Monthly Archives: March 2002

Self-Hypnosis may cut stress, Boost Immune System

  • 7/24/2002
  • New York
  • Rueters Health

A number of studies have suggested stress can hinder the body’s immune system defenses. Now researchers say people may be able to fight back with the stress-relieving techniques of self-hypnosis. In a study of medical students under exam-time stress, investigators found that those who received “hypnotic-relaxation training” did not show the same reduction in key immune system components that their untrained counterparts did. Janice K. Kiecolt-Glaser and colleagues at Ohio State University in Columbus reported the findings recently in the Journal of Consulting and Clinical Psychology.

The researchers looked at 33 medical and dental students during relatively low-stress periods and around the time of the first major exam of the term. Half of the students attended sessions where they learned to relax through self-hypnosis. Kiecolt-Glaser’s team took blood samples from all students at the start of the study and just before exams. They exposed the samples to foreign substances in order to observe the activity of T cells and other immune system defenses. The investigators found that during exam time, the self-hypnosis students launched stronger immune responses compared with students who did not learn the technique. And the more often students practiced the relaxation strategy, the stronger their immune response.

In previous studies, Kiecolt-Glaser and her colleagues have found that stressful times may impair the body’s wound-healing process and response to vaccination. They and other researchers have also found that relaxation techniques may combat these effects by relieving stress and boosting the immune system. “The data from this study provide encouraging evidence that interventions may reduce the immunological dysregulation associated with acute stressors,” they write.

The authors add that some of the strongest evidence for the benefits of self-hypnosis, in particular, comes from studies of surgical patients. This work has suggested the technique can reduce patients’ pain and anxiety, shorten hospital stays and speed recovery. “Given the substantial consequences of stress for wound repair,” the researchers conclude, “even small diminutions in stress or anxiety among surgery patients could have substantial clinical consequences.” SOURCE: Journal of Consulting and Clinical Psychology 2001;69.

March, 2002|Archive|

Tongue cancer rates are increasing

  • 3/19/2002
  • New York
  • Drs. Stimson P. Schantz and Guo-Pei Yu
  • Rueters Health

The incidence of tongue cancer, increased 60 percent over the last three decades in U.S. adults under age 40, according to a new report. “Because incidence rates of overall head and neck cancer have remained stable and have even shown a very small declining trend since the 1970s, the increase in the number of young adult patients (with tongue cancer) is concerning,” write co-authors Drs. Stimson P. Schantz and Guo-Pei Yu of New York Medical College in Manhattan. While factors responsible for the increase remain unknown, the authors suggest increasing use of marijuana as well as smokeless tobacco products like chewing tobacco among this population group may be to blame. Another possible cause may be infections with the sexually transmitted human papillomavirus (HPV), the report indicates. HPV has been under suspicion as a cause of head and neck cancer, since DNA of the virus has been detected in head and neck tumors. But studies of the relationship have provided mixed results.

Schantz and Yu identified a total of 63,409 patients with head and neck cancer between 1973 and 1997 from a cancer surveillance database established by the National Cancer Institute. Within this group, 3,339 patients were younger than 40 years of age. The incidence of head and neck cancers remained stable for people over age 40, but tongue cancer in younger adults increased approximately 60 percent during the same time period, the investigators found. “The present study exhibits a significantly increased trend of tongue cancer in Americans born after 1938,” write Schantz and Yu in the March issue of the medical journal Archives of Otolaryngology-Head and Neck Surgery. “The acceleration (of tongue cancer) began in 1973, peaked in 1985, and subsequently has been stable,” they add. “In contrast to oral tongue cancer, the incidence rates of other head and neck cancers in younger Americans, such as cancers of pharynx and larynx, remained relatively stable during the same period.” The researchers conclude that the trend they observed may be the “tip-of-the-iceberg” and call for continued vigilance on rates of tongue cancer.

SOURCE: Archives of Otolaryngology-Head and Neck Surgery 2002;128:268-274

March, 2002|Archive|

Goals to Lower Smoking in the U.S. Not Being Met

  • 3/17/2002
  • Atlanta, GA
  • Emma Hitt, PhD
  • Morbidity and Mortality Weekly Report

The percentage of US adults who smoke ranges from about 13% in Utah to about 30% in Kentucky, and only three states have meet federal goals for reducing the number of residents who smoke, according to researchers at the US Centers for Disease Control and Prevention (CDC).Two reports in the December 14th issue of the CDC’s Morbidity and Mortality Weekly Report describe state-based statistics for adult smokers and, for the first time, smoking patterns in major metropolitan areas.

In their “Healthy People 2010” guidelines, federal officials have set the goal of reducing cigarette smoking among adults to 12% by the year 2010.
The CDC points out that the average number of people who smoked in 2000 was similar to that reported for the preceding 5 years; however, the number of smokers varied from state to state. For the year 2000, the goal was to reduce cigarette smoking among adults to 15% in every state, but only three states, Puerto Rico, Utah and California, were able to meet that goal.

The 12 states with the highest number of smokers were Kentucky, Nevada, Missouri, Indiana, Ohio, West Virginia, North Carolina, Tennessee, New Hampshire, Alabama, Arkansas and Alaska, the researchers report.
The CDC also investigated the percentages of smokers in 99 metropolitan areas across the US. Similarly to the state-based figures, they ranged from 13% to 31%. Toledo, Ohio had the highest percentage of adult smokers and Orange County, California had the lowest, they found.

According to the CDC, the findings indicate support for smoking bans, with nearly universal support for bans in schools and day care centers and strong support for bans in indoor work areas and restaurants.” Just over 60% of adults reported a smoke-free office in Mississippi compared to nearly 84% of adults in Montana, the CDC notes. “The low prevalence of smokers in California, Utah and Puerto Rico may be a result of stronger social and cultural norms against tobacco use compared with other parts of the country,” the CDC’s Dr. Terry Pechacek said during a telephone press conference. “We have seen variances with states, but they have been stable from year to year, suggesting that there are broad cultural and social differences,” he told Reuters Health. Utah, for example, has religious and social traditions that may influence smoking, he explained. According to Pechacek, some states have stronger anti-smoking policies than others. “We are encouraging all states to look at their trends and smoking within their own state, and where the rates of smoking rates are high. We see that as an opportunity to apply the strategies that we know have worked for other states, such as California.”

March, 2002|Archive|

Acupuncture may aid cancer patients’ dry mouth

  • 3/10/2002
  • New York
  • Amy Norton
  • Rueters Health

Acupuncture may help some cancer patients who have severe dry mouth as a side effect of treatment, California researchers report.

Their study, which included mainly patients with head and neck cancers treated with radiation, showed that acupuncture to the ear and index finger improved dry mouth in a majority of patients.

An ancient therapy that arose in China more than 2,000 years ago, acupuncture involves placing fine needles in specific points on the body’s surface. Traditional theory holds that these points connect with energy pathways that run through the body, and acupuncture helps keep this natural energy flow running smoothly. Modern science as well has suggested that acupuncture can help ease a range of conditions, from arthritis pain and migraine to morning sickness. But researchers are still trying to understand why it works. “When we try to explain the relief of (dry mouth) using ear acupuncture, we presume it is a function of a subtle activation of the autonomous nervous system,” the new study’s lead author, Dr. Peter A. S. Johnstone of the Naval Medical Center in San Diego, told Reuters Health. The autonomic nervous system regulates bodily functions that are not under conscious control, including activity in the glands.

In the study, Johnstone’s team followed 50 patients undergoing acupuncture. Most had received radiation for head and neck cancers and had dry mouth that did not respond to treatment with the saliva-inducing compound pilocarpine. One patient had dry mouth after chemotherapy, and two had Sjogren’s syndrome–an autoimmune disease in which the immune system mistakenly attacks the salivary glands.

The researchers found that 70% of the patients improved with acupuncture, although the length of their responses varied. Most patients, they note, have required monthly or bimonthly treatments to sustain the benefit. For about one-quarter, though, the improvement has lasted more than 3 months, Johnstone’s team reports in the February 15th issue of Cancer. “Different patients will require different maintenance,” Johnstone explained, noting that most appear to need periodic “booster” treatments.

During the acupuncture treatments, which involve three needles placed on the ear and one on the index finger, patients also get sugar-free candy to help stimulate salivation. According to the researchers, “frothy salivation” usually gets started within 15 to 20 minutes

March, 2002|Archive|

Cuban cancer drug shows promise

  • 3/8/2002
  • Havana, Cuba
  • Mary Murray
  • Nbc News

Cuban researchers this week reported early, but notable success with a biotech drug that attacks advanced cancer of the head and neck regions. In preliminary trials, the novel agent, called Theracim h-R3, enhanced conventional radiation therapy to radically shrink and even completely eradicate tumors.

Researchers at Havana’s Center of Molecular Immunology administered radiation plus Theracim h-R3 to 70 patients whose head and neck cancers had failed to respond to conventional therapy. Tumors completely disappeared in 60 percent. In contrast, only 30 percent to 40 percent of advanced patients given radiation alone in Cuba would expect to see their tumors eliminated, said the Center’s Normando Iznaga-Escobar. To date, patients given the one-two punch from radiation and Theracim h-R3 have remained tumor-free for as many as 28 months, he added. Additionally, another 20 percent of patients saw their tumors shrink by at least half, said Dr. Rolando Perez, head of the Center’s research and development division. “Few therapies have demonstrated such an overall response rate and survival benefit of this disease,” said study author Dr. Tania Crombet, also of the Center.

To develop Theracim h-R3, the researchers took advantage of the fact that the growth of some tumors is fueled by substances known as epidermal growth factors. And, on their outside shell, some tumors have chemical docking stations known as receptors to these growth factors. Scientists figured out that when they stimulate these receptors, tumors grow faster than ever. So, they reasoned that if they developed an antibody that seeks out, attaches to and gums up these receptors, cancer growth will be slowed, even halted. Which is just what happened, according to Iznaga-Escobar.

HER-1 TARGETED
Specifically, Theracim h-R3 inhibits an epidermal growth factor receptor known as HER-1. Up to 90 percent of patients with head and neck cancer have too much HER-1, he said, causing cancer cells to reproduce out of control and spread through the body. Dr. Roy Herbst, a molecular oncologist at M.D. Anderson Cancer Center in Houston, said that HER-1 “is a good target” for an anti-cancer drug. By blocking HER-1, which has been implicated in head and neck, colon, pancreatic and other tumors, a drug should theoretically slow down, even reverse, cancer’s course. But large clinical trials comparing the drug to placebo are needed to prove that, Herbst said. In the United States, where radiation therapy is more sophisticated than in Cuba, the tumor-eradication rate can reach 60 percent – as high as seen in the Cuban trial of radiation plus Theracim h-R3, he added. And other HER-1 blockers, such as IMC-C225, are further along down this road than Theracim h-R3. “This is interesting, but for now it’s just another of many such molecules being tested,” Herbst said. “We look forward to seeing further study.”

A head-to-head trial comparing radiation plus placebo to radiation plus Theracim h-R3 is already underway by the Center, in partnership with Ontario-based YM BioSciences Inc., said Iznaga-Escobar. He acknowledged that there are some other agents further along in development. But, he added, Theracim h-R5 has a very favorable safety profle, the most common side effects being mild fever, chills and nausea in some 45 percent of patients.

FAST TRACK
According to Perez, Cuba’s National Regulatory Authority – the U.S. Food and Drug Administration’s equivalent – has placed Theracim h-R3 on fast-track approval. In Cuba, unlike in the United States, this allows the drug to be sold during the final phase of testing now underway. That makes Theracim h-R3 one of only a handful of so-called humanized monoclonal antibodies available around the world, he said. Others include Panorex, approved in Germany in 1994 for patients with colon cancer, and Herceptin, approved in the United States for treating breast cancer. If the final phase of testing goes as expected, with the same good results, Perez said he believes Canada will approve Theracim h-R3 by early next year.

HEAD AND NECK CANCER
In 2001, close to half a million new cases of head and neck cancer were detected around the world. During that same period, 244,413 people died from the disease. Cuba’s National Cancer Institute blames lifestyle, particularly alcohol abuse and tobacco consumption, as the leading causes. “Cuba has the dubious distinction of having one of the highest smoking rates in the world. We are in the midst of a very important anti-smoking campaign. If we manage to reduce smoking over the next 20 years, we could cut all cancer rates by one-third,” said CNCI’s Dr. Miguel Azcuy.

Portia Siegelbaum in Havana contributed to this report.

March, 2002|Archive|

Protein Associated with lung cancer linked for the first time to head and neck cancer

  • 3/6/2002
  • Pittsburgh, PA
  • University Of Pittsburgh Medical Center

Researchers from the University of Pittsburgh Cancer Institute (UPCI) are the first to find that a protein appearing on lung cancer cells in people with extensive smoking histories also is present in head and neck cancers. The results, published in the March 6 issue of the Journal of the National Cancer Institute, suggest that the protein gastrin-releasing peptide receptor (GRPR), known to be associated with lung cancer, is linked to the growth and proliferation of squamous cell carcinoma of the head and neck (SCCHN).

“Previous research from our group has indicated that when stimulated by its hormone, gastrin-releasing peptide (GRP), GRPR triggers lung cancer cells to grow,” said Jennifer R. Grandis, M.D., associate professor, departments of otolaryngology and pharmacology, University of Pittsburgh School of Medicine. Since tobacco exposure is a well-known risk factor for both lung cancer and SCCHN, the investigators decided to examine the expression of GRPR in the cells of patients with head and neck cancer. “We found that GRPR was expressed in the cells of patients with head and neck cancer and that increased GRPR expression occurs early on in the formation of SCCHN tumors,” added Jill M. Siegfried, Ph.D., co-author of the study and co-leader of UPCI’s lung cancer program.

In the study, Dr. Grandis and her colleagues compared that expression of GRPR in 25 people with SCCHN and six people without cancer. They found a fivefold increase in the level of GRPR in the tissues of people with cancer compared to those without cancer.

According to Dr. Grandis, also leader of the head and neck cancer program at UPCI, strategies that specifically target GRP to block GRPR may prove to be effective therapies for SCCHN. “If we can create new receptor-directed therapies for head and neck cancer, this may result in very useful anti-cancer strategies for patients. This is especially important given that survival rates for head and neck cancer are among the lowest compared to other major cancers and that treatment studies over the past two decades have failed to demonstrate improved survival for patients with locally advanced SCCHN.”

Nearly 45,000 cases of head and neck cancer are diagnosed annually in the United States, and 13,000 die from causes related to this disease. Head and neck cancer occurs in the oral cavity, pharynx and larynx. The early warning signs are persistent mouth sores that do not heal; lumps on the lips, mouth, throat or neck; difficulty chewing or swallowing; chronic hoarseness or a change in the voice; red or white patches in the mouth and persistent earaches.

Support for this study was provided by a grant from the National Cancer Institute Early Detection Research Network. Co-authors include Miriam N. Lango, M.D.; Kevin F. Dyer, B.S.; Vivian Wai Yan Lui, Ph.D.; William E. Gooding, M.S.; Christopher Gubish, M.S., and Jill M. Siegfried, Ph.D., whose laboratory is investigating GRPR in lung cancer.

March, 2002|Archive|

Tongue cancer patient finds hope in new radiation treatment

  • 3/4/2002
  • New York, NY
  • St. Vincent’s Comprehensive Cancer Center

New SmartBeam IMRT technology from Varian Medical Systems zeroes in on tumors while sparing healthy tissue.

When the CFO of a New York company was diagnosed with a cancerous tumor at the base of his tongue last March, he learned that conventional radiation therapy could potentially cure him, but might also cause serious side effects. The tumor was near his salivary glands and his brain stem. If not targeted precisely, radiation could affect one or both.

He and his wife had been going over their treatment options with his doctor at St. Vincent’s Comprehensive Cancer Center here when his wife asked about intensity modulated radiation therapy, or IMRT, a new and more precise radiation therapy technique that enables doctors to escalate the radiation dose to tumor cells while protecting nearby healthy tissues. By coincidence, St. Vincent’s had just commissioned a SmartBeam® IMRT system from Varian Medical Systems, and after reviewing the case, doctors decided that the man was an ideal candidate to be their first IMRT patient.

“In cases like this, conventional radiotherapy can damage one or both parotid glands, causing xerostomia, a severe, chronic, and irreversible dry mouth condition that makes it difficult for patients to chew, swallow, or speak,” said Dr. Anthony Berson, Chief Radiation Oncologist at St. Vincent’s. “With IMRT we increase the chances of eradicating the cancer while preventing dry mouth and other serious side effects. IMRT enables us to concentrate more of the dose on the tumor, and that gives us a much greater chance of completely eradicating the tumor,” he said. “Because the technique is so precise, we can treat areas that would have been considered much too risky before IMRT, too close to important critical structures.”

The St. Vincent’s radiotherapy team, led by Dr. Berson and medical physicist Richard Emery, began treating their first IMRT patient in April 2001. The patient completed the entire course of treatment without any breaks and continued to work full time. One month after treatment was over, the patient’s salivary function was essentially normal and a diagnostic PET scan showed that glucose metabolism at the tumor site had decreased significantly. “This is what you want to see at this point in time post-treatment,” said Dr. Berson. “It will take a little longer before we can know whether we’ve eliminated the cancer but these are encouraging results.”

According to Emery, in addition to head and neck cancers, St. Vincent’s will also use SmartBeam IMRT to treat prostate, breast, lung, pancreatic, and other cancers. SmartBeam IMRT treatments are delivered using a sophisticated computer-controlled medical linear accelerator that generates high-energy X-rays beams through a beam-shaping accessory called a multi-leaf collimator. St. Vincent’s has two linear accelerators. Each has a multi-leaf collimator with 120 computer-controlled mechanical “leaves” or “fingers” that shape and size the beam to as small as 2.5 mm by 5 mm to deliver an exact dose directly to the tumor.

St. Vincent’s also uses sophisticated multimodality imaging to create their complex IMRT treatment plans. They combine computed tomography (CT) and magnetic resonance (MR) scanning to locate tumors and to develop intricate treatment plans that enable them to deliver precise radiation doses of varying intensities to different areas of a tumor while sparing nearby healthy tissues. This improved precision makes it possible for physicians to safely escalate doses and thus improve the chances of eradicating tumors.

“In the past, we were often very restricted as to the amount of radiation we could give to a tumor, because we needed to protect critical structures nearby,” Dr. Berson said. “With IMRT, we are doing things we couldn’t do before.”

In the State of New York, there will be 83,200 new cancer cases and 36,300 cancer related deaths in 2001, according to statistics published by the American Cancer Society. St. Vincent’s Comprehensive Cancer Center, with its new IMRT capabilities, will be able to help many of them.

OCF Note: While this article showcases St.Vincents in NY, many cancer centers around the country are involved in the use and further testing of IMRT technologies.

March, 2002|Archive|

Oral and tongue cancer rates rise among young Americans

  • 3/3/2002
  • Palm Desert
  • American Head and Neck Society

A new research study asserts that even though the overall incidence of head and neck cancers has remained stable, young Americans are being diagnosed with higher rates of oral and tongue cancer.

The goal of the research was to update and confirm the changes in incidence of young adult oral tongue cancer, as well as other head and neck cancers, using a large cancer surveillance database in the United States. A unique feature of the analysis was to describe incidence trends by use of a new statistical methodology, joinpoint regression, and to establish the statistical significance of changes in disease rate.

Methodology: Data for the analysis were obtained from the Surveillance, Epidemiology, and End Results Program Public-Use CD-ROM (1973-1997), National Cancer Institute, DCCPS, Cancer Surveillance Research Program, Cancer Statistics Branch, released April 2000. Information was obtained on all cancers occurring in residents from nine population-based registries, i.e., five states (Connecticut, Hawaii, Iowa, New Mexico, and Utah) and four standard metropolitan statistical areas (Atlanta, Detroit, San Francisco-Oakland, and Seattle-Puget Sound). The studied cities encompass 10 percent of the U.S. population.

The SEER Program used the International Classification of Diseases for Oncology to code site, histology, and behavior for all cancers. The study only included invasive tongue cancer cases Incidence rates were tabulated as per 100,000 population and age-adjusted by the direct method to the 1970 U.S. standard population. Rates for three age groups (<40 years, 40-64 years, and >=65 years) age-adjusted within these groups, according to every single calendar year from 1973 to 1997. To better describe tongue cancer data, calculations were made for race- and gender-specific age-adjusted incidence rates with five-year intervals of time beginning in 1973-1977 and extending to 1993-1997.

Results: The SEER program registered 63,409 head and neck cancer (oral and pharynx) patients from 1973 to 1997. Of these, 3,339 patients were less than 40 years old. Between 1973-1984 and 1985-1997 periods, the overall incidence of head and neck cancer was stable.

In regard to the number of cases and observed incidence rates, researchers noted a slight decrease in 1985-1997 in both age groups of 40-64 and >=65 years. In contrast, however, the number of patients with head and neck cancer increased among young Americans less than 40 years. The increase seemed to be mainly caused by tongue cancer. Tongue cancer among young Americans ranked second to salivary gland cancers in all head and neck cancers and increased 62 percent when comparing 1985-1997 to 1973-1984. Laryngeal cancer showed no significant change in incidence during the two time periods.

Using joinpoint regression analysis, the significant increase in tongue cancer among young adults occurred during the 1973-1984 period, the estimated annual percent change (EAPC) being 6.7 (95 percent). After 1985, the incidence rates stopped rising but remained steadily high. An absolute increase of 5-year survival from tongue cancer occurred over the last 25 years and ranged from 11.7 percent (<40 years) to 6.6 percent (40-64 years) with the most significant improvement occurring in young Americans with regional and distant disease (27 percent and 21 percent, respectively).

Conclusions: The increase in tongue cancer in individuals born after 1938 and its association with improved survival suggest the emergence of a distinct disease process independent of tobacco and alcohol use. This disease process is apparent in white, but not black, populations and is of uncertain cause.

Many reports suggest that head and neck cancer, particularly oral tongue cancer, is increasing among young adults internationally. Within the United States, one study reported an increase in tongue cancer mortality among young adults under the age of 30. The increase was cited as beginning in the mid-1970s. A recent clinical report indicated that the percentage of young adults with oral tongue cancer as a percentage of the total tongue cancer population seen at the M.D. Anderson Cancer Center increased from four percent in 1971 to 18 percent in 1993.

Because incidence rates for overall head and neck cancer have remained stable, the increase of young adult patients is highly concerning. Factors that may account for oral cancer in the young adults remain unknown. Suspected causes include smokeless tobacco, various forms of drug abuse, virus, as well as host susceptibility factors. However no clear evidence exists to support the significance of any single determinant including the role of tobacco.

The authors of Head and Neck Cancer Incidence Trends in Young Americans, 1973-1997, With a Special Analysis for Tongue Cancer, are Stimson P. Schantz, MD, and Guo-Pei Yu, MD, both from the The New York Eye and Ear Infirmary, New York, NY. Their findings were presented before the spring meeting of the American Head and Neck Society in Palm Desert, CA.

March, 2002|Archive|

Platinol plus radiation increases survival of patients with head and neck cancer

  • 3/2/2002
  • American Society for Therapeutic Radiology and Oncology

According to data recently published by the American Society for Therapeutic Radiology and Oncology, a treatment program consisting of Platinol® and radiation therapy following surgery appears to significantly increase cancer-free survival and overall survival of patients diagnosed with head and neck cancer. These results are consistent with previous clinical trials and have prompted European health-care providers to adopt this treatment approach as their new standard of care for patients with locally advanced head and neck cancer.

The term head and neck cancer refers to any number of cancers that may occur in the head and/or neck region. These may include cancers of the tongue, mouth, salivary glands, pharynx, larynx, sinus and other sites located in the head and neck area. If the cancer is locally advanced (has spread to nearby tissue or lymph nodes), surgery alone may not be curative. Nonetheless, the patient may elect surgery to remove as much of the cancer as possible. Following surgery, the patient then undergoes radiation therapy in an attempt to destroy remaining cancer cells. Despite this treatment, most individuals will experience disease progression.

New research from Japanese and European studies indicates that the use of chemotherapy in addition to radiation therapy following surgery (adjuvant therapy) may increase the length of time a patient is cancer-free and overall survival time.

The European Organization for Research and Treatment of Cancer recruited 334 patients diagnosed with locally advanced squamous cell carcinomas of the oral cavity, oropharynx (middle part of the throat including the base of the tongue and tonsils), larynx (area of the throat containing vocal cords) or hypopharynx (where the pharynx meets the top of the trachea and esophagus). Following surgery, the patients were randomly divided into two treatment groups: radiation alone and radiation plus chemotherapy. All patients received one daily session of radiation (2 Gy) for up to 33 days. Patients in the radiation plus chemotherapy group also received a high dose of Platinol®, a chemotherapy agent, on days 1, 22, and 43 of the study.

Three years following treatment, 59% of patients who received radiation and chemotherapy were cancer-free, compared to only 41% of patients who received radiation alone. In addition, 65% of the patients in the combination protocol and only 49% of the radiation patients were alive after three years. Patients given Platinol® and radiation experienced fewer metastases and significantly later disease than patients treated with radiation alone. The side effects of the high-dose Platinol® were minimal, consisting mainly of increased incidences of mucositis (inflammation of mucosal membranes) that were not dose-limiting.

In Europe, the combination of adjuvant chemotherapy and radiation is a newly adopted treatment standard for locally advanced head and neck cancers. This European study provides further evidence that such combination treatment increases the length of time a patient is cancer-free as well as the overall length of time a patient lives post treatment compared to radiation alone. Patients with head or neck cancer may wish to speak with their physician regarding the risks and benefits of receiving radiation therapy plus chemotherapy or about participating in a clinical trial further evaluating this combination treatment. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancertrials.nci.nih.gov) and www.eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

March, 2002|Archive|

Smokeless tobacco can cause Researchers find more education needed for young users in West Virginia

  • 3/1/2002
  • West Virginia
  • Fran Berger
  • HealthScout Reporter

A pinch between the cheek and gum can cause oral cancer, experts know. But researchers in West Virginia have found the kids who stick a wad in their mouth don’t know the dangers.

A recent survey of 808 public school students in the Mountaineer State found that use of chewing tobacco increased with age, with more than a third using smokeless tobacco monthly or daily by 11th grade — and many didn’t realize the substance could lead to disease.

“West Virginia is usually No. 1 in the U.S. when it comes to use of smokeless tobacco,” says Dr. Lynne J. Goebel, the study’s lead author. “We’ve heard from doctors in rural areas that some people are using smokeless tobacco to help ease teething pain, rubbing it on babies’ gums, and parents are giving it to kids as a reward for good grades,” she says. Smokeless tobacco is “highly addictive. People who use smokeless tobacco have sustained nicotine levels,” she says, explaining that with smoking, you’re exposed for five minutes. But you have “a chew in your mouth for up to 30 minutes. Some sleep with it in their mouth.”

Goebel and her team compared 648 non-users with 160 male users of smokeless tobacco in the fifth, eighth and 11th grades in West Virginia public schools. Women were excluded, based on the small percentage who indulge.
Seven percent of the fifth graders said they used smokeless tobacco. That rose to 22 percent in eighth grade and topped at 32 percent in the 11th grade. The most frequent grade for initiation was the seventh. Ten percent reported use as early as first or second grade. Of the users, only 74 percent knew smokeless tobacco is harmful. That contrasted with 91 percent of non-users who were aware of the dangers. Users were also four times more likely to believe smokeless tobacco was safer than cigarettes, Goebel reports.

And that belief is dead wrong, says James R. Giebfried, director of tobacco treatment services and of the Massachusetts Quitline of the American Cancer Society. “Smokeless tobacco delivers a high dosage of nicotine,” he says. The average dose for snuff, a fine-grain tobacco placed between the cheek and gum, contains 3.6 milligrams of nicotine. “Chew” contains 4.6 milligrams, compared with a cigarette at 1.8 milligrams. “You can see that the addiction capabilities are much greater.”

And there are long-term health risks. “Leukoplakia, white sores or patches in the mouth which can turn cancerous, have been found in 73 percent of daily users. That’s significant,” Giebfried says. Smokeless tobacco can also cause gum recession, bone loss around the teeth, abrasion of the teeth and bad breath. It may also play a role in cardiovascular diseases and high blood pressure, says Giebfried.

What makes kids use smokeless tobacco? Goebel says her team was surprised to discover that young users seemed to be influenced a great deal by relatives living outside the home. “One hypothesis to explain this fact is that uncles and cousins living nearby may act as both peers and family members, they exert a stronger influence than brothers and fathers,” she says. And, she adds, it’s a macho thing. “Among some West Virginians, family and friends see the ability to tolerate tobacco without becoming nauseated as a sign of manhood. Our study showed that family permitting use in the home was strongly correlated with use of smokeless tobacco,” she says.

Then there’s the media. “It’s in the magazines. NASCAR, which is very big here, [has smokeless tobacco] as the sponsors of the cars. It’s glorifying the use. Our study showed that users more often described themselves as ‘cool, macho and attractive,’ consistent with the image portrayed in ads,” Goebel says.

The study is published in the current issue of the journal Nicotine and Tobacco Research. Goebel cautions that since smokeless tobacco holds a unique place in Appalachian culture, her study’s findings cannot be generalized to the entire country.

“Parents should be aware that smokeless tobacco is harmful and causes cancer,” says Goebel. “They should discourage use in children, not allow use at home, and develop programs that would prevent the use that begins in kindergarten and continue through all 12 grades.” Goebel also says raising the price of smokeless tobacco would help, but the legislature in West Virginia is not likely to do that. “We’ve had trouble passing excise tax on smokeless tobacco. No one wants to be responsible for adding another tax, even though that would help,” she explains.

March, 2002|Archive|