Monthly Archives: February 2012

Evaluation of a combined triple method to detect causative HPV in oral and oropharyngeal squamous cell carcinomas: p16 Immunohistochemistry, Consensus PCR HPV-DNA, and In Situ Hybridization

Source: 7thspace.com

Recent emerging evidences identify Human Papillomavirus (HPV) related Head and Neck squamous cell carcinomas (HN-SCCs) as a separate subgroup among Head and Neck Cancers with different epidemiology, histopathological characteristics, therapeutic response to chemo-radiation treatment and clinical outcome. However, there is not a worldwide consensus on the methods to be used in clinical practice.

The endpoint of this study was to demonstrate the reliability of a triple method which combines evaluation of: 1. p16 protein expression by immunohistochemistry (p16-IHC); 2.

HPV-DNA genotyping by consensus HPV-DNA PCR methods (Consensus PCR); and 3 viral integration into the host by in situ hybridization method (ISH). This triple method has been applied to HN-SCC originated from oral cavity (OSCC) and oropharynx (OPSCC), the two anatomical sites in which high risk (HR) HPVs have been clearly implicated as etiologic factors.

Methylation-Specific PCR (MSP) was performed to study inactivation of p16-CDKN2a locus by epigenetic events. Reliability of multiple methods was measured by Kappa statistics.

Results: All the HN-SCCs confirmed HPV positive by PCR and/or ISH were also p16 positive by IHC, with the latter showing a very high level of sensitivity as single test (100% in both OSCC and OPSCC) but lower specificity level (74% in OSCC and 93% in OPSCC).Concordance analysis between ISH and Consensus PCR showed a faint agreement in OPSCC (kappa = 0.38) and a moderate agreement in OSCC (kappa = 0.44).

Furthermore, the addition of double positive score (ISHpositive and Consensus PCR positive) increased significantly the specificity of HR-HPV detection on formalin-fixed paraffin embedded (FFPE) samples (100% in OSCC and 78.5% in OPSCC), but reduced the sensitivity (33% in OSCC and 60% in OPSCC). The significant reduction of sensitivity by the double method was compensated by a very high sensitivity of p16-IHC detection in the triple approach.

Conclusions: Although HR-HPVs detection is of utmost importance in clinical settings for the Head and Neck Cancer patients, there is no consensus on which to consider the ‘golden standard’among the numerous detection methods available either as single test or combinations.

Until recently, quantitative E6 RNA PCR has been considered the ‘golden standard’since it was demonstrated to have very high accuracy level and very high statistical significance associated with prognostic parameters. In contrast, quantitative E6 DNA PCR has proven to have very high level of accuracy but lesser prognostic association with clinical outcome than the HPV E6 oncoprotein RNA PCR.

However, although it is theoretically possible to perform quantitative PCR detection methods also on FFPE samples, they reach the maximum of accuracy on fresh frozen tissue. Furthermore, worldwide diagnostic laboratories have not all the same ability to analyze simultaneously both FFPE and fresh tissues with these quantitative molecular detection methods.

Therefore, in the current clinical practice a p16-IHC test is considered as sufficient for HPV diagnostic in accordance with the recently published Head and Neck Cancer international guidelines. Although p16-IHC may serve as a good prognostic indicator, our study clearly demonstrated that it is not satisfactory when used exclusively as the only HPV detecting method.

Adding ISH, although known as less sensitive than PCR-based detection methods, has the advantage to preserve the morphological context of HPV-DNA signals in FFPE samples and, thus increase the overall specificity of p16/Consensus PCR combination tests.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|

Cancer Patients Who Smoke Report Worse Pain, Symptoms

Source: MedScapeToday.com

February 24, 2012 (Palm Springs, California) — Cancer patients who smoke experience more severe symptoms than nonsmoking cancer patients and are also at greater risk of misusing opioids, a new study shows.

“Our findings show a profile of higher levels of physical symptoms (pain, fatigue, poor appetite, and insomnia) and psychological symptoms (depression and anxiety) among smokers than non-smokers,” report Diane Novy, PhD, from the Pain Management Center at the University of Texas MD Anderson Cancer Center in Houston, Texas, and colleagues.

The findings underscore the importance of smoking cessation for this patient population, she told Medscape Medical News, even though it’s unclear if there is a causal effect.

“We don’t know the cause. They may smoke more because of the pain,” she said in an interview. However, studies also show that smoking has been known to increase certain types of pain such as back pain, and nerve pain, she added. “If we can motivate them to stop smoking, I think they’re better off.”

The findings were presented here at the American Academy of Pain Medicine (AAPM) 28th Annual Meeting.

Pain, Fatigue, Insomnia

The study included 486 cancer patients (52% female), with a mean age of 55 years, who were referred to the Pain Management Center for uncontrolled pain. Ninety-four patients were smokers, and the rest (n = 356), classified as nonsmokers, were former smokers or never-smokers. The patients were diagnosed with a wide range of cancers, the most common being gastrointestinal (18.5%), followed by hematologic (15%) and head and neck cancer (14.6%).

The most common cancer among the smokers was head and neck cancer (22.3% vs 12.8% in nonsmokers), and the most common cancer in nonsmokers was gastrointestinal (19.9% vs 12.8% in smokers). Lung cancer was slightly less common among smokers than nonsmokers (10.6% vs 11.5%).

As part of their intake, patients completed the Edmonton Symptom Assessment Scale (ESAS) and the Screener and Opioid Assessment for Patients with Pain (SOAPP).

The ESAS showed that pain, fatigue, insomnia, appetite, depression, and anxiety were all statistically significantly worse in smokers than nonsmokers.

Specifically, on a scale of 0 (no symptoms) to 10, smokers reported the following:

  • a median pain level of 6.5 compared with 5 in nonsmokers (P < .001);
  • a median fatigue level of 8 compared with 7 in nonsmokers (P < .001);
  • a median depression level of 5 compared with 3 in nonsmokers (P < .001);
  • a median anxiety level of 6 compared with 3 in nonsmokers (P < .001);
  • a median level of 5 for poor appetite compared with 3 in nonsmokers (P = .023); and
  • a median insomnia level of 6 compared with 4 in nonsmokers (P = .026).

In addition, the SOAPP suggested that smokers were at greater risk for opioid misuse than were nonsmokers. Smokers reported more frequent mood swings than nonsmokers (26.6% vs 12.5%; P = .002) and were more likely to admit to occasional use of medication in a manner other than how it was prescribed (39.4% vs 19.6%; P < .001), occasional use of illegal drugs in the past 5 years (13.8% vs 2.6%; P < .001), and past legal problems or arrest (25.5% vs 8.2%; P < .001).

Further, among the smokers, 51% reported that they smoke within an hour of waking — an indication of higher risk for opioid misuse compared with smokers who delay their first cigarette.

Taken together, the findings point to the importance of extra caution when managing pain in cancer patients, said Dr. Novy.

“With cancer patients, opioids will always be the mainstay of treatment,” she said. With smokers, “we might change the route of delivery, so it might be a fentanyl patch that the patient can’t misuse, or it might be an opioid that does not have as much addiction potential like methadone, or maybe nerve blocks or other procedures.”

Smoking cessation should also be emphasized, she added. “When we work with patients and we’re able to say smokers seem to experience more pain and more of a symptom burden… for some patients it is an amazing wake-up call.”

On the basis of her results she suggests a clinical interview that explores a patient’s pain coping mechanisms and smoking triggers could help to inform treatment.

“For example, if expectation of analgesic benefit appeared to be an important smoking motivator, challenging these expectations and increasing coping self-efficacy would be reasonable treatment goals,” she reported.

If future studies confirm that smoking is associated with depression symptoms, treatment of depression would be appropriate.

Bi-Directional Interaction

The study by Dr. Novy and colleagues “makes an important contribution to a small, but rapidly growing scientific literature regarding complex and potentially bi-directional interactions between pain and smoking,” commented Joseph W. Ditre, PhD, a clinical psychologist at Texas A & M University in College Station.

“There is growing empirical and clinical interest in purported associations between tobacco smoking and the aggravation of cancer symptoms and treatment side effects, such as pain,” said Dr. Ditre, who recently published findings very similar to those of the current study.

“The current findings are highly consistent with the results of our 2011 study, which showed that continued smoking despite a cancer diagnosis was associated with greater pain severity and interference from pain,” he told Medscape Medical News.

“Some researchers have suggested that other factors (eg, depression) may be responsible for observed relations between smoking and increased pain,” he noted. “Thus, it would be interesting to know whether the current findings remain significant after accounting for sociodemographic, disease-specific, and psychiatric factors. Also, to get a better sense of whether continued smoking may increase pain and functional impairment in a causal fashion, future research should investigate longitudinal relations between continued smoking, smoking abstinence, and pain-related outcomes among persons with cancer.”

He said he agreed with Dr. Novy that smoking cessation should be emphasized in this population.

“Interestingly, our 2011 study showed a negative correlation between pain ratings and number of years since quitting smoking, suggesting that quitting smoking may confer benefit with respect to pain reporting,” he told Medscape Medical News. “Conversely, there is some question as to whether abstaining from smoking may increase pain in the short term (perhaps via removal of a preferred coping strategy, or via direct neurobiological processes).

“That said, smoking cessation is clearly indicated for persons with cancer, not just because smoking may increase pain, but because persistent smoking has been associated with impaired healing, reduced treatment efficacy, and increased risk for developing a second primary cancer,” Dr. Ditre added. “Thus, the advantages of quitting smoking likely greatly outweigh potential disadvantages, especially with respect to cancer-related outcomes.”

The study was supported by funding from the American Cancer Society and the National Institute on Drug Abuse. Dr. Novy has disclosed no relevant financial relationships. Dr. Ditre and his coauthors have disclosed no relevant financial relationships.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|

Kenneth Price dies at 77; artist transformed traditional ceramics

Source: Los Angeles Times

 

Kenneth Price was among the first generation of iconoclastic L.A. artists to attain international stature. His work with glazed and painted clay was ‘resolutely original’ and redefined contemporary sculpture, an observer says.

Kenneth Price, a prolific Los Angeles artist whose work with glazed and painted clay transformed traditional ceramics while also expanding orthodox definitions of American and European sculpture, died early Friday at his home and studio in Taos, N.M. He was 77.

Price had struggled with tongue and throat cancer for several years, his food intake restricted to liquids supplied through a feeding tube. Despite his infirmity, he continued to produce challenging new work and to mount critically acclaimed exhibitions at galleries in Los Angeles, New York and Europe.

At the time of his death Price had completed preparations for a 50-year retrospective, scheduled to open at the Los Angeles County Museum of Art in the fall in an exhibition designed by architect Frank Gehry. The show will travel to the Nasher Sculpture Center in Dallas and the Metropolitan Museum of Art in New York. A 1992 retrospective traveled from the Menil Collection in Houston to the Walker Art Center in Minneapolis.

In the decades following World War II, Price was among the first generation of iconoclastic L.A. artists to attain international stature. Three Price sculptures were on view in “Pacific Standard Time: Crosscurrents in L.A. Painting and Sculpture, 1950-1970,” a survey of 47 leading postwar artists that closed this month at theJ. Paul Getty Museum. Important examples of his work are currently included in three additional museum shows featured as part of the Getty-sponsored Pacific Standard Time, which chronicles significant aspects of Los Angeles art made during the city’s efflorescence between World War II and 1980.

Price’s work is often erroneously described as having “transcended” ceramics to become sculpture. However, his organic and geometric forms, use of vibrant colors and provocative installation motifs instead speak of a thorough knowledge and embrace of critical aspects of ceramic history and its shifting place in art’s continuum. Price’s exquisitely crafted art, often leavened by erotic wit, simply accepted clay’s sculptural bona fides.

“Price’s practice has remained resolutely original, challenging categorization and redefining contemporary sculpture,” said Stephanie Barron, senior curator of modern art at LACMA and organizer of the Price retrospective. “The observation that critic Lucy Lippard made in 1966 seems prescient: ‘It is a fact rather than a value judgment that no one else on the East or West Coast is working like Kenneth Price.’ ”

Especially important to his work was the precedent of the Bauhaus, the experimental school in 1920s Germany that sought to fuse crafts and the fine arts. Hand fabrication had been separated from machine manufacture during the Industrial Revolution, creating a distinction between fine art and applied art and establishing a rigid hierarchy for them. The Bauhaus sought to reconcile the two into a modern, unified whole.

For many years Price kept an abstract image of nested color-squares by Bauhaus instructor Josef Albers, the German-born painter and color theorist, hanging on a wall in his Venice studio — the only work by another artist displayed there.

Price, reflecting egalitarian impulses of the 1960s, found surprising ways to incorporate that legacy in contemporary social terms. Among his most charming works is an extensive series of drinking vessels he called “snail cups.” A variety of snails — a garden nuisance but an ancient symbol for slow, steady and self-sufficient progress — carry and adorn the small cups, one of the oldest and most basic vessel forms. With humor and affection, the snail cups nod to the ’60s handicraft fashions of the Aquarian Age.

Completely different in form, but likewise indebted to the Bauhaus, are geometric vessels glazed in flat, bright, primary and secondary hues. Their compositions recall early 20th century Russian Constructivist paintings by El Lissitzky and Dutch De Stijl works by Piet Mondrian, Theo van Doesburg and architect Gerrit Rietveld. Like the Bauhaus, Constructivism and De Stijl valued pure abstraction, dynamic asymmetry and simplified shapes and colors. Price’s exquisitely made cups brought down to earth the grand Utopian aspirations of those early 20th century movements.

Price’s use of bright color on clay forms was a distinctive feature of his work. Sometimes he achieved it through the use of acrylic paint rather than fired glazes, a method that upset ceramic purists but satisfied the artist’s determination to follow his interests. The technique has reached new heights since the 1990s. Sexy, bulbous forms are painted black, layered with lush acrylic colors and then sanded to reveal the under-paint in richly textured spots of brilliant hues. Some sculptures carry 70 thin coats of paint.

Speaking of his early years, Price told interviewer Kristine McKenna in 1996, “In those days everything was supposed to reflect the inherent nature of the materials, and consequently there wasn’t much colored clay sculpture prior to the ’60s. … But I didn’t think it was a big deal to put color on form. L.A. was the city of cars and fabrication shops where you could have anything made, so it didn’t seem unusual to me to make an organic form and then give it an industrial paint job.”

Similarly critical to Price’s development was his adoption of attitudes and motifs familiar in Mexican pottery. His inspirations include the sensuous, poured glazes of traditional Oaxacan ceramics, plus the domestic and souvenir production of commercial centers such as Tlaquepaque, just outside Guadalajara. Encountering Mexican folk ceramics in roadside stands and souvenir shops during surfing trips to Tijuana and visits to other border regions of the American Southwest, as well as in Taos, he admired their verve, frequent humor and evident humanity.

In an era when many sculptors farm out production to commercial fabricators, Price valued studio labor throughout his career. In the 1970s he spent nearly six years producing “Happy’s Curios,” an elaborate mixed-media installation named for his wife, Happy Ward. A sprawling homage to Mexican folk traditions, Pre-Columbian motifs and popular designs, the work is composed of nine cabinets of pottery, store display-windows, multimedia “Death Shrines,” paintings, tapestries and drawings.

The ambitious project was never completed. “It took a toll,” said New Mexico art critic MaLin Wilson-Powell, who conducted an extensive interview with the artist for the LACMA retrospective’s forthcoming catalog. “It was meant to be an installation to fill an entire building in Taos, but it was too big to finish. So Kenny said he had to do what we did in Vietnam: Call it a victory and get the hell out.”

Portions of “Happy’s Curios” were shown to critical acclaim at LACMA in the spring of 1978. In a serendipitous juxtaposition, the memorial-themed work was displayed in galleries upstairs from the traveling “Treasures of Tutankhamun” extravaganza, a hugely popular presentation of Egyptian tomb artifacts that is generally regarded as the first museum blockbuster exhibition.

The Price installation’s “Death Shrine I,” an elaborate funerary altar behind a cheerful white picket fence and crowned with a skull-shaped vessel, its grinning teeth echoing the white slats in the fence, is now on long-term loan to the Harwood Museum of Art in Taos. “Unit 3,” a knotty pine display case for 15 decorated vessels, is in LACMA’s permanent collection. “Town Unit 1,” a fenced display case for 22 plates, cups, bowls and a double-spouted teapot is in the collection of the Museum of Contemporary Art.

Other Price ceramics, as well as prints and drawings, are in the collections of Washington’s National Gallery of Art, New York’s Museum of Modern Art, the Chicago Art Institute, London’s Victoria and Albert Museum and 35 other international museums. In addition to sculptures, prints and drawings, he also made illustrations for books of poetry by Harvey Mudd and Charles Bukowski, an album cover for Ry Cooder and several bottle labels for Del Maguey mezcal spirits.

Price’s fusion of fine and applied art made him the godfather of significant younger generations of artists, many working in Southern California. Functional design is now a central component of sculpture for Kim MacConnel, Jim Isermann, Pae White and MacArthur Fellows Josiah McElheny and Jorge Pardo. Adrian Saxe, a leading artist whose elaborate clay sculptures were the subject of a 1993 LACMA retrospective, cites Price’s precedent as a key inspiration.

Born in Los Angeles on Feb. 16, 1935, Price took informal trumpet lessons from jazz musician Chet Baker and drawing classes at Chouinard Art Institute while still a student at University High School. His first ceramics class came after graduation at Santa Monica College. In 1954 he transferred to USC, where he later taught, and in 1957 he enrolled at the Los Angeles County Art Institute (now Otis College of Art and Design). There, artist Peter Voulkos had shaken up the ceramics establishment with muscular, monumental slabs of roughly worked clay that infuse Asian traditions with Abstract Expressionist bravura. Voulkos’ slashed and gouged platters and brawny sculptures bucked the prevailing ceramic taste for refined harmonies between elegant form and punctilious surface.

Price began to chafe under Voulkos’ domineering influence. Deciding that he also needed specialized training in the intricate technical aspects of firing clay and the complex sciences of glazing, he enrolled in the rigorous ceramics program at the State University of New York at Alfred. He finished the two-year course in just a year, receiving a master’s degree in 1959.

The following year he had the first of three solo exhibitions at Ferus Gallery in Los Angeles, showing rough-hewn, beehive-shaped covered jars, some displayed inside modest wood cases reminiscent of Joseph Cornell‘s boxed assemblages. The small size of his works surprised people more accustomed to large-scale sculpture, but it announced a lifelong interest in intimacy as a subject.

His second show in 1961 featured a now-famous poster of Price casually riding a Pacific wave on his surfboard, arms held high with his name printed in a rainbow-arch between outstretched hands. It included small, sleek, brightly painted “eggs” with sexually provocative fingers of tangled clay erupting from dark orifices. Friend and fellow artist Edward Ruscha once described them as “psycho-erotic.” The stylistic break with Voulkos was complete. The beautifully crafted and brightly painted work was as effortless and triumphant as the playful surfing poster implied.

Examples of these and other early sculptures are currently featured in the exhibitions “Common Ground: Ceramics in Southern California, 1945-1975,” at the American Museum of Ceramic Art, Pomona, and “Clay’s Tectonic Shift: John Mason, Ken Price and Peter Voulkos, 1956-1968,” at the Ruth Chandler Williamson Gallery at Scripps College, Claremont.

In 1968 Price married Ward, who survives him along with their son, Jackson, and his step-children, Romy and Sydney. Two years later the couple moved to Taos. In 1983 they relocated to the Massachusetts coast, where they remained for seven years, until Price returned to Los Angeles and joined the USC faculty. After teaching for a decade Price went back to Taos with his family. He lived and worked in both New Mexico and California ever since.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|

Palliation Trumps PET in Prolonging Head and Neck Cancer Survival

Source: Elsevier Global Medical News. 2012 Feb 23, D McNamara

MIAMI BEACH (EGMN) – Using PET scans to diagnose distant metastasis in patients with advanced head and neck squamous cell carcinoma does not significantly prolong life expectancy, compared with other imaging techniques, according to a retrospective study.

Palliative chemotherapy did make a difference, however, significantly increasing life expectancy by 215 days in patients who received it, Dr. Matthew E. Spector and colleagues from the University of Michigan, Ann Arbor, reported at a meeting of the Triological Society.

“Over 90% of patients at University of Michigan have at least one PET scan at some point in their treatment,” Dr. Spector said. Increased sensitivity is one reason for such widespread adoption of the imaging technique. “We were wondering, while it may be more sensitive to identify distant metastatic disease, was it changing what we were doing?”

In a retrospective look at 170 patients with such cancers at their institution, researchers found no significant difference in median survival between patients who had a PET scan (168 days) and those who did not (193 days). Determination of any survival difference was a primary aim of the study.

“A lot of studies have looked at PET scans, and we know in up to one-third of cases it may change our decisions,” Dr. Spector said. For example, a negative PET scan might mean definitive treatment, whereas a positive PET finding might lead to palliative therapy. However, “no one has looked at the impact of the PET findings on the life expectancy after diagnosis.”

All patients in the study had a distant metastasis diagnosis. “We found PET was more likely to diagnose multiple distant metastasis sites [P = .03],” Dr. Spector said. “But there were no differences in life expectancy when comparing PET to the various other imaging modalities like CT or chest x-ray.”

Mean patient age was 59 years, and 135 of the patients were men. Kaplan-Meier survival curves revealed no difference in survival between patients with a single distant metastatic site vs. multiple distant metastatic sites, said Dr. Spector, a head and neck surgery resident at the University of Michigan Health System in Ann Arbor.

The investigators intentionally controlled for chemotherapy use (110 patients, or 65%) in their survival calculations. “Chemotherapy could alter the course of their distant metastasis. Since [survival] was our main outcome measure, we wanted to control for that.”

There were no differences in survival by patient age, sex, or site of primary tumor. Primary head and neck tumor sites included the oropharynx in 75 patients, the oral cavity in 40 patients, and the larynx in 36 others. The hypopharynx, nasopharynx, and some cases with unknown primary sites accounted for the remainder.

Dr. Spector and his associates did find a significant difference between the 86% of patients whose distant metastasis was detected during routine follow-up cancer care and the 14% who presented with symptoms. Median survival was 247 days in the routine surveillance group vs. 73 days for patients who might have come into the clinic complaining of chest pain after which subsequent imaging studies revealed a distant metastasis.

“Patients who were symptomatic, as you would imagine, had a worse life expectancy,” Dr. Spector said. For the group detected on routine follow-up, the median time to distant metastasis diagnosis was 324 days.

Identification of any factors that did prolong survival was a second aim of the study. For the 85 patients who received palliative chemotherapy, median survival was significantly longer at 285 days, compared with 70 days for those who did not receive it. Palliative chemotherapy was an independent factor that increased life expectancy, “and should be promoted for patients with these cancers,”

Dr. Spector said at the meeting, which was sponsored by the Triological Society and the American College of Surgeons. Previous chemotherapy did not alter patient response to palliative chemotherapy.”Even for patients who were symptomatic at the time of diagnosis of their distant metastasis, palliative chemotherapy was still found to be effective,” he added.

By cancer subtype, there was a nonsignificant trend for palliative chemotherapy to prolong survival among patients with primary oropharyngeal cancers (median, 333 days) compared with patients with primary laryngeal cancers (195 days).

Dr. Spector said that he had no relevant disclosures.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|

More troops on smokeless tobacco after deployment

Source: Reuters.com

The findings, reported in the journal Addiction, follow other studies that have tied deployment and combat to health risks, including higher rates of smoking and drinking.

“This adds to the list of things we’re learning are associated with combat,” said lead researcher Dr. Eric D.A. Hermes, of the Yale University School of Medicine in New Haven, Connecticut.

It’s not fully clear why some troops take up smokeless tobacco after deployment. But Hermes suspects stress is involved.

That’s because deployment with combat exposure was linked to a higher risk than deployment alone. And troops with symptoms of post-traumatic stress disorder (PTSD) also had an increased risk.

The findings come from the Millennium Cohort Study, an ongoing government project looking at the health effects of military service.

Of more than 45,000 personnel followed from 2001 to 2006, 2 percent started using smokeless tobacco during that time. Another 9 percent had already developed the habit, and kept it up.

Overall, troops who were deployed but did not see combat were almost one-third more likely to take up a smokeless tobacco habit than their non-deployed counterparts. Those odds were two-thirds to three-quarters higher for troops who were in combat or who deployed multiple times.

According to Hermes, those different levels of deployment can be seen as stand-ins for different levels of stress.

So it’s possible that stress plays a role, he said.

Another finding gives weight to that idea. “We also saw a relationship with PTSD symptoms,” Hermes said.

Just under 4 percent of all troops had PTSD symptoms, based on a standard questionnaire. And they were 54 percent more likely to start using smokeless tobacco than troops without symptoms, Hermes and his colleagues found.

There are other factors that, along with stress, might push some deployed troops toward tobacco, according to Hermes.

“You’re not at home, you have more exposure to smokeless tobacco, you’re around more people doing it,” Hermes said. “Maybe it’s all these little things coming together.”

MILITARY TOBACCO USE STILL HIGH

Past studies have found that while tobacco use in the military is declining, it’s still higher when compared to the U.S. public as a whole. In 2005, almost 15 percent of military personnel said they’d used smokeless tobacco in the past year — versus just three percent of Americans overall.

“Smoking is the thing that everyone talks about,” Hermes said. “But there’s also smokeless tobacco, and it seems to be related to the stress of combat.”

Whether some troops are “treating” their stress with tobacco, or whether the tobacco somehow feeds the stress is not entirely clear, according to Hermes. “There’s still a chicken-and-egg question,” he said.

But the findings suggest that doctors treating military personnel should ask not only about smoking habits, but any use of the smokeless forms of tobacco, Hermes said.

Tobacco products are widely available at U.S. military bases. A 2009 study commissioned by the Pentagon and the Department of Veterans Affairs recommended a phased-in ban on tobacco on military property. But whether that will ever happen remains up in the air.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|

Canadian provinces weighing HPV vaccination of boys

Source: www.cmaj.ca/
Author: Laura Eggertson

Provinces weighing the merits of implementing the National Advisory Committee on Immunization’s recommendation to offer human papillomavirus (HPV) vaccine to boys and men aged 9–26 are facing a tricky trade-off between benefits and costs.

“I think the benefits are there, but the costs are high,” which is a crucial issue for publicly funded programs, says Dr. Monika Naus, medical director of immunization programs and vaccine-preventable diseases for the British Columbia Centre for Disease Control.

The National Advisory Committee on Immunization last month recommended extending the human papillomavirus vaccine to boys and men aged 9 to 26 “for the prevention of anal intraepithelial neoplasia (AIN) grades 1, 2, and 3, anal cancer, and anogenital warts”. The move followed on the heels of an October 2011 recommendation from United States Centers for Disease Control and Prevention advisory panel recommendation that HPV vaccine be given to boys aged 11–12 to ward off genital warts, anal cancer and “possibly” head and neck cancer.

In deciding whether to proceed, the provinces should note that “the public health and economic burden of AGWs [anogenital warts] in Canada is considerable, particularly among men whose incidence rates and incidence rate ratios compared to females have been increasing in recent years,” the committee stated.

The committee’s report also noted that the number of annual cases (and average annual incidence per 100 000) of penile cancer among men in Canada is 127.4 (1.0 per 100 000), while the number for cancer of the anus is 208.2 (1.6), oral cavity 853.1 (6.5) and oropharynx 84.3 (0.64). The estimated portion of those cancers that are attributable to HPV is 63% for penal cancer, 92% for anal cancer and 89% for both oral cavity and orapharyngeal cancer.

The committee also advised that the provinces weigh whether an HPV vaccination program for boys is preferable to campaigns designed to increase female vaccination rates.

It also cautioned provinces against making the presumption that vaccinating boys would lower cervical cancer rates among girls. “While current models predict that addition of males to a routine HPV vaccination program would prevent additional cases of genital warts and cervical cancer among females to varying degrees, this is based on assumptions that such transmission from males to females will be reduced, rather than observational data.”

Data on the economic burden of HPV is often highly conditional on a series of assumptions. The Canadian Consensus Guidelines on Human Papillomavirus issued by the Society of Obstetricians and Gynaecologists of Canada in 2007 projected the annual economic burden at $300 million, with the bulk of that — $244 million — representing the cost of “more than 9.3 million Pap tests that produce negative or false-positive results; the rest ($53.7 million) is due to true genital or cervical disease. HPV types 6, 11, 16, and 18 are thought to be responsible for 100% of the cost of genital warts ($9.2 million), 36% of the cost of CIN 1 [cervical intraepithelial neoplasia] (total cost $15.7 million), 61% of the cost of CIN 2/3 (total cost $14.5 million), and 73% of the cost of cervical cancer (total cost $13.6),” (www.hpvinfo.ca/uploads/hpvinfo.previewsite.ca/files/hpv-guideline-full_e.pdf).

The cost of a three-dose HPV vaccination, meanwhile, is generally projected to be in the neighbourhood of $450–$500. That can quickly add up, as evidenced by the decision to vaccinate girls aged 11–14, which in 2007 resulted in a federal government allocation of $300 million over three years.

Whether the federal government might provide a similar chunk of funds to vaccinate boys is unknown, says Dr. John Spika, director general of the Public Health Agency of Canada’s Centre for Immunization and Respiratory Infectious Diseases.

Naus notes that lower incidence rates of oral, anal and penile cancer, as compared with cervical cancer, make it much harder to justify the outlay of tax dollars for a generalized campaign for boys. She also indicated the provinces are awaiting the findings of a Public Health Agency of Canada commissioned cost–benefit analysis of HPV vaccination of boys expected to be completed this spring.

The provinces must also grapple with the advisory committee’s precaution that a program for boys must be weighed against measures designed to increase vaccination take-up by girls.

The Federation of Medical Women of Canada argues that vaccinating boys makes sense when there is a low uptake among girls, so it urges gender equity in the funding of HPV vaccination.

If a prove has less than an 85% uptake among girls, there is a benefit to immunizing both sexes, says Dr. Vivien Brown, a member of the federation’s board. “You cannot eradicate disease by simply vaccinating one sex,” Brown says. “We don’t have fantastic uptake of vaccine in women.”

Naus notes that the vaccination rate among eligible girls in BC is now 70% and climbing annually at a rate of 5%. But Brown notes the rate is only 55% in Ontario.

The provincial government is awaiting advice from Public Health Ontario before deciding whether to provide HPV vaccination of boys, says David Jensen, a spokesman for the province’s Ministry of Health and Long-Term Care, while Quebec is awaiting advice from its public health institute, says Stephanie Menard, a spokesperson for the Quebec Ministry of Health and Social Services.

Spika says another major consideration is whether the intent of a vaccination program will be to prevent only HPV-related cancers, or all HPV infections.

Both the Canadian and US advisory panels recommended against the use of one of those vaccines (Cervarix) for boys, on the grounds that its efficacy has not yet been proven.

Cervarix is not yet approved in Canada for use in boys but if it does become available and a province chooses to target only cancer-causing strains of HPV, that might reduce costs, Spika says. “Obviously, it’s a competitive process, and having two products on the market is better than one.”

No decisions are expected to be taken by provinces until the Canadian Immunization Committee, which represents provincial governments, finalizes its position on the issue.

February, 2012|Oral Cancer News|

CD4 counts predict chemo response in laryngeal cancer

Source: www.oncologyreport.com/
Author: Miriam E. Tucker

Pretreatment CD4 levels predicted response to induction chemotherapy among 97 patients with advanced laryngeal cancer, but not for 66 patients with advanced oropharyngeal cancer, according to a retrospective analysis of data from two clinical trials.

The two groups of head and neck cancer patients were enrolled in two identical prospective, phase II trials of induction chemotherapy and organ preservation, in which tumor response after one cycle of cisplatin and 5-fluorouracil was used to select those who would undergo surgery or definitive chemoradiation (J. Clin. Oncol. 2006;24:593-8 in laryngeal cancer; J. Clin. Oncol. 2008;26:3138-46 in oropharyngeal cancer).

Several lymphocyte subsets were measured before treatment via routine flow cytometry in peripheral blood in the laryngeal cancer patients, but only CD4 (helper cell) levels were significantly associated with chemotherapy response. Both absolute CD4 counts and CD4 percentages were higher among induction chemotherapy responders than nonresponders (P = .006 and P = .04, respectively).

Investigators also saw a trend for responders to have an increased percentage of CD3 cells (P = .13), decreased percentage of CD8 cells (P = .11), and higher CD4/CD8 ratios.

“Host immune parameters are important factors in treatment outcome, and may be useful in identifying subsets of patients with cancers that are responsive to organ-preserving therapy,” said Dr. Gregory T. Wolf, who presented the data at a head and neck cancer symposium sponsored by the American Society for Radiation Oncology.

“It is likely that immunobiology of head and neck cancers differ significantly by tumor site and predisposing factors,” added Dr. Wolf, a professor in the department of otolaryngology at the University of Michigan, Ann Arbor.

The median length of follow-up in the two studies was 7.9 years for the patients with laryngeal cancer and 6.6 years for those with cancer of the oropharynx. Disease-free survival was 86% at 3 years and 82% at 5 years for laryngeal cancer, and 78% at 3 years and 76% at 4 years for oropharyngeal cancer. The proportions responding to induction chemotherapy were 75% in the laryngeal cancer trial and 82% in the oropharyngeal cancer study.

In an interview, Dr. Wolf said that having two identical treatment trials provided an opportunity to determine whether correlations of pretreatment CD4 levels with chemoresponse differed by tumor site. When the laryngeal and oropharyngeal cancer patient groups were combined, higher CD4 levels were still associated with response, but this was primarily because of the strong correlation among the larynx cancer patients.

Statistical regression testing determined that for patients with oropharyngeal cancer, CD8 cells were more closely associated with chemotherapy response, but the relationship was not as strong as the strong correlation of CD4 levels among laryngeal cancer patients.

There was a trend toward improved survival by both CD4 percentage (P = .36) and absolute CD4 count (P = .15) in the laryngeal cohort, but not in the oropharyngeal cohort. None of the other lymphocyte subsets predicted survival in either group, Dr. Wolf said.

Results for the oropharyngeal cancer patients were further stratified by human papillomavirus status, and were combined with the laryngeal cancer group. Both lower CD4/CD8 ratio and higher CD8 levels were consistent with better prognosis among patients who were HPV positive (P = .02 and P = .06, respectively).

“We combined the results to get the largest sample size and [to see] if the relationship was independent of tumor site, since the biology of these cancers is so different. It was remarkable that the prediction differed by tumor site, with CD4 cells being predictive for larynx and CD8 cells predictive for oropharynx,” Dr. Wolf explained in an interview. This finding likely reflects the major biological differences between these cancers, and is why it was important to also include HPV status, he added.

Note: Dr. Wolf is a consultant for IRX Therapeutics, Inc.

February, 2012|Oral Cancer News|

Radiotherapy technique significantly reduces irradiation of healthy tissue

Source: www.sciencecodex.com/
Author: staff

Researchers at the University of Granada and the university hospital Virgen de las Nieves in Granada have developed a new radiotherapy technique that is much less toxic than that traditionally used and only targets cancerous tissue. This new protocol provides a less invasive but equally efficient cancer postoperative treatment for cases of cancer of the oral cavity and pharynx.

The study -conducted between 2005 and 2008- included 80 patients diagnosed with epidermoid cancer of the oral cavity and pharynx, who had undergone lymph node removal. The affected nodes were located by the surgeon during the intervention and classified into different risk levels. Classification allowed physicians to target the areas at a higher risk of recurrence. This way, neck areas at a lower risk of containing residual cancer cells were not irradiated. Researchers achieved both to minimize the side effects of radiotherapy, and to reduce treatment discontinuation, thus achieving the therapy to be more effective.

A Highly Toxic Treatment
Over 70% of oral and pharynx cancer treated with surgery require supplementary treatment with radiotherapy occasionally associated to chemotherapy, because of the high risk for recurrence and spread through the lymph nodes. Radiotherapy and chemotherapy are highly toxic, mainly due to the ulceration of the mucous membranes lining the oral cavity; toxicity leads may patients to stop the treatment, which significantly reduces the chances of cure.

By using the risk map obtained with the collaboration of the surgeon and the pathologist, an individualized treatment was designed and adapted to the specific risk level of recurrence in each neck area. The volume of tissue irradiated was significantly smaller than that usually irradiated with traditional techniques.

This trial was led by the radiation oncologist at the university hospital Virgen de las Nieves, Miguel Martínez Carrillo, and conducted in collaboration with the Services of Radiation Oncology, Medical Physics, Maxillofacial Surgery and Pathology of the university hospital Virgen de las Nieves, and the University of Granada Department of Radiology and Physical Medicine

After a three-year follow up, using this new technique, scientists achieved to reduce the volume of irradiated tissue in 44% of patients. By this new technique, irradiation of an average volume of 118 cc of tissue was avoided. A total of 95% of patients completed radiotherapy and presented significantly lower toxicity than patients treated with the traditional technique. Recurrence rates did not increase.

This study was coordinated by University of Granada professors Rosario del Moral Ávila and José Mariano Ruiz de Almodóvar Rivera. The results of this study will be published in the next issue of the journal Radiation Oncology.

Source: University of Granada

February, 2012|Oral Cancer News|

Cancer patients who smoke report worse pain, symptoms

Source: www.medscape.com/
Author: Kate Johnson

Cancer patients who smoke experience more severe symptoms than nonsmoking cancer patients and are also at greater risk of misusing opioids, a new study shows.

“Our findings show a profile of higher levels of physical symptoms (pain, fatigue, poor appetite, and insomnia) and psychological symptoms (depression and anxiety) among smokers than non-smokers,” report Diane Novy, PhD, from the Pain Management Center at the University of Texas MD Anderson Cancer Center in Houston, Texas, and colleagues.

The findings underscore the importance of smoking cessation for this patient population, she told Medscape Medical News, even though it’s unclear if there is a causal effect.

“We don’t know the cause. They may smoke more because of the pain,” she said in an interview. However, studies also show that smoking has been known to increase certain types of pain such as back pain, and nerve pain, she added. “If we can motivate them to stop smoking, I think they’re better off.”

The findings were presented here at the American Academy of Pain Medicine (AAPM) 28th Annual Meeting.

Pain, Fatigue, Insomnia
The study included 486 cancer patients (52% female), with a mean age of 55 years, who were referred to the Pain Management Center for uncontrolled pain. Ninety-four patients were smokers, and the rest (n = 356), classified as nonsmokers, were former smokers or never-smokers. The patients were diagnosed with a wide range of cancers, the most common being gastrointestinal (18.5%), followed by hematologic (15%) and head and neck cancer (14.6%).

The most common cancer among the smokers was head and neck cancer (22.3% vs 12.8% in nonsmokers), and the most common cancer in nonsmokers was gastrointestinal (19.9% vs 12.8% in smokers). Lung cancer was slightly less common among smokers than nonsmokers (10.6% vs 11.5%).

As part of their intake, patients completed the Edmonton Symptom Assessment Scale (ESAS) and the Screener and Opioid Assessment for Patients with Pain (SOAPP).

The ESAS showed that pain, fatigue, insomnia, appetite, depression, and anxiety were all statistically significantly worse in smokers than nonsmokers.

Specifically, on a scale of 0 (no symptoms) to 10, smokers reported the following:

a median pain level of 6.5 compared with 5 in nonsmokers (P < .001);
a median fatigue level of 8 compared with 7 in nonsmokers (P < .001);
a median depression level of 5 compared with 3 in nonsmokers (P < .001);
a median anxiety level of 6 compared with 3 in nonsmokers (P < .001);
a median level of 5 for poor appetite compared with 3 in nonsmokers (P = .023); and
a median insomnia level of 6 compared with 4 in nonsmokers (P = .026).
In addition, the SOAPP suggested that smokers were at greater risk for opioid misuse than were nonsmokers. Smokers reported more frequent mood swings than nonsmokers (26.6% vs 12.5%; P = .002) and were more likely to admit to occasional use of medication in a manner other than how it was prescribed (39.4% vs 19.6%; P < .001), occasional use of illegal drugs in the past 5 years (13.8% vs 2.6%; P < .001), and past legal problems or arrest (25.5% vs 8.2%; P < .001).

Further, among the smokers, 51% reported that they smoke within an hour of waking — an indication of higher risk for opioid misuse compared with smokers who delay their first cigarette.

Taken together, the findings point to the importance of extra caution when managing pain in cancer patients, said Dr. Novy.

“With cancer patients, opioids will always be the mainstay of treatment,” she said. With smokers, “we might change the route of delivery, so it might be a fentanyl patch that the patient can’t misuse, or it might be an opioid that does not have as much addiction potential like methadone, or maybe nerve blocks or other procedures.”

Smoking cessation should also be emphasized, she added. “When we work with patients and we’re able to say smokers seem to experience more pain and more of a symptom burden… for some patients it is an amazing wake-up call.”

On the basis of her results she suggests a clinical interview that explores a patient’s pain coping mechanisms and smoking triggers could help to inform treatment.

“For example, if expectation of analgesic benefit appeared to be an important smoking motivator, challenging these expectations and increasing coping self-efficacy would be reasonable treatment goals,” she reported.

If future studies confirm that smoking is associated with depression symptoms, treatment of depression would be appropriate.

Bi-Directional Interaction
The study by Dr. Novy and colleagues “makes an important contribution to a small, but rapidly growing scientific literature regarding complex and potentially bi-directional interactions between pain and smoking,” commented Joseph W. Ditre, PhD, a clinical psychologist at Texas A & M University in College Station.

“There is growing empirical and clinical interest in purported associations between tobacco smoking and the aggravation of cancer symptoms and treatment side effects, such as pain,” said Dr. Ditre, who recently published findings very similar to those of the current study.

“The current findings are highly consistent with the results of our 2011 study, which showed that continued smoking despite a cancer diagnosis was associated with greater pain severity and interference from pain,” he told Medscape Medical News.

“Some researchers have suggested that other factors (eg, depression) may be responsible for observed relations between smoking and increased pain,” he noted. “Thus, it would be interesting to know whether the current findings remain significant after accounting for sociodemographic, disease-specific, and psychiatric factors. Also, to get a better sense of whether continued smoking may increase pain and functional impairment in a causal fashion, future research should investigate longitudinal relations between continued smoking, smoking abstinence, and pain-related outcomes among persons with cancer.”

He said he agreed with Dr. Novy that smoking cessation should be emphasized in this population.

“Interestingly, our 2011 study showed a negative correlation between pain ratings and number of years since quitting smoking, suggesting that quitting smoking may confer benefit with respect to pain reporting,” he told Medscape Medical News. “Conversely, there is some question as to whether abstaining from smoking may increase pain in the short term (perhaps via removal of a preferred coping strategy, or via direct neurobiological processes).

“That said, smoking cessation is clearly indicated for persons with cancer, not just because smoking may increase pain, but because persistent smoking has been associated with impaired healing, reduced treatment efficacy, and increased risk for developing a second primary cancer,” Dr. Ditre added. “Thus, the advantages of quitting smoking likely greatly outweigh potential disadvantages, especially with respect to cancer-related outcomes.”

Note: The study was supported by funding from the American Cancer Society and the National Institute on Drug Abuse. Dr. Novy has disclosed no relevant financial relationships. Dr. Ditre and his coauthors have disclosed no relevant financial relationships.

Source: American Academy of Pain Medicine 28th Annual Meeting: Abstract #180. Presented February 23, 2012.

February, 2012|Oral Cancer News|

UPDATE 1-Swedish Match pushes ahead with snus in the U.S

Source: Reuters.com

STOCKHOLM, Feb 22 (Reuters) – Tobacco products group Swedish Match will step up promotion of moist Swedish-style snuff, called snus, in the United States this year where it expect the market to grow faster than its Scandinavian home territory.

Snus, a tobacco product put under the lip and sucked, mostly in pouches, is the group’s main cash cow, sold mainly in Scandinavia.

Swedish Match wants to differentiate itself in the larger U.S. market by growing sales of snus, which is pasteurized and has a different texture and taste to fermented U.S.-style snuff.

“During 2012, we will continue to invest for growth. In the U.S. we will expand distribution and invest further in marketing activities …,” said Swedish Match, which is the largest producer of snus in Sweden. The product is banned in the rest of the European Union.

Swedish Match, a rival to Altria Group Inc, Reynolds American Inc and BAT., also makes cigars.

Marketing costs for snus in the U.S. weighed on fourth-quarter profit, the group said on Wednesday. Operating profit fell to 1.02 billion crowns ($153.6 million) from a year-earlier 1.42 billion, against a mean forecast for 1.03 billion in a Reuters poll of analysts.

It said significantly higher international snus investments weighed on the profit margin for snuff and snus, which make up more than half of profit. The margin fell to 45.9 percent from 48.1 percent, well below a forecast for 47.6 percent.

As well as aiming at the U.S. market, its venture with Phillip Morris , SMPM International, planned to trial snus in at least one more market this year, after tests in the Russian city of St Petersburg, Taiwan and Canada.

Chief Executive Lars Dahlgren told Reuters he expected the U.S. snuff market to grow 5 percent this year, against 6 percent in 2011, and the Scandinavian market to grow by at least 3 percent, against 5-6 percent in 2011.

He said the group would spend 60-100 million crowns more this year on marketing snus outside Scandinavia. Swedish Match said volume at its second key business, U.S. mass-market cigars, was up 14 percent.

“In the U.S. mass market cigar business … we expect to continue to grow faster than the overall market and generate increased sales and profits in local currency,” it said.

Swedish Match increased it dividend slightly more than expected, to 6.50 crowns. Its shares were up 3 percent by 0950 GMT, while the broader market in Stockholm was down. ($1 = 6.6396 Swedish crowns) (Reporting by Anna Ringstrom; Editing by Erica Billingham)

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2012|Oral Cancer News|