one of its daughter cells inherits far more mTORC1 activity than the other daughter cell.

The researchers activated mouse T cells using a virus. Once the T cells divided, the team used antibodies to detect mTORC1 activity in each of the daughter cells.

Then, the researchers sorted the daughter cells and examined their function by injecting them into mice given two identical infections and tracking the cells’ activity.

The team found the difference in mTORC1 activity levels between the daughter cells varied depending on the population of cells studied.

And the lopsided distribution of mTORC1 activity appeared to reprogram the use of energy and other metabolic activities of each daughter cell.

The cells with high levels of mTORC1 activity were found to be potently activated, killer/effector T cells, while the cells with low mTORC1 levels behaved like memory T cells, persisting for long periods of time and rapidly activating upon reinfection.

The researchers said this finding could be used to improve immunotherapy, but another aspect of this discovery is the prospect that asymmetric partitioning of mTORC1 might be widespread across cells in many biological systems.

Dr Powell said it’s possible the mechanism may help explain how stem cells develop into more specialized cells in the bone marrow, for instance, or how cells differentiate to become hair, skin, or brain cells in a growing embryo.

“We think there will be implications for biology well beyond the immune system,” he concluded.

Scanning electron

micrograph of a T cell

Image from NIAID

The “asymmetric division” of T cells could provide new ways to enhance cancer immunotherapy, according to researchers.

When a T cell divides, the activity of the enzyme mTORC1, which controls protein production, splits unevenly between the progeny.

Results of a new study suggest this uneven division reprograms the daughter cells so that one goes on to become an effector T cell and the other becomes a memory T cell.

This study was published in Nature Immunology.

“One of the critical steps needed to improve cancer immunotherapy, in general, is finding out ways to make antitumor T cells persist or hang around in the body longer,” said study author Jonathan Powell, MD, PhD, of the Johns Hopkins University School of Medicine in Baltimore, Maryland.

With that in mind, Dr Powell and his colleagues analyzed murine T cells. They found that when a “mother” T cell that is naïve to immune threats encounters such a threat and divides, one of its daughter cells inherits far more mTORC1 activity than the other daughter cell.

The researchers activated mouse T cells using a virus. Once the T cells divided, the team used antibodies to detect mTORC1 activity in each of the daughter cells.

Then, the researchers sorted the daughter cells and examined their function by injecting them into mice given two identical infections and tracking the cells’ activity.

The team found the difference in mTORC1 activity levels between the daughter cells varied depending on the population of cells studied.

And the lopsided distribution of mTORC1 activity appeared to reprogram the use of energy and other metabolic activities of each daughter cell.

The cells with high levels of mTORC1 activity were found to be potently activated, killer/effector T cells, while the cells with low mTORC1 levels behaved like memory T cells, persisting for long periods of time and rapidly activating upon reinfection.

The researchers said this finding could be used to improve immunotherapy, but another aspect of this discovery is the prospect that asymmetric partitioning of mTORC1 might be widespread across cells in many biological systems.

Dr Powell said it’s possible the mechanism may help explain how stem cells develop into more specialized cells in the bone marrow, for instance, or how cells differentiate to become hair, skin, or brain cells in a growing embryo.

“We think there will be implications for biology well beyond the immune system,” he concluded.

Red and white blood cells

The US Food and Drug Administration has granted 510(k) clearance for the GloCyte Automated Cell Counter System and GloCyte Low and High Level Controls.

The GloCyte Automated Cell Counter System is intended for use by trained healthcare professionals in clinical laboratories to quantify red blood cells (RBCs) and total nucleated cells (TNCs) in cerebrospinal fluid collected from adult and pediatric patients.

Low and High Level Controls are assayed hematology controls designed to monitor the performance of the GloCyte system.

The GloCyte system is designed to provide accurate cell counts at clinically relevant low levels to assist the diagnosis of infections, inflammatory processes, hemorrhage, leukemia, and malignancies that may involve the central nervous system.

“To date, there has not been a way to provide dependable, low cell counts,” said John Coughlin, president and CEO of Advanced Instruments, Inc., makers of the GloCyte system.

“We use a novel combination of fluorescence, microscopy with digital image analysis principles, highly specific reagents, and an intelligent counting algorithm to provide accurate and precise cell counts.”

The GloCyte system includes the GloCyte instrument, computer (hardware and software), vacuum station, sample preparation tray, barcode reader, pipettes (10 and 30 μL), test cartridge, TNC and RBC reagents, and Low and High Level Controls.

The test method uses 1 of 2 reagents to stain TNCs (propidium iodide with detergent) or RBCs (fluorochrome labeled anti-human RBC antibody in buffer with stabilizers) and a digital imaging system to count the cells. The image is captured by a digital CCD camera, and the fluorescent stained cells are counted via digital image processing.

The GloCyte system requires 30 μL of sample per test, and it uses disposable test cartridges to ensure no sample carryover. The system also includes Levey-Jennings charts and an audit table.

Advanced Instruments expects to begin shipping the GloCyte system in September. For more information about the system, visit aicompanies.com/glocyte.

Red and white blood cells

The US Food and Drug Administration has granted 510(k) clearance for the GloCyte Automated Cell Counter System and GloCyte Low and High Level Controls.

The GloCyte Automated Cell Counter System is intended for use by trained healthcare professionals in clinical laboratories to quantify red blood cells (RBCs) and total nucleated cells (TNCs) in cerebrospinal fluid collected from adult and pediatric patients.

Low and High Level Controls are assayed hematology controls designed to monitor the performance of the GloCyte system.

The GloCyte system is designed to provide accurate cell counts at clinically relevant low levels to assist the diagnosis of infections, inflammatory processes, hemorrhage, leukemia, and malignancies that may involve the central nervous system.

“To date, there has not been a way to provide dependable, low cell counts,” said John Coughlin, president and CEO of Advanced Instruments, Inc., makers of the GloCyte system.

“We use a novel combination of fluorescence, microscopy with digital image analysis principles, highly specific reagents, and an intelligent counting algorithm to provide accurate and precise cell counts.”

The GloCyte system includes the GloCyte instrument, computer (hardware and software), vacuum station, sample preparation tray, barcode reader, pipettes (10 and 30 μL), test cartridge, TNC and RBC reagents, and Low and High Level Controls.

The test method uses 1 of 2 reagents to stain TNCs (propidium iodide with detergent) or RBCs (fluorochrome labeled anti-human RBC antibody in buffer with stabilizers) and a digital imaging system to count the cells. The image is captured by a digital CCD camera, and the fluorescent stained cells are counted via digital image processing.

The GloCyte system requires 30 μL of sample per test, and it uses disposable test cartridges to ensure no sample carryover. The system also includes Levey-Jennings charts and an audit table.

Advanced Instruments expects to begin shipping the GloCyte system in September. For more information about the system, visit aicompanies.com/glocyte.

Red and white blood cells

The US Food and Drug Administration has granted 510(k) clearance for the GloCyte Automated Cell Counter System and GloCyte Low and High Level Controls.

The GloCyte Automated Cell Counter System is intended for use by trained healthcare professionals in clinical laboratories to quantify red blood cells (RBCs) and total nucleated cells (TNCs) in cerebrospinal fluid collected from adult and pediatric patients.

Low and High Level Controls are assayed hematology controls designed to monitor the performance of the GloCyte system.

The GloCyte system is designed to provide accurate cell counts at clinically relevant low levels to assist the diagnosis of infections, inflammatory processes, hemorrhage, leukemia, and malignancies that may involve the central nervous system.

“To date, there has not been a way to provide dependable, low cell counts,” said John Coughlin, president and CEO of Advanced Instruments, Inc., makers of the GloCyte system.

“We use a novel combination of fluorescence, microscopy with digital image analysis principles, highly specific reagents, and an intelligent counting algorithm to provide accurate and precise cell counts.”

The GloCyte system includes the GloCyte instrument, computer (hardware and software), vacuum station, sample preparation tray, barcode reader, pipettes (10 and 30 μL), test cartridge, TNC and RBC reagents, and Low and High Level Controls.

The test method uses 1 of 2 reagents to stain TNCs (propidium iodide with detergent) or RBCs (fluorochrome labeled anti-human RBC antibody in buffer with stabilizers) and a digital imaging system to count the cells. The image is captured by a digital CCD camera, and the fluorescent stained cells are counted via digital image processing.

The GloCyte system requires 30 μL of sample per test, and it uses disposable test cartridges to ensure no sample carryover. The system also includes Levey-Jennings charts and an audit table.

Advanced Instruments expects to begin shipping the GloCyte system in September. For more information about the system, visit aicompanies.com/glocyte.

Doctor consults with cancer

patient and her father

Photo by Rhoda Baer

In a survey of advanced cancer patients and their oncologists, differing opinions about prognosis were common.

And the vast majority of patients didn’t know their doctors held different opinions about how long the patients might live.

Results of the survey were published in JAMA Oncology.

“We’ve discovered 2 important things happening between oncologists and patients with advanced cancer,” said study author Ronald M. Epstein, MD, of the University of Rochester Medical Center in Rochester, New York.

“First, some patients might know the doctor’s prognosis estimate, but the patient chooses to disagree, often because they believe other sources. And, second, some patients think that their doctor agrees with their opinion about prognosis but, in fact, the doctor doesn’t.”

Dr Epstein and his colleagues surveyed 236 patients with stage 3 or 4 cancer. According to medical evidence, fewer than 5% of these patients would be expected to live for 5 years.

The 38 oncologists who treated these patients were also surveyed. The doctors were asked,“What do you believe are the chances that this patient will live for 2 years or more?” And the patients were asked, “What do you believe are the chances that you will live for 2 years or more?”

Additional survey questions gauged whether patients knew their prognosis opinions differed from their doctors and to what extent treatment options were discussed in the context of life expectancy.

Among the 236 patients, 68% rated their survival prognosis differently than their oncologists, and 89% of these patients did not realize their opinions differed from their oncologists. In nearly all cases (96%), the patients were more optimistic than their doctors.

“Of course, it’s only possible for doctors to provide a ball-park estimate about life expectancy, and some people do beat the odds,” Dr Epstein noted. “But when a patient with very advanced cancer says that he has a 90% to 100% chance of being alive in 2 years and his oncologist believes that chance is more like 10%, there’s a problem.”

The challenge, according to Dr Epstein and his colleagues, is that talking about a cancer prognosis is not a straightforward exchange of information. It occurs in the context of fear, confusion, and uncertainty.

The researchers said prognosis should be addressed in several conversations about personal values and treatment goals. When doctor-patient communication is poor, it can result in mutual regret about end-of-life circumstances.

For example, nearly all of the patients surveyed said they wanted to be involved in treatment decisions. And 70% said they preferred supportive care at the end of their lives as opposed to aggressive therapy. However, as the researchers pointed out, making an informed decision requires knowing when death is approaching.

“When people think they’ll live a very long time with cancer, despite evidence to the contrary, they may end up taking more aggressive chemotherapy and agreeing to be placed on ventilators or dialysis, paradoxically reducing their quality of life, keeping them from enjoying time with family, and sometimes even shortening their lives,” Dr Epstein said. “So it’s very important for doctors and patients to be on the same page.”

Doctor consults with cancer

patient and her father

Photo by Rhoda Baer

In a survey of advanced cancer patients and their oncologists, differing opinions about prognosis were common.

And the vast majority of patients didn’t know their doctors held different opinions about how long the patients might live.

Results of the survey were published in JAMA Oncology.

“We’ve discovered 2 important things happening between oncologists and patients with advanced cancer,” said study author Ronald M. Epstein, MD, of the University of Rochester Medical Center in Rochester, New York.

“First, some patients might know the doctor’s prognosis estimate, but the patient chooses to disagree, often because they believe other sources. And, second, some patients think that their doctor agrees with their opinion about prognosis but, in fact, the doctor doesn’t.”

Dr Epstein and his colleagues surveyed 236 patients with stage 3 or 4 cancer. According to medical evidence, fewer than 5% of these patients would be expected to live for 5 years.

The 38 oncologists who treated these patients were also surveyed. The doctors were asked,“What do you believe are the chances that this patient will live for 2 years or more?” And the patients were asked, “What do you believe are the chances that you will live for 2 years or more?”

Additional survey questions gauged whether patients knew their prognosis opinions differed from their doctors and to what extent treatment options were discussed in the context of life expectancy.

Among the 236 patients, 68% rated their survival prognosis differently than their oncologists, and 89% of these patients did not realize their opinions differed from their oncologists. In nearly all cases (96%), the patients were more optimistic than their doctors.

“Of course, it’s only possible for doctors to provide a ball-park estimate about life expectancy, and some people do beat the odds,” Dr Epstein noted. “But when a patient with very advanced cancer says that he has a 90% to 100% chance of being alive in 2 years and his oncologist believes that chance is more like 10%, there’s a problem.”

The challenge, according to Dr Epstein and his colleagues, is that talking about a cancer prognosis is not a straightforward exchange of information. It occurs in the context of fear, confusion, and uncertainty.

The researchers said prognosis should be addressed in several conversations about personal values and treatment goals. When doctor-patient communication is poor, it can result in mutual regret about end-of-life circumstances.

For example, nearly all of the patients surveyed said they wanted to be involved in treatment decisions. And 70% said they preferred supportive care at the end of their lives as opposed to aggressive therapy. However, as the researchers pointed out, making an informed decision requires knowing when death is approaching.

“When people think they’ll live a very long time with cancer, despite evidence to the contrary, they may end up taking more aggressive chemotherapy and agreeing to be placed on ventilators or dialysis, paradoxically reducing their quality of life, keeping them from enjoying time with family, and sometimes even shortening their lives,” Dr Epstein said. “So it’s very important for doctors and patients to be on the same page.”

Doctor consults with cancer

patient and her father

Photo by Rhoda Baer

In a survey of advanced cancer patients and their oncologists, differing opinions about prognosis were common.

And the vast majority of patients didn’t know their doctors held different opinions about how long the patients might live.

Results of the survey were published in JAMA Oncology.

“We’ve discovered 2 important things happening between oncologists and patients with advanced cancer,” said study author Ronald M. Epstein, MD, of the University of Rochester Medical Center in Rochester, New York.

“First, some patients might know the doctor’s prognosis estimate, but the patient chooses to disagree, often because they believe other sources. And, second, some patients think that their doctor agrees with their opinion about prognosis but, in fact, the doctor doesn’t.”

Dr Epstein and his colleagues surveyed 236 patients with stage 3 or 4 cancer. According to medical evidence, fewer than 5% of these patients would be expected to live for 5 years.

The 38 oncologists who treated these patients were also surveyed. The doctors were asked,“What do you believe are the chances that this patient will live for 2 years or more?” And the patients were asked, “What do you believe are the chances that you will live for 2 years or more?”

Additional survey questions gauged whether patients knew their prognosis opinions differed from their doctors and to what extent treatment options were discussed in the context of life expectancy.

Among the 236 patients, 68% rated their survival prognosis differently than their oncologists, and 89% of these patients did not realize their opinions differed from their oncologists. In nearly all cases (96%), the patients were more optimistic than their doctors.

“Of course, it’s only possible for doctors to provide a ball-park estimate about life expectancy, and some people do beat the odds,” Dr Epstein noted. “But when a patient with very advanced cancer says that he has a 90% to 100% chance of being alive in 2 years and his oncologist believes that chance is more like 10%, there’s a problem.”

The challenge, according to Dr Epstein and his colleagues, is that talking about a cancer prognosis is not a straightforward exchange of information. It occurs in the context of fear, confusion, and uncertainty.

The researchers said prognosis should be addressed in several conversations about personal values and treatment goals. When doctor-patient communication is poor, it can result in mutual regret about end-of-life circumstances.

For example, nearly all of the patients surveyed said they wanted to be involved in treatment decisions. And 70% said they preferred supportive care at the end of their lives as opposed to aggressive therapy. However, as the researchers pointed out, making an informed decision requires knowing when death is approaching.

“When people think they’ll live a very long time with cancer, despite evidence to the contrary, they may end up taking more aggressive chemotherapy and agreeing to be placed on ventilators or dialysis, paradoxically reducing their quality of life, keeping them from enjoying time with family, and sometimes even shortening their lives,” Dr Epstein said. “So it’s very important for doctors and patients to be on the same page.”

Woman on a scale

A study of more than 400 women suggests that losing weight can reduce levels of cancer-promoting proteins in the blood.

Overweight or obese women who lost weight over a 12-month period—through diet alone or both diet and exercise—significantly lowered their levels of proteins that play a role in angiogenesis.

Researchers say this finding suggests that losing weight might help reduce the risk of developing certain cancers.

“We know that being overweight and having a sedentary lifestyle is associated with an increase in risk for developing certain types of cancer,” said Catherine Duggan, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington.

“However, we don’t know exactly why. We wanted to investigate how levels of some biomarkers associated with angiogenesis were altered when overweight, sedentary, postmenopausal women enrolled in a research study lost weight and/or became physically active over the course of a year.”

Dr Duggan and her colleagues described this investigation in Cancer Research.

The team studied 439 women who were postmenopausal and overweight or obese but were otherwise healthy and ranged in age from 50 to 75.

The women were randomized to 1 of 4 study arms:

• A diet arm, in which women restricted their calorie intake to no more than 2000 kcal per day that included less than 30% of fat calories
• An aerobic exercise arm, in which women performed 45 minutes of moderate to vigorous exercise 5 days a week
• A combined diet and exercise arm
• A control arm.

The researchers collected blood samples at baseline and at 12 months, measuring levels of the angiogenesis-related proteins VEGF, PAI-1, and PEDF.

They also measured weight loss at 12 months and found that women in all 3 intervention arms had a significantly higher mean weight loss than women in the control arm.

The mean weight loss was 0.8% of body weight for women in the control arm, 2.4% for women in the exercise arm (P=0.03), 8.5% for women in the diet arm (P<0.001), and 10.8% for women in the diet and exercise arm (P<0.001).

Compared with women in the control arm, those in the diet-only arm and the diet and exercise arm had significantly lower levels of the angiogenesis-related proteins at 12 months. However, such effects were not apparent among women in the exercise-only arm.

Specifically, women in the diet and exercise arm had a significantly greater reduction in PAI-1 at 12 months than women in the control arm (-19.3% and +3.48%, respectively, P<0.0001).

Women in the diet-only arm and the diet and exercise arm had significantly greater reductions in PEDF than controls (-9.20%, -9.90%, and +0.18%, respectively, both P<0.0001).

And women in the diet-only arm (-8.25%, P=0.0005) and the diet and exercise arm (-9.98%, P<0.0001) had significantly greater reductions in VEGF than controls (-1.21%).

The researchers also observed a linear trend in the reductions. So the more weight loss the women experienced, the greater the reduction in angiogenesis-related protein levels.

“Our study shows that weight loss is a safe and effective method of improving the angiogenic profile in healthy individuals,” Dr Duggan said. “We were surprised by the magnitude of change in these biomarkers with weight loss.”

“While we can’t say for certain that reducing the circulating levels of angiogenic factors through weight loss would impact the growth of tumors, it is possible that they might be associated with a less favorable milieu for tumor growth and proliferation.”

Dr Duggan and her colleagues said limitations of this study include the fact that the researchers only measured 3 angiogenic factors and did not measure them in adipose or other tissues.

Woman on a scale

A study of more than 400 women suggests that losing weight can reduce levels of cancer-promoting proteins in the blood.

Overweight or obese women who lost weight over a 12-month period—through diet alone or both diet and exercise—significantly lowered their levels of proteins that play a role in angiogenesis.

Researchers say this finding suggests that losing weight might help reduce the risk of developing certain cancers.

“We know that being overweight and having a sedentary lifestyle is associated with an increase in risk for developing certain types of cancer,” said Catherine Duggan, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington.

“However, we don’t know exactly why. We wanted to investigate how levels of some biomarkers associated with angiogenesis were altered when overweight, sedentary, postmenopausal women enrolled in a research study lost weight and/or became physically active over the course of a year.”

Dr Duggan and her colleagues described this investigation in Cancer Research.

The team studied 439 women who were postmenopausal and overweight or obese but were otherwise healthy and ranged in age from 50 to 75.

The women were randomized to 1 of 4 study arms:

• A diet arm, in which women restricted their calorie intake to no more than 2000 kcal per day that included less than 30% of fat calories
• An aerobic exercise arm, in which women performed 45 minutes of moderate to vigorous exercise 5 days a week
• A combined diet and exercise arm
• A control arm.

The researchers collected blood samples at baseline and at 12 months, measuring levels of the angiogenesis-related proteins VEGF, PAI-1, and PEDF.

They also measured weight loss at 12 months and found that women in all 3 intervention arms had a significantly higher mean weight loss than women in the control arm.

The mean weight loss was 0.8% of body weight for women in the control arm, 2.4% for women in the exercise arm (P=0.03), 8.5% for women in the diet arm (P<0.001), and 10.8% for women in the diet and exercise arm (P<0.001).

Compared with women in the control arm, those in the diet-only arm and the diet and exercise arm had significantly lower levels of the angiogenesis-related proteins at 12 months. However, such effects were not apparent among women in the exercise-only arm.

Specifically, women in the diet and exercise arm had a significantly greater reduction in PAI-1 at 12 months than women in the control arm (-19.3% and +3.48%, respectively, P<0.0001).

Women in the diet-only arm and the diet and exercise arm had significantly greater reductions in PEDF than controls (-9.20%, -9.90%, and +0.18%, respectively, both P<0.0001).

And women in the diet-only arm (-8.25%, P=0.0005) and the diet and exercise arm (-9.98%, P<0.0001) had significantly greater reductions in VEGF than controls (-1.21%).

The researchers also observed a linear trend in the reductions. So the more weight loss the women experienced, the greater the reduction in angiogenesis-related protein levels.

“Our study shows that weight loss is a safe and effective method of improving the angiogenic profile in healthy individuals,” Dr Duggan said. “We were surprised by the magnitude of change in these biomarkers with weight loss.”

“While we can’t say for certain that reducing the circulating levels of angiogenic factors through weight loss would impact the growth of tumors, it is possible that they might be associated with a less favorable milieu for tumor growth and proliferation.”

Dr Duggan and her colleagues said limitations of this study include the fact that the researchers only measured 3 angiogenic factors and did not measure them in adipose or other tissues.

Woman on a scale

A study of more than 400 women suggests that losing weight can reduce levels of cancer-promoting proteins in the blood.

Overweight or obese women who lost weight over a 12-month period—through diet alone or both diet and exercise—significantly lowered their levels of proteins that play a role in angiogenesis.

Researchers say this finding suggests that losing weight might help reduce the risk of developing certain cancers.

“We know that being overweight and having a sedentary lifestyle is associated with an increase in risk for developing certain types of cancer,” said Catherine Duggan, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, Washington.

“However, we don’t know exactly why. We wanted to investigate how levels of some biomarkers associated with angiogenesis were altered when overweight, sedentary, postmenopausal women enrolled in a research study lost weight and/or became physically active over the course of a year.”

Dr Duggan and her colleagues described this investigation in Cancer Research.

The team studied 439 women who were postmenopausal and overweight or obese but were otherwise healthy and ranged in age from 50 to 75.

The women were randomized to 1 of 4 study arms:

• A diet arm, in which women restricted their calorie intake to no more than 2000 kcal per day that included less than 30% of fat calories
• An aerobic exercise arm, in which women performed 45 minutes of moderate to vigorous exercise 5 days a week
• A combined diet and exercise arm
• A control arm.

The researchers collected blood samples at baseline and at 12 months, measuring levels of the angiogenesis-related proteins VEGF, PAI-1, and PEDF.

They also measured weight loss at 12 months and found that women in all 3 intervention arms had a significantly higher mean weight loss than women in the control arm.

The mean weight loss was 0.8% of body weight for women in the control arm, 2.4% for women in the exercise arm (P=0.03), 8.5% for women in the diet arm (P<0.001), and 10.8% for women in the diet and exercise arm (P<0.001).

Compared with women in the control arm, those in the diet-only arm and the diet and exercise arm had significantly lower levels of the angiogenesis-related proteins at 12 months. However, such effects were not apparent among women in the exercise-only arm.

Specifically, women in the diet and exercise arm had a significantly greater reduction in PAI-1 at 12 months than women in the control arm (-19.3% and +3.48%, respectively, P<0.0001).

Women in the diet-only arm and the diet and exercise arm had significantly greater reductions in PEDF than controls (-9.20%, -9.90%, and +0.18%, respectively, both P<0.0001).

And women in the diet-only arm (-8.25%, P=0.0005) and the diet and exercise arm (-9.98%, P<0.0001) had significantly greater reductions in VEGF than controls (-1.21%).

The researchers also observed a linear trend in the reductions. So the more weight loss the women experienced, the greater the reduction in angiogenesis-related protein levels.

“Our study shows that weight loss is a safe and effective method of improving the angiogenic profile in healthy individuals,” Dr Duggan said. “We were surprised by the magnitude of change in these biomarkers with weight loss.”

“While we can’t say for certain that reducing the circulating levels of angiogenic factors through weight loss would impact the growth of tumors, it is possible that they might be associated with a less favorable milieu for tumor growth and proliferation.”

Dr Duggan and her colleagues said limitations of this study include the fact that the researchers only measured 3 angiogenic factors and did not measure them in adipose or other tissues.

Kids in Kenya

Photo by Gabrielle Tenenbaum

Progress in reducing the malaria burden in Africa may have had the paradoxical effect of increasing malaria transmission among older children in recent years, according to research published in PLOS Medicine.

Researchers analyzed data on children admitted to a hospital in Kenya over a 25-year period and found that malaria transmission decreased from 1998 to 2009 but began to rise after that, and older children accounted for most of this increase.

The researchers believe this may be a result of a decrease in acquired immunity among the older children.

Philip Bejon, PhD, of the University of Oxford in the UK, and his colleagues conducted this study. The team analyzed malaria screening data from pediatric emergency admissions to Kilifi County Hospital between 1990 and 2014 and linked it to data on residence and insecticide-treated bednet (ITN) use.

During the period studied, 69,104 children, ages 3 months to 13 years, had malaria screening data available.

The proportion of hospital admissions found positive for malaria decreased from a high of 56% in 1998 to a low of 7% in 2009, but then rose again to 24% in 2014.

The researchers said they were unable to determine the cause of the decline in malaria infections between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use in the area.

However, they noted that the subsequent increases in malaria infections coincided with a shift in burden from younger to older children, and children who lived in areas with high usage of ITNs were less likely to present with malaria than children who lived in areas with low usage of ITNs.

The researchers said the upswing in malaria transmission among older children following a period of low malaria transmission may be due to decreased acquired immunity because these children were less likely to have been exposed to malaria early in life.

The team also noted that varying levels of access to care and ITN use may have introduced bias in this study, and these data were taken from a single geographic setting. However, they still believe the findings suggest malaria elimination will require continued—and increasing—vigilance.

Kids in Kenya

Photo by Gabrielle Tenenbaum

Progress in reducing the malaria burden in Africa may have had the paradoxical effect of increasing malaria transmission among older children in recent years, according to research published in PLOS Medicine.

Researchers analyzed data on children admitted to a hospital in Kenya over a 25-year period and found that malaria transmission decreased from 1998 to 2009 but began to rise after that, and older children accounted for most of this increase.

The researchers believe this may be a result of a decrease in acquired immunity among the older children.

Philip Bejon, PhD, of the University of Oxford in the UK, and his colleagues conducted this study. The team analyzed malaria screening data from pediatric emergency admissions to Kilifi County Hospital between 1990 and 2014 and linked it to data on residence and insecticide-treated bednet (ITN) use.

During the period studied, 69,104 children, ages 3 months to 13 years, had malaria screening data available.

The proportion of hospital admissions found positive for malaria decreased from a high of 56% in 1998 to a low of 7% in 2009, but then rose again to 24% in 2014.

The researchers said they were unable to determine the cause of the decline in malaria infections between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use in the area.

However, they noted that the subsequent increases in malaria infections coincided with a shift in burden from younger to older children, and children who lived in areas with high usage of ITNs were less likely to present with malaria than children who lived in areas with low usage of ITNs.

The researchers said the upswing in malaria transmission among older children following a period of low malaria transmission may be due to decreased acquired immunity because these children were less likely to have been exposed to malaria early in life.

The team also noted that varying levels of access to care and ITN use may have introduced bias in this study, and these data were taken from a single geographic setting. However, they still believe the findings suggest malaria elimination will require continued—and increasing—vigilance.

Kids in Kenya

Photo by Gabrielle Tenenbaum

Progress in reducing the malaria burden in Africa may have had the paradoxical effect of increasing malaria transmission among older children in recent years, according to research published in PLOS Medicine.

Researchers analyzed data on children admitted to a hospital in Kenya over a 25-year period and found that malaria transmission decreased from 1998 to 2009 but began to rise after that, and older children accounted for most of this increase.

The researchers believe this may be a result of a decrease in acquired immunity among the older children.

Philip Bejon, PhD, of the University of Oxford in the UK, and his colleagues conducted this study. The team analyzed malaria screening data from pediatric emergency admissions to Kilifi County Hospital between 1990 and 2014 and linked it to data on residence and insecticide-treated bednet (ITN) use.

During the period studied, 69,104 children, ages 3 months to 13 years, had malaria screening data available.

The proportion of hospital admissions found positive for malaria decreased from a high of 56% in 1998 to a low of 7% in 2009, but then rose again to 24% in 2014.

The researchers said they were unable to determine the cause of the decline in malaria infections between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use in the area.

However, they noted that the subsequent increases in malaria infections coincided with a shift in burden from younger to older children, and children who lived in areas with high usage of ITNs were less likely to present with malaria than children who lived in areas with low usage of ITNs.

The researchers said the upswing in malaria transmission among older children following a period of low malaria transmission may be due to decreased acquired immunity because these children were less likely to have been exposed to malaria early in life.

The team also noted that varying levels of access to care and ITN use may have introduced bias in this study, and these data were taken from a single geographic setting. However, they still believe the findings suggest malaria elimination will require continued—and increasing—vigilance.