Monthly Archives: June 2012

Perspectives on Coping Among Patients With Head and Neck Cancer Receiving Radiation

Source: MedScape News Today

Abstract and Introduction

Abstract

Purpose/Objectives: To describe coping among patients with laryngeal and oropharyngeal cancer during definitive radiation with or without chemotherapy.
Research Approach: Qualitative content analysis conducted within a larger study.
Setting: Two radiation oncology outpatient clinics in Baltimore, MD.
Participants: 21 patients with oropharyngeal or laryngeal cancer.
Methodologic Approach: Interviews with open-ended questions were conducted during treatment. Questions covered topics such as coping during treatment, treatment-related issues, and resources.
Main Research Variables: Coping, treatment, and coping resources.
Findings: Patients’ self-assessments suggested they were coping or that coping was rough or upsetting. Issues that required coping varied over four time points. Physical side effects were problematic during and one month after treatment completion. Patients used coping to manage the uncertainties of physical and psychological aspects of their experience. Family and friend support was a common coping strategy used by patients, with the intensity of side effects corresponding with the support provided across time points.
Conclusions: Findings confirm previous research, but also provide new information about ways in which patients with head and neck cancer cope with their illness experience. Emergent themes provide insight into patients’ feelings, issues, and assistance received with coping.
Interpretation: Patients with head and neck cancer need education on the amount and severity of side effects and should be appraised of potential difficulties with scheduling, driving, and other logistic issues. Patients also should be informed of helpful types of support and coping strategies. Additional research is needed to expand the findings related to patients’ coping with treatment and to explore the experiences of family and friends who provide social support.

Introduction

Head and neck cancer (HNC) accounts for 3% of all cancers in the United States and is twice as common in men compared to women (National Cancer Insitute [NCI], 2011). The incidence in the United States was estimated to be 52,000 new cases in 2011 (NCI, 2011). Treatment for HNC is multimodal, including surgery, radiation, and often chemotherapy. Patients’ illness experiences involve physical symptoms, side effects from treatment, symptom distress, and psychological distress (Archer, Hutchison, & Korszun, 2008; Haman, 2008). Patients also experience uncertainty about the effectiveness of an unfamiliar treatment, their ability to manage daily living, and long-term effects of the disease and treatment (Rose & Yates, 2001). Because of uncertainty, each patient perceives illness, cognitively appraises his or her situation, and copes with illness differently (Mishel, 1988).

Patients with HNC experience an array of physical symptoms resulting from their cancer and its treatment (Chandu, Smith, & Rogers, 2006). Symptoms related to side effects of radiation include dysphagia, xerostomia, pain, fatigue, altered taste, mucositis, skin changes, and weight loss (Olmi et al., 2003; Khoda et al., 2005). Symptoms related to side effects of chemotherapy include difficulty swallowing, anemia, nausea, neutropenia, diarrhea, and mucositis (Lambertz, Robenstein, Mueller-Funaiole, Cummings, & Knapp, 2010; Schrijvers, Van Herpen, & Kerger, 2004). Patients with HNC may experience several of those symptoms and side effects at any time during their treatment.

Symptom distress is defined as the degree or amount of physical or mental upset, anguish, or suffering experienced from specific symptoms (Rhodes & Watson, 1987). Few researchers have examined symptom distress among patients with HNC. Lai et al. (2003) reported that patients undergoing treatment had a moderate amount of symptom distress related to dry mouth, fatigue, loss of appetite, insomnia, and pain. Symptom distress also changes over time in response to the perceived difficulties of patients as a result of the physical and psychological demands of treatment (Haisfield-Wolfe et al., 2011). Symptom distress among patients with HNC can influence coping with symptoms and psychological distress (Elani & Allison, 2010).

Psychological distress, including the presence of anxiety, depression, and depressive symptoms, is present during the course of HNC treatment. Patients experience high levels of anxiety, particularly at diagnosis and pretreatment (Horney et al., 2011). Researchers have found depression and depressive symptoms prior to treatment (Baile, Gibertini, Scott, & Endicott, 1992; Davies, Davies, & Delpo, 1986), during treatment (Haisfield-Wolfe, McGuire, Soeken, Geiger-Brown, &, De Forge, 2009; Kugaya et al., 2000), at the completion of radiation treatment (Katz, Irish, Devins, & Gullane, 2003; Sehlen et al., 2003), and three months after diagnosis (Hammerlid, Silander, Hornestam, & Sullivan, 2001).

Uncertainty in illness is defined as an inability to determine the meaning of events, assign values to objects and events, and accurately predict outcomes (Mishel, 1988). Uncertainty and symptoms have been shown to interfere with adaptation to cancer (Bailey, Mishel, Belyea, Stewart, & Moher, 2004), and high levels of uncertainty interfere with coping (Mishel, 1984). In studies of patients with cancer, increased uncertainty has been related to depression (Bailey et al., 2004), poorer coping with stress (Badger, Braden, & Mishel, 2001), and inadequate psychological adjustment (Christman, 1990). However, few research studies have addressed coping in the context of uncertainty among patients with HNC.

Coping is defined as a “cognitive and behavioral effort to manage specific external or internal demands and conflicts that are appraised as taxing or exceeding the resources of a person” (Lazarus & Folkman, 1984, p. 112). Cognitive appraisal of taxing situations is a prerequisite for initiation of coping attempts that are aimed at adapting to the new reality of living with HNC. Variables associated with adaptation include those of a physical, psychological, and social nature. Research that investigates coping among patients with HNC, focusing on areas patients cope with and what coping strategies they use, is limited. Chaturvedi, Mbulaiteye, and Engels (2008) found that major concerns faced by patients with HNC were worries about their current illness and future (e.g., physical evaluation, communication, inability to perform usual tasks, finances, being upset).

During treatment, patients with HNC cope with symptoms and worries such as weight loss, dry and sore mouth, difficulty masticating and swallowing food, altered perception of taste, and missing meals (Lees, 1999). Patients receiving radiotherapy reported experiencing insufficient information and lack of time to ask questions (Larsson, Hedlin, & Athlin, 2007). Patients also have described coping with “disruption of their daily lives,” “waiting in suspense,” and “being left to their own devices” (Larsson et al., 2007, p. 324). Other areas identified as requiring coping after treatment were feelings of being self-diminished, underreported suffering, and loss of meaning in life (Moore, Chamberlain, & Khuri, 2004). Six to 12 months after treatment, patients were faced with physical changes, concerns about cancer, difficulties with work, interpersonal relationships, and social functioning (Semple, Dunwoody, Kernohan, McCaughan, & Sullivan, 2008).

Coping strategies used by patients with HNC vary. List et al. (2002) found that at pretreatment, patients with HNC primarily used social support. Recently treated patients with HNC used a greater number of coping strategies and commonly employed emotional ventilation, disengagement, denial, and suppression of competing activities (Sherman & Simonton, 2010). Elani and Allison (2010) found an association between levels of patients’ anxiety and depression and the types of coping strategies used. Those with higher levels used more self-blame, wishful thinking, and avoidance strategies. Thambyrajah, Herod, Altman, and Llewellyn (2010) examined benefit finding after HNC treatment and found that major themes were change in life priorities, greater closeness to family and friends, a greater awareness of self, and spirituality. Those few studies demonstrate that although patients with HNC are challenged with numerous physical, psychological, and social effects, their coping remains poorly understood.

Patients cope with symptoms and side effects, worry about disruption in their lives, and often are left to their own devices (Larsson et al., 2007; Lees, 1999). Patients also experience loss of meaning in life, underreport their pain, feel (or are) disfigured, and have changes in interpersonal relationships (Moore et al., 2004). They verbalize that they feel concerned about the uncertainties of cancer recurrence and daily living (Semple et al., 2008). Despite that large burden, few intervention studies have been designed to assist patients with HNC in coping. Learning more about how patients with HNC cope during each phase of their cancer experience will provide clarity in understanding the coping needs of and strategies used by this population.

The purpose of this study was to describe coping in the context of uncertainty among patients with laryngeal and oropharyngeal cancer during definitive radiotherapy with or without chemotherapy over four time points. This work was conducted as a substudy within a larger, longitudinal descriptive study (Haisfield-Wolfe et al., 2009) examining symptoms, symptom distress, depressive symptoms, and uncertainty.

Mishel’s (1988) Uncertainty in Illness Theory (UIT) guided the study research. UIT centers on an ill individual’s appraisal and coping with uncertainty. UIT views coping as a context-specific behavior in which an individual appraises and manages uncertain objects or events as a threat or as a positive challenge (Lazarus, 1967; Lazarus & Launier, 1978; Mishel, 1988). This substudy focuses on coping related to uncertainty. In designing this substudy, the researchers developed three open-ended interview questions to illicit information regarding how patients with HNC cope with treatment. Exploring coping within the context of uncertainty will help increase understanding of coping issues and strategies, with the ultimate aim of developing interventions that will improve practice.

Methods

Design, Setting, and Sample

The current study is a descriptive, qualitative content analysis of open-ended questions that patients answered about their coping during treatment. Patients were recruited from radiation oncology clinics at two cancer centers in Baltimore, MD. The sample consisted of 21 patients who met the following inclusion criteria: being aged 18 years or older, newly diagnosed with oropharyngeal or laryngeal cancer, and undergoing definitive radiation with or without chemotherapy. Patients were interviewed at four time points: week 1 (treatment initiation), week 5 (midpoint in treatment), week 9 (end of treatment), and week 12 (one-month visit with radiation oncologist after completion of radiation).

Procedures and Analysis

Approval was obtained from the human subjects institutional review boards at the University of Maryland Medical Center and Johns Hopkins Medical Institutions. Procedures were similar at each site, with physicians and nurses screening new patients for eligibility and identifying those interested in participating. Those individuals then were contacted by the researchers. Of 24 patients meeting inclusion criteria, 21 signed informed consent and provided demographic information. Patients who declined participation stated they were overwhelmed by their diagnosis and schedule. During a structured interview that was conducted as part of the larger study, researchers used the following prompts at each time point.

  • Tell me about how you are coping during treatment.
  • Tell me about any issues related to your treatment.
  • What resources are helping you to cope?

Depending on patients’ responses, the researchers occasionally asked additional questions for clarification. Patients were given as much time as needed to answer the questions, with the average interview lasting 15–30 minutes. Participants’ responses were recorded manually.

The recorded responses were categorized by time point and entered into a Microsoft® Word® document. Using a content analysis approach, the first author examined the text. A qualitative method was used to sort words and sentences having aspects related to each other by content and context into content areas (Graneheim & Lundman, 2004; Krippendorff, 2004). After rereading the whole interview again, content areas were labeled. The individual content areas were tabulated to identify the frequency with which they occurred (Krippendorff, 2004) and then discussed by the researcher and two HNC content area experts. When the researcher or the content experts had different perspectives, discussion occurred until consensus was reached. The categories and their content then were formulated into themes. Finally, the data were reviewed and judged by an HNC survivor who agreed that the themes and content reflected the experience of patients with HNC coping during and after treatment.

Study integrity was established using the aspects of trustworthiness: credibility, dependability, transferability, and confirmability (Lincoln & Guba, 1985). Credibility was demonstrated in the unique responses of patients with HNC to the interview questions, which focused on specific areas of coping with treatment. Dependability was demonstrated not only in the agreement among HNC experts and researchers regarding the results, but also by similar research findings in the literature that are reported in the Discussion section of this article. Transferability was judged by HNC content experts and an HNC survivor who reviewed the findings and agreed that they were transferable to other HNC contexts and settings. Finally, confirmability was maintained when a code book was developed and an audit trail of coding and content area decisions were recorded by the researchers to help ensure rigor and provide guidance for future research.

Results

Demographic and Clinical Characteristics

Sample characteristics are presented in Table 1 . Most patients were Caucasian, married, and men. The mean age was 59.2 years (SD = 9.2), and most patients had 12 years of education. Five patients reported a prior mental health disorder, and one patient was taking antidepressant medications. All patients were receiving radiation treatment at the time of the study, and 15 patients were receiving concomitant chemotherapy.

Open-ended Questions

Coping During Treatment: See Table 2 for the number of participants reporting each theme across time points. Exemplars for the three most prevalent themes that emerged related to coping are presented in Table 3 . At all four time points, the most prevalent theme was the patient’s self-perception of managing to cope. Responses revealed degrees of coping, for example, “quite well,” “as expected,” or “fair.” More than half of the patients reported they were coping with their illness and treatment. Although patients self-perceived they were coping across time points, they also identified physical and psychological issues that challenged their coping abilities. The second most prevalent theme was upsetting or rough experience, which increased over time. At the beginning of treatment, patients reported areas of difficulty with coping as stress related to disease and treatment. At midtreatment, patients reported bothersome side effects. At end of treatment, patients reported coping with aspects of treatment related to managing stressful events or severe side effects. One month after treatment, patients reported being upset about not feeling better by this point in time.

The third most prevalent theme was anticipation, which was highest at baseline and end of treatment (week 9). Patients were anticipating the end of both treatment and side effects. Responses that demonstrated anticipation included “I’m counting the days,” or “I can see the end of the tunnel.” Patients also reported using coping strategies (e.g., blogging, walking, accepting assistance from family or friends, acceptance of their illness, denial).

Issues Related to Treatment: Selected exemplars for the three most prevalent themes related to issues during treatment are presented in Table 4 . The most prevalent theme throughout the four time points was having physical side effects related to treatment, which increased at midtreatment and declined at end of treatment and one month after treatment. Patients reported 16 different side effects: weight loss, taste changes, sore throat, skin sores, pain, nausea, hiccoughs, hearing loss, fatigue, excess mucous, dry throat, difficulty talking, difficulty eating or swallowing, anorexia, and change in body image. One month after completion of treatment, patients still reported persistent symptoms (e.g, pain, difficulty swallowing, fatigue). Of note, the second most prevalent theme (six patients at weeks 5 and 9) was minimal or no issues, with the frequency declining over time. The third most prevalent theme was fear, anxiety, or worrying, which was present at all time points, but was most prevalent at baseline and one month after treatment. Exemplars emphasized the uncertainty associated with completion of treatment, for example, “fear of recurrence of cancer” and “don’t know what to expect.”

Assistance With Coping: Illustrative exemplars for the three most prevalent themes related to assistance are shown in Table 5 . The most prevalent theme was family support, with the majority of patients reporting family as the main source of support received over the four time points. The second most prevalent theme was friend support, which also persisted over four time points. Many patients told stories about how their friends and family had supported them. As the number of side effects increased at midtreatment and end of treatment, the number of individuals supporting the patient increased. At end of treatment (week 9), patients reported the importance of hospital personnel. One month after treatment, the amount of family support decreased and the interactions with friends increased. The third most prevalent theme was mental outlook, which increased over time. Coping strategies reported included Web support, keeping a normal schedule, weekly massage, walking, keeping busy, working at home, journaling, pets, and going to the mall for a few hours to take a “minivacation.”

Discussion

The results indicate that patients used coping to manage the uncertainties of physical and psychological aspects of their experience. Emergent themes provided insight into patients’ issues and feelings, as well as the support they received during treatment and afterward. Common themes uncovered for each question will be discussed briefly.

Coping at Each Treatment Time Point

Coping is defined as managing internal and external demands of illness (Lazarus & Folkman, 1984). Although the majority of patients perceived that they were coping, they reported different degrees of individual coping (e.g., “excellent,” “fair”) and noted issues that influenced how they coped, such as symptoms, fear, or anxiety. Therefore, most individuals appeared to be coping with the internal and external demands of treatment, with the exception of those who found their situation to be rough or upsetting. Interestingly, patients who reported that their coping was rough or upsetting were not the same grouping of patients across all time points. Patients reported better coping or more difficulty coping depending on the time point; for example, a patient who was coping adequately at baseline and midtreatment reported not coping well at end of treatment because of pain when swallowing. The adequacy of coping appeared to vary depending on the physical and psychological demands the patient had to face. Anticipation emerged at week 9 when patients were experiencing their worst symptoms and were anticipating the end of treatment and the results of their scans, which would determine whether the treatment was successful. That appears to be similar to the theme of waiting in suspense reported by Larsson et al. (2007), who studied patients with HNC six to eight weeks after radiotherapy. Those findings highlight a major issue among patients with HNC: the fear of recurrence experienced by cancer survivors. Coping interventions are needed to assist patients with that issue. One strategy is to educate patients about the wide variety of coping strategies used by participants in this substudy.

Issues Related to Treatment

Physical side effects of treatment were the most prevalent theme identified as an issue to be coped with, revealing specific areas of concern for patients with HNC and verifying findings of other researchers on coping with treatment side effects (Lees, 1999). Specific side effects included difficulty talking, eating, and swallowing; taste changes; excess mucous; and changes in body image. At the midpoint of treatment, patients reported coping with 17 different symptoms, with one patient reporting concurrent presence of three to four side effects at one time. The large number of symptoms patients coped with also has been reported by others (Hansen & Roach, 2007; Vissink, Jansma, Spijkervet, Burlage, & Coppes, 2003). Even one month after treatment, patients still identified pain (mainly in the throat), fatigue, and difficulty swallowing as issues. Treatment-related issues that were problematic for patients generally were related to the processes and procedures of radiation treatment, such as wearing a mask. Both treatment side effects and treatment-related issues revealed the complexities of the illness experience and the challenges posed to patients’ coping. Ten patients reported minimal or no issues at baseline, although that theme was less common at subsequent time points. That finding was surprising because patients were just starting their treatments and one might anticipate that they were coping with a variety of issues. Alternatively, patients simply may have been coping more effectively with their illness. In a study of patients with HNC, Moore et al. (2004) found that patients may underreport their pain and suffering. Finally, the theme of fear, anxiety, or worry was present at all time points, but particularly at baseline and end of treatment. Patients expressed distress about the uncertainties of their illness and their future. They were anxious about treatment and afraid of the outcomes. They worried about the cancer spreading, the treatment schedule, and whether they would endure their treatment. Those fears and worries have been observed by other researchers and clinicians (Hodges & Humphris, 2009). Clearly, uncertainties related to cancer cure and what the future holds are a major issue in the illness experience of patients with HNC. Additional study to determine interventions to assist patients in this area is needed.

Assistance With Coping

Patients used social support to cope with their treatment over the four study time points. They depended on their families and friends to assist them with many aspects of their lives, including traveling to outpatient clinic visits and radiation treatments, daily living activities, communicating with healthcare providers, managing symptoms, scheduling appointments, reading information and educational materials, and engaging in other activities to manage and cope with treatment. Patients also relied on those support people for companionship. As patients progressed with their treatment, more family and friend support was needed to cope with the resulting complexities. Patients used a broad range of coping strategies and also articulated acceptance of their situation or, occasionally, denial.

Of note, some patients took breaks from their situations by going to the mall or turning off their cellular phones to reduce disturbances to their focus on getting well. Sherman and Simonton (2010) reported coping strategies of ventilation, disengagement, and suppression of competing activities, but the wide array of activities reported in the current study provides insights into how patients may take the initiative to cope with their illness and treatment.

Mental outlook was a prevalent theme that helped patients’ cope, and that mindset increased as they progressed through treatment. Patients were convinced that they were getting through the treatment because of their mindset and that they were going to endure. That finding is important because it suggests that patients with a positive mental outlook represent a patient subgroup with a greater ability to cope. Each individual copes with illness and cognitively appraises his or her situation differently (Lazarus & Folkman, 1984). Therefore, mental outlook could have influenced the way patients coped with the physical and psychological demands of illness and treatment.

Limitations

The current study was limited by the unrecognized individual biases of the researchers and the HNC content experts who analyzed the data. Interviews were conducted at four time points during radiation treatment and, therefore, cannot reflect the entire experience of coping in patients with HNC. During interviews, patients were experiencing fatigue and other factors that may have affected the amount and degree of self-reporting that occurred. Finally, different ways to ask about coping may have revealed different perspectives.

Implications for Nursing

The findings confirm previous research, but also provide new information about the ways in which patients with HNC cope with their illness experience. In the clinical setting, patients with HNC should be educated regarding the number and severity of side effects they may experience and be appraised of potential difficulties with scheduling, driving, and other logistic issues. Patients also should be informed of the types of support and coping strategies that can be helpful. Healthcare providers also should inform patients that they may experience low energy during treatment, thus requiring support of significant others who can assist them with a variety of activities and issues.

Additional research is needed to expand the findings related to patients’ coping during and after treatment because this study was small with limited exploration of coping. For example, future researchers should explore the illness and coping experience of patients with HNC who perceive that they are coping adequately, but then report multiple treatment-related issues. Another area for future research is an exploration of the issues, burdens, and individual coping of family and friends who provide social support to patients with HNC during treatment, which can ultimately strengthen support for patients and reduce the negative impact of caregiving.

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

June, 2012|Oral Cancer News|

Study links gum disease, HPV-status of head and neck cancer

Source: www.buffalo.edu/ubreporter
Author: Sara R. Saldi

Human Papilloma Virus (HPV), once almost exclusively associated with cancer of the cervix, is now linked to head and neck cancer. Furthermore, according to a new UB study just published in the Archives of Otolaryngology—Head & Neck Surgery, a JAMA publication, gum disease is associated with increased odds of tumors being HPV-positive.

Primary investigator Mine Tezal, assistant professor of oral biology in the School of Dental Medicine, and a team of scientists from UB evaluated data from 124 patients diagnosed with primary head and neck squamous cell carcinoma (HNSCC) between 1999 and 2007.

“The aim of the study was to test the presence of periodontitis, a persistent inflammatory process and HPV-status of HNSCC,” Tezal says.

Of the 124 tumor samples Tezal and her team studied, 50 were positive for HPV-16 DNA and that subjects with HPV-positive tumors had a significantly higher severity of periodontitis when compared to subjects with HPV-negative tumors.

According to the National Cancer Institute, there has been a steady increase in the prevalence of oropharyngeal cancers in the U.S. since 1973. This is despite the significant decline in tobacco use since 1965, a year after the U.S. Surgeon General issued the landmark Report on Smoking and Health. Tezal notes that this increase has mainly been attributed to oral HPV infection.

Understanding the natural history of the oral HPV infection and targeting factors associated not only with its acquisition but also with its persistence, says Tezal, will lead to more effective strategies, not only for prevention, but also for treatment.

“While there is an effective vaccine for cervical HPV infection if given prior to the exposure of the virus (females 9-26; males 9-21), oral HPV infection can be transmitted at or any time after birth, and the target population for a vaccine to prevent oral HPV infection has not yet been defined,” says Tezal.

Tezal pointed out that though many previous studies combined periodontitis and dental decay as indicators of poor oral health, dental decay was not significantly linked to tumor-HPV status in the present study.

“The fact that only periodontitis was associated with tumor HPV status points to the potential association of [this] inflammation with tumor HPV status,” she says.

When Tezal and colleagues started their research about eight years ago they were looking at the potential association between chronic inflammation and head and neck cancers because the importance of the local oral environment for malignant tumor growth was widely accepted. However there wasn’t research evaluating the role of local oral factors in the natural history of HNSCC, Tezal says.

“The next step in this research will be intervention studies to test whether treating the sources of inflammation, like gum disease, can reduce the acquisition and/or persistence of oral HPV infection and improve the prognosis of HPV-related diseases,” she says.

Gruesome images on cigarette packs seem to be working

Source: http://www.winnipegfreepress.com/

Sometimes it takes a good swift kick to open a person’s eyes. That’s the federal government’s strategy in its “scared straight” campaign urging Canadians to butt out by forcing tobacco companies to adorn their addictive products with gruesome images showing the consequences of smoking.

The graphic pictures include that of a human tongue rotting in the mouth of a person inflicted with mouth cancer. Other images portray cancer victims, literally human skeletons, at various stages of cancer with the Grim Reaper knocking at their back door.

Handout photo / Postmedia News Archives

Another shows a man with a hole in his neck — a victim of throat cancer — through which he now breathes. His message on the smoke pack: “I wish I had never started smoking.”

It’s a frank message that had to be brought home, and it’s apparently working. Statistics Canada reported this week smoking rates have dropped dramatically in the last 10 years, with steep declines in the number of teen smokers. Ottawa credits, in part, its mandatory, graphic anti-smoking packaging for tobacco products.

The new rules became official Tuesday. Tobacco companies must now label three-quarters of a cigarette package with grisly pictures showing the horrific consequences of smoking. The image of an emaciated, cancer-stricken Barb Tarbox, curled up in a fetal position in a hospital bed not long before her death, takes up three-quarters of some of the packages.

Tarbox became well-known as a powerful anti-smoking activist who, while inflicted with brain and lung cancers, gave numerous public appearances addressing younger people. The former model died in an Edmonton hospital in 2003, at the age of 42.

“This (graphic) initiative continues our efforts to inform Canadians — especially young people — about the hazards of smoking, said federal Health Minister Leona Aglukkaq.

Cigarette packages also display a national “quitline” and website addresses that smokers can access for help in kicking the addiction. It’s important to note nicotine is a for-real addiction, not a habit. It has been repeated countless times the addiction is more powerful than it is in the case of heroin.

Statistics Canada reported that not only are fewer people smoking, many who do are smoking less. Last year, one in five Canadians aged 12 and over — 5.8 million people — smoke on an occasional or a daily basis, down from 25.9 per cent in 2001. For teens aged 15 to 17, the rate fell over the same period to 9.4 per cent from 20.8 per cent. For those aged 18 to 19, the rate dropped to one in five from one in three. Not only that, but exposure to second-hand smoke has been halved.

Ottawa alone, however, can’t take full credit for the encouraging statistics. Increased education programs across the country, some beginning at the school-age level, and tough laws imposing harsh restrictions on when and where people can smoke, have contributed greatly to this downward trend.

Hopefully Ottawa’s “scared straight” initiative has a long-term effect, and more and more smokers will be butting out for good.

Source: Republished from the Winnipeg Free Press print edition June 22, 2012 A12

Electrochemical sensor spots oral cancer

Source: cen.acs.org
Author: Erika Gebel

Medical Diagnostics: A simple and inexpensive device detects multiple cancer biomarkers

When doctors spot cancerous lesions in patients’ mouths, it’s often too late: The disease has already reached a difficult-to-treat stage. As a result, oral cancer has a high death rate. To help doctors catch the disease earlier, researchers have developed a simple, low-cost method to identify multiple oral cancer biomarkers at once (Anal. Chem., DOI: 10.1021/ac301392g).

Scientists previously have shown that oral cancer patients have altered levels of several proteins, including vascular endothelial growth factor C (VEGF-C), in their blood (J. Clin. Pathol., DOI: 10.1136/jcp.2007.047662). Doctors would like to use these biomarkers to diagnose the disease.

A magnetic microbead (beige) covered in horseradish peroxidase (red stars) and antibodies (blue) captures an oral cancer protein (green circle). Another antibody (pink), which is attached to gold nanoparticles (yellow) on the surface of an electrical sensor, binds to the same cancer protein. When researchers add peroxide to the mix, the peroxidases generate an electrical signal proportional to the cancer protein’s concentration. Credit: Anal. Chem.

But James Rusling of the University of Connecticut, Storrs, says that to improve diagnostic accuracy, it’s necessary to detect multiple proteins at once. What’s more, current technology can’t easily measure subtle changes in the low concentrations of these proteins found in patients’ blood. Such tests would require trained technicians and expensive equipment, such as spectrometers, that most clinics don’t have. Rusling and his colleagues, including J. Silvio Gutkind of the National Institutes of Health, wanted to develop a low-cost test doctors could easily use.

The team built a device that can measure concentrations of multiple biomarker proteins at once through easy-to-read electrical signals. For each protein they want to detect, the scientists use two antibodies that each bind to a different part of the biomarker. One antibody decorates magnetic microbeads. The team also coats these microbeads with a thick forest of some 400,000 copies of the horseradish peroxidase protein, an enzyme that reacts with hydrogen peroxide to produce a current.

In a blood sample, the microbeads capture the specific oral cancer protein. Then the researchers apply the microbeads to a disposable chip with electrical sensors. On the surface of the sensors are gold nanoparticles that the researchers had covered in the second antibody. Antibodies on the gold nanoparticles grab onto the beads via the captured biomarker. The scientists repeat this process for each biomarker they want to measure. Their device contains a chip with room for eight sensors.

The nanoparticles on the chip conduct the electron flow produced by the peroxidases through the chip’s circuits. The resulting electrical signal is proportional to that biomarker’s concentration. In initial tests of the device, the researchers found that the concentrations of the biomarkers measured using this method matched those made using enzyme-linked immunosorbent assay, the gold standard for protein detection.

To test the method’s diagnostic capabilities, the researchers measured levels of four oral cancer biomarkers: interleukin 6 (IL-6), IL-8, VEGF, and VEGF-C. For each biomarker, they mixed the corresponding magnetic microbeads with diluted serum samples from 78 oral cancer patients and 49 cancer-free people. Using a small magnet, they pulled out the beads from the serum. After injecting the beads into a microfluidic chamber atop the sensor chip, they added a hydrogen peroxide solution to the chamber and measured the resulting electrical signal.

They found a detection limit for the device between 5 and 50 fg of protein, depending on the biomarker. Based on this small data set, the researchers estimate that their method could correctly diagnose oral cancer in 89% of people with the disease and rule it out in 98% of healthy people.

“They demonstrated a very impressive detection limit,” says Chang Lu of Virginia Polytechnic Institute & State University. He thinks the technology is practical for hospital settings, and he hopes Rusling will extend it to diagnose other types of cancer. Rusling is already adapting the method to diagnose prostate cancer.

Darwin’s Principles Say Cancer Will Always Evolve to Resist Treatment

Source: ScienceDaily.com

According to researchers at Moffitt Cancer Center, cancer is subject to the evolutionary processes laid out by Charles Darwin in his concept of natural selection. Natural selection was the process identified by Darwin by which nature selects certain physical attributes, or phenotypes, to pass on to offspring to better “fit” the organism to the environment.

As applied to cancer, natural selection, a key principle of modern biology, suggests that malignancies in distinct “microhabitats” promote the evolution of resistance to therapies. However, these same evolutionary principles of natural selection can be applied to successfully manage cancer, say Moffitt researchers who published an opinion piece in a recent issue of Nature Reviews Cancer.

“Understanding cancer as a disease starts with identifying crucial environmental forces and corresponding adaptive cellular strategies,” said Robert A. Gatenby, M.D., chair of the Department of Diagnostic Imaging. “Cancer is driven by environmental selection forces that interact with individual cellular adaptive strategies.”

Cancer cell development, like any natural selection (or Darwinian) process, is governed by environmental selection forces and cellular adaptive strategies, the authors wrote. Investigating cancer and its proliferation through genetic changes and ignoring the adaptive landscape is most likely futile. Under “selective pressure” of chemotherapy, in this case the “adaptive landscape,” resistant populations of cancer cells invariably evolve.

The authors say that tumors can be thought of as “continents” populated by multiple cellular species that adapt to regional variations in environmental selection forces. Their strategy in offering this metaphor, they wrote, is to “integrate microenvironmental factors at work during cancer’s progression” into the model of the evolution of cancer and, particularly, the evolution of drug resistance.

“Hundreds of mutations can be found in tumors,” said co-author Daniel Verduzco, Ph.D., a post-doctoral fellow at Moffitt. “The physical environment of the early tumor is constantly changing, often in response to inflammation.”

This reality should remind us, they wrote, that natural selection selects for phenotype, for observable physical characteristics, and that natural selection forces at work in local environments causes populations to change phenotypically rather than genotypically.

The authors point out that for most patients with advanced cancers — even when there is a well-known target and a highly specific drug — response to therapy is fleeting owing to the evolution and proliferation of a resistant population of cancer cells.

While targeted therapies have been among the most recent approaches to treating cancer, the authors suggest that the vast changes in the genetics of tumors via mutations reduce the effectiveness of targeted therapies and are a reason why targeted therapies cease to work.

“The emergence of resistance is predictable and inevitable as a fundamental property of carcinogenesis,” Gatenby said. “However, this fundamental fact is commonly ignored in the design of treatment strategies. The emergence of drug resistance is rarely, if ever, dealt with until it occurs.”

In an effort to develop patient-specific, long-term therapeutic strategies, the authors contend that resistance should be anticipated. By “anticipation” in action, they mean developing “adaptive therapies” prior to the emergence of resistance.

Cancer cells, they wrote, can only adapt to immediate selection forces. Cancer cells cannot anticipate future environmental conditions or evolutionary dynamics. This concept, said the authors, may provide an advantage when designing new therapies by “directing” the natural selection processes to prevent the outgrowth of resistant cancer populations and so improve outcomes.

“This potentially unifying theory places the evolution of cancer within a dynamically active landscape,” said Robert J. Gillies, chair of the Department of Cancer Imaging and Metabolism, and program leader of Experimental Therapeutics. “The outcome is cancer’s heterogeneity — those variations that negatively affect targeted therapies to control cancer.

“Recognizing that evolutionary dynamics are an essential component of carcinogenesis itself can lead to development of appropriate therapeutic strategies,” Gillies said. “For example, knowing ahead of time that resistant cancers are likely to emerge provides us with lead time to develop preventive or adaptive therapeutic approaches. We have recently completed studies with our colleagues, Dr. Ariosto Silva , showing that evolutionarily informed therapies can forestall the emergence of resistant tumors for a very long time.”

The authors conclude that we can use our understanding of evolution to strategically direct natural selection toward preventing the outgrowth of resistant cancer populations and, in so doing, improve outcomes.

This research is supported in part by a grant from the McDonnell Foundation (Grant# 220020270) and two grants from the National Cancer Institute, part of the National Institutes of Health (Gant # U54 CA143970 and Grant # R01 CA077575).

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

June, 2012|Oral Cancer News|

More On Why The Adverse Event Reports On Gardasil Don’t Point To A Problem

Source: Forbes.com

Readers are still commenting on my post on why the adverse event reports on Gardasil seem to indicate the vaccine is safe. One particularly persuasive line of comment comes from reader Stephanie Rehak, who does some reporting for me. Basically, she points out, many of these reports are third-hand and for problems that a vaccine would be unlikely to cause.

Rehak writes:

Have you read through the (currently) 107 reports of death on VAERS tied to Gardasil? It’s well worth the read. The first page has mostly cases of death with other underlying factors that contributed to the patient’s death (congenital heart disease, seizure disorders, DVT in patients taking Yaz BCP). The further in you get the crazier it becomes.

There are several fourth and fifth hand reports such as VAERS ID 344385

“Information has been received from an office manager that the physician heard from the physician”s colleague that a 16 year old female colleague”s patient was given an unspecified dose of GARDASIL (Lot not reported) on a Friday and on Monday the patient passed away (specific dates were unknown).”

There are at least a dozen regarding cases the reporter read about on the internet, heard about on the radio or saw on TV, like 383175

“Information has been received from a consumer via an internet newspaper concerning a patient who on an unspecified date was vaccinated with a dose of GARDASIL… It was also reported that polysorbato 80 or tween 80 that is a chemical that causes infertility in mice and aluminum which is neurological toxin are in GARDASIL. This is one of several reports from the same source. Additional information is not expected.”

There are also a couple of suicides, a car accident and a case where a girl fell into an open well and died that were reported to VAERS. Of the cases that could be verified there are about half a dozen reports where the patient died of anaphylaxis possibly due to the vaccine or where the cause of death truly remains a mystery.

As a woman, I find it particularly sad that so many of the opponents of this vaccine are other women. This vaccine has the potential to save a lot of lives, and sadly, the public reaction has been negative due to irrational fears and smear campaigns based on lies.

Have you read through the (currently) 107 reports of death on VAERS tied to Gardasil? It’s well worth the read. The first page has mostly cases of death with other underlying factors that contributed to the patient’s death (congenital heart disease, seizure disorders, DVT in patients taking Yaz BCP). The further in you get the crazier it becomes.

There are several fourth and fifth hand reports such as VAERS ID 344385

“Information has been received from an office manager that the physician heard from the physician”s colleague that a 16 year old female colleague”s patient was given an unspecified dose of GARDASIL (Lot not reported) on a Friday and on Monday the patient passed away (specific dates were unknown).”

There are at least a dozen regarding cases the reporter read about on the internet, heard about on the radio or saw on TV, like 383175

It’s not impossible that Gardasil could cause some rare side effects that we have not found out about yet. But using the tally of deaths reported the Vaccine Adverse Event Reporting System, as critics often do, is simply wrong. There’s nothing in these reports to indicate a problem.

June, 2012|Oral Cancer News|

Facing the Facts: HPV-Associated Head and Neck Cancers Get a Second Look

Source: CureToday.com

HPV causes surge in oral cancer rates.

Kevin Pruyne knew he didn’t fit the stereotype of a hard drinker or heavy smoker who one day develops an oral cancer.

The 52-year-old mechanic had been working a three-week stint in a remote section of northern Alaska, repairing trucks on an oil field, when he noticed a hard lump beneath his jaw while shaving. For nearly three months, as Pruyne was prescribed antibiotics for a possible infection and then later shuttled between physician specialists, he kept hearing the same thing: the lump could not be cancer.

Pruyne only occasionally consumed alcohol and had never smoked. His wife, Kathy, began researching her husband’s symptoms, which included repetitive throat clearing, a nagging sensation that something was lodged in his throat and ringing in his ears. And the lump, which looked like the top half of an egg, felt solid to the touch.

This wasn’t some inflamed lymph node from a lingering head cold, Kathy Pruyne says. “He had every symptom [of cancer], but nobody would listen to me.”

 

Kevin Pruyne, with his wife, Kathy, is hopeful his HPV-positive oral cancer will be cured. Photo by Rick Bacmanski.

Pruyne received a diagnosis of stage 4 oral cancer, which started with a tumor at the base of his tongue. He had already begun chemotherapy when he learned that researchers had discovered an association between the human papillomavirus (HPV) and increasing rates of oropharyngeal cancers. He asked that his tissue be tested; the results came back positive. Pruyne says he wanted to know whether his cancer was caused by HPV because “the prognosis is considerably better with HPV-positive cancer.” He adds he “wanted to hear that there was a better chance of a cure.”

An Explosion of Cases

For researchers and clinicians alike, determining appropriate treatment has taken on new urgency: HPV-positive oropharyngeal malignancies—most typically found on the tonsils or at the base of the tongue—increased 225 percent from 1988 to 2004. If current trends continue, HPV-positive oral cancer cases could soon surpass cervical cancer diagnoses, according to a 2011 study published in the Journal of Clinical Oncology.

As researchers have revisited data from prior oral cancer treatment studies, they’re realizing that patients with HPV-positive tumors respond better to chemotherapy and radiation. One study, which retrospectively analyzed treatment outcomes for stage 3 and stage 4 oropharyngeal patients based on their HPV status, found that the three-year overall survival rate was 82.4 percent in patients with HPV-positive tumors. Among those who tested negative, the three-year overall survival rate was 57.1 percent, according to the findings published in 2010 in The New England Journal of Medicine.

With that in mind, research trials are being launched to determine whether treatment can be modified in some way or even dialed back. The goal? To achieve the same survival with fewer of the swallowing difficulties, taste problems and other debilitating side effects.

“For a subset of patients, we’ve actually achieved a pretty high cure rate,” says James Rocco, MD, PhD, a head and neck surgeon at Massachusetts Eye and Ear Infirmary, and director of head and neck cancer research at Massachusetts General Hospital. “And the question is: Can we maintain that cure and reduce some of the major side effects of treatment?”

It’s very clear that HPV-positive oropharyngeal cancer is a completely different entity from HPV-negative.

—Stephen Liu, MD

But researchers and oncologists have only just begun to understand HPV-positive malignancies. “It’s very clear that HPV-positive oropharyngeal cancer is a completely different entity from HPV-negative,” says Stephen Liu, MD, a head and neck cancer specialist, and an assistant professor of medicine at the University of Southern California.

“We think that it’s going to impact treatment in the future,” Liu adds. But, he stresses, outside of a clinical trial, he “would really discourage anyone from receiving less treatment because their tumor is HPV-positive.”

Identifying the Virus

Traditionally, tobacco and alcohol use have been the primary culprits for triggering cancers in the oropharynx and nearby areas of the mouth, as well as other structures in the throat, such as the larynx. Each year, nearly 40,000 Americans develop cancer of the oral cavity or pharynx. Men are more than twice as likely to receive a diagnosis.

But, until recent years, not someone like David Hastings. The certified public accountant was 58 years old, a lean cyclist who rode some 100 miles each week, when he learned six years ago that he had stage 4 oropharyngeal cancer located at the base of his tongue. Clinicians at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla., also were puzzled, as the Gulfport resident tells it. “They said the typical oral cancer patient is a man in his 60s or 70s who sits in a bar all day and drinks and smokes.”

The association with HPV emerged from a perplexing conundrum, says Kian Ang, MD, PhD, a professor in the department of radiation oncology at M.D. Anderson Cancer Center in Houston. As cigarette smoking has declined in recent decades, so have head and neck cancers, with the exception of tumors in the oropharynx. (The region encompasses the middle section of the throat, along with the back portion of the tongue, the soft palate and the tonsils.) That statistical anomaly, Ang says, “gave us the first clue that something else might be going on.”

Starting with a pivotal study published in 2000, researchers began honing in on the role of HPV. Of the 150-plus strains in the HPV family, more than 40 are believed to be transmitted through sexual contact, including anal, genital and oral, according to the National Cancer Institute. The body’s immune system typically eradicates the viruses in a few years before any symptoms emerge (but, in some cases, the cells remain molecularly altered forever). Several of the HPV strains to date, most frequently HPV type 16, have been linked to oral malignancies.

Increasingly, HPV-16 has become a major player in those oral malignancies, according to last year’s Journal of Clinical Oncology study, which projected an explosion in cases in the decades to come.

When researchers studied 271 tissue samples in previously diagnosed patients, HPV prevalence was identified in only 16.3 percent of those collected between 1984 and 1989. Between 2000 and 2004, 72.7 percent of specimens tested positive, a trend that also perhaps correlates with population-wide increases in oral sex, the researchers wrote.

The analysis also highlighted survival differences. If tumors tested HPV-positive, the median survival was nearly 11 years versus 1.6 years for people whose tumors didn’t carry the virus.

Some of the strides in oral cancer treatment that physicians thought they were achieving can at least be partially explained by the emergence of a less aggressive form of cancer, Ang says. “The other part of the improvement,” he says, “is really due to the addition of chemotherapy and the use of high-precision radiation.”

Multifaceted Treatment

Cancers located in the tonsils or at the base of the tongue can sometimes spread undetected, not becoming visible until they’ve reached the nearby lymph nodes. Some early symptoms include swallowing difficulties or a sudden change or hoarseness in the voice. Like Pruyne, Hastings first became concerned when he felt a mysterious lump while shaving. “Totally painless, no sore throat—nothing,” he says.

Oropharyngeal tumors can be classified as stage 3 or 4 but still be considered localized, as long as they have not spread beyond lymph nodes and structures in the head and neck. Pruyne, whose cancer had migrated to numerous nodes on his neck’s right side, recalls how his oncologist hurried out of the room when his imaging test results became available.

The doctor had already warned Pruyne that he could offer relatively little help if the cancer had spread to his chest. “When he came back up, he was visibly relieved,” Pruyne recalls. “And he said, ‘Your lungs are clear.’”

 

Kevin Pruyne received chemotherapy and radiation for his oropharyngeal cancer. Photo by Rick Bacmanski.

To thwart oropharyngeal malignancies, cancer specialists may incorporate a mix of treatments, including surgery, radiation and chemotherapy, depending upon the location and the aggressiveness of the tumor involved. Ang estimates that only about one-third of patients will undergo surgery. If the tumor can be removed and there’s no evidence that it’s spread to lymph nodes, radiation may not be needed, he says.

But if there’s any concern, patients may receive six weeks of radiation for smaller tumors and seven weeks for larger ones, Ang says. Intensity-modulated radiation therapy (IMRT) is used because it better targets the radiation and thus can limit damage to the salivary glands, reducing dry mouth, as well as damage to other normal tissues, Ang says.

For larger and more aggressive tumors, adding chemotherapy to radiation therapy has been shown to extend survival. One meta-analysis published last year, based on 87 studies involving more than 16,000 patients, analyzed results by tumor location. Researchers found that the combination approach increased five-year overall survival by 8.1 percent in oropharyngeal patients compared with those who didn’t receive any chemotherapy.

The chemotherapy is believed to boost the effectiveness of the radiation, but at a cost—amplified side effects for the patient. The list of potential side effects is lengthy, with so many vulnerable structures and nerves packed into the head and neck area, Liu says. Patients can develop ulcers in their mouth and down their throat, he says. Their salivary glands can generate thick secretions that make it difficult to swallow and to eat.

“The ability to taste, to speak, to salivate,” says Liu, ticking off several more. “Dry mouth. These things can often be permanent. It’s a necessary evil right now because we do what we need to do to cure the cancer.”

Pruyne received two cycles of a cisplatin-based protocol that also included Taxotere (docetaxel) and 5-FU (fluorouracil). Then he started the biologic agent Erbitux (cetuximab) along with hefty doses of IMRT, delivered twice daily for six weeks.

Pruyne’s oncologist warned him that the treatment would be difficult, and it was. He endured radiation burns around the right side of his neck and had to use a feeding tube for two months.

Dialing Back

Although radiation and chemotherapy can be difficult, some patients prefer to take that route, rather than run the risks of surgery, Rocco says. “For advanced local disease, removing the back of the tongue or the soft palate has huge consequences for people,” Rocco says. “They can’t eat. They don’t speak so well.”

But given that patients with HPV-positive tumors are typically diagnosed at a younger age, with potentially decades ahead of them to cope with long-term side effects, the aggressiveness of today’s chemotherapy and radiation regimens are also questionable, he says.

Clinical trials are recruiting patients to answer a question that’s relatively rare in cancer: Can treatment be ramped down? One closely watched phase 3 trial will assess whether Erbitux works as well in HPV-positive patients as the long-standing cisplatin-based chemotherapy regimen.

Cisplatin has been one of the standard drugs used in head and neck cancer, but it’s “very toxic,” says Andy Trotti III, MD, the study’s principal investigator and director of radiation oncology clinical research at Moffitt Cancer Center. The platinum-based drug can impact kidney function and sometimes damage hearing, among other side effects, he says.

Erbitux, which targets the epidermal growth factor receptor (EGFR), primarily affects the skin, Trotti says. In the phase 3 trial, now recruiting HPV-positive patients, the five-year overall survival of patients on Erbitux will be compared with those taking cisplatin. Both groups will receive IMRT.

Another ongoing trial is looking at whether the IMRT regimen can be shortened from six to five weeks, thereby delivering a lower dose of radiation in HPV-positive patients. The patients enrolled in that phase 2 trial, who also will receive cisplatin,  paclitaxel and Erbitux, will be followed for two years.

The study represents a “first step” toward learning whether less radiation can be safely prescribed for HPV-positive patients, Liu says. Since radiation’s effects are cumulative, the extra week of radiation adds “a significant amount of toxicity.”

A New Era in Treatment

Meanwhile, the impact of HPV status on surgical decisions appears to be the subject of some unresolved debate. Given that HPV-positive oropharyngeal malignancies respond well to chemotherapy and radiation, Trotti says, “there has been a real trend away from surgery.”

But new surgical techniques are providing other options for HPV-positive patients who might prefer to limit the long-term side effects of chemotherapy and radiation, says Bert O’Malley, Jr., MD, chairman of the department of otorhinolaryngology of the University of Pennsylvania Health System.

Along with a physician colleague, O’Malley has developed a robotic surgery protocol called TransOral Robotic Surgery. With the assistance of tiny robotic arms and three-dimensional cameras, O’Malley operates through the patient’s mouth, enabling him to remove difficult-to-reach tumors.

A surgery that previously required between six and 16 hours might only take two, he says. Also the approach results in less scarring and fewer surgical complications than the traditional surgery, which may require the jaw to be split, he says.

It’s a new era in HPV-positive treatment, Rocco says. To make his point, he tells of a patient who recently walked in asking to be referred for robotic surgery. The gold standard is still to wait for clinical trial results, but that could take five-plus years, he adds.

There are people who are risk-takers. They’ll look at the data and they’ll make a decision, weighing cure and long-term side effects.

—James Rocco, MD, PhD

HPV-positive patients are frequently “savvy young professionals in the prime of life,” who sort through the latest research online, Rocco points out.

“There are people who are risk-takers,” he says. “They’ll look at the data, and they’ll make a decision, weighing cure and long-term side effects.”

Despite the rigors of treatment, Pruyne was able to resume his job near the Arctic Circle within a few months. He hopes to soon be telling a tale similar to Hastings’, who returned to his biking routine about a year after wrapping up treatment.

Hastings still copes with dry mouth and a reduced ability to taste. But the last time he visited Moffitt for an annual checkup, it felt more like a social call. After some chatting, he quips: “They said, ‘Get out of here. We need to spend more time with people who are sick.’”

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

June, 2012|Oral Cancer News|

Allentown woman who lost jaw to cancer shares anti-smoking message

Source: LehighVallyLive.com

People often stare at Christine Brader. Sometimes strangers ask the Allentown woman what happened to her.
She tells them, “I used to smoke.” Tobacco users flinch when they hear her response, Brader says.
Smoking led to oral cancer, which eventually cost the 49-year-old all of her teeth and part of her lower jaw.Brader has had three bouts with the disease since her first diagnosis five years ago, but is now cancer free.

“I have to go through life disfigured, all because I made a bad decision and smoked,” she says.

Brader doesn’t want others to follow in her footsteps, so she is working with Tobacco Free Northeast Pennsylvania to spread the word about the dangers of smoking. The organization serves a 10-county area, including Lehigh and Northampton, spokeswoman Alice Dalla Palu said.

Brader recently shared her story in a radio advertisement broadcast during the week of World No Tobacco Day, which was May 31.

In the ad — part of the Centers for Disease Control “Tips from Former Smokers” campaign — she describes preparing liquid meals and consuming them through a feeding tube.

Last year, Brader appeared in a TV commercial for Truth, a national smoking prevention campaign that targets youth.

BREAK THE HABIT: Call 1-800-784-8669 or visit tobaccofreene.com to get help quitting smoking.

She started smoking at 16 to fit in with her peers and continued for 28 years. Brader quit cold turkey at 44 after learning in June 2007 that the growth inside her cheek was cancer.

“I felt a little run down, but I had no idea I was sick,” she said. “I had what I thought was a canker sore.”

Brader received radiation treatments and chemotherapy, but the cancer came back in April 2008, so she underwent surgery. The disease resurfaced a third time in June 2009 and had spread to her jaw.

Doctors performed a mandibulectomy and replaced her jaw with a titanium plate. Brader’s body rejected the plate and she nearly died.

The single-mother of two spent weeks in a medically induced coma and months in the hospital. Afterward, Brader looked and felt 20 years older, she said.“It took a year to recover,” she said.

Cancer forced Brader to leave her job and her Lehighton, Carbon County, home behind. She moved to Lehigh County to be closer to Lehigh Valley Hospital in Salisbury Township, where she received treatment.

Brader, who describes herself as independent and strong-willed, was forced to rely on her teenage children as she battled for life.

It was a humbling, frustrating experience, she said. “It was a pretty big blow to realize that I might have to depend on somebody.”

When Brader learned the cancer had spread to her jaw, she considered skipping surgery doctors said was necessary to save her life. She credits her family and The Oral Cancer Foundation with encouraging her to keep up the fight.

Brader is disabled and unable to work, so she volunteers for Tobacco Free Northeast PA and similar organizations.

“I try to use my time to make a difference in the world,” she said. “Young people, maybe, by seeing me, they will realize that it’s not a cool thing to smoke. It’s not cool at all. It can kill you.”

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

 

Cross-sectional study on the prevalence of HPV antibodies in the general population of the Czech Republic

Source: BMJ

  1. Correspondence to Dr Eva Hamsikova, Department of Experimental Virology, Institute of Hematology and Blood Transfusion, U Nemocnice 1, 128 20 Praha 2, Czech Republic; eva.hamsikova@uhkt.cz
  1. Contributors EH participated in the design and coordination of the study, evaluated results, performed statistical analysis and drafted the manuscript. VL prepared antigens for assessment of antibody presence. JS performed the immunoassays. RT participated in the design of the study and helped to draft the manuscript. All authors read and approved the final manuscript.

Abstract

Objectives The assessment of the prevalence of antibodies to human papillomaviruses (HPV) in the healthy population is essential for effective planning of HPV vaccine implementation into the preventive programmes for HPV-associated diseases and for the prospective monitoring of the impact of HPV vaccines in the Czech population.

Methods The seropositivity for HPV-6, 11, 16, 18, 31 and 33 virus-like particles was determined in sera from 3150 healthy individuals (age range 6–76 years) by means of enzyme-linked immunoassay.

Results The seroprevalences for HPV-6, 11, 16, 18, 31 and 33 were 23.8%, 15.2%, 14.5%, 9.9%, 16.4% and 9.6% in women and 18.4%, 13.7%, 6.5%, 5.4%, 6.1% and 4.3% in men. For both genders, except for HPV11, these rates were age dependent. The prevalence of antibodies to HPV-16 and/or 18 reached the maximum of 27.0% in women 30–39 years of age and of 14.4% in men 50–59 years of age. The highest proportion of individuals’ seropositive for any of the vaccine types HPV-6/11/16/18 was in 30- to 39-year-old women (50.0%) and in ≥60-year-old men (37.6%). Antibodies specific for vaccine HPV types were detected in 18.0% of children 6- to 14-year-old but in 26.4%, those older than 14 years.

Conclusions The data reveal age-specific differences in the HPV seropositivity rates between healthy women and men and support the implementation of HPV vaccination in the Czech Republic before the age of 13.

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

 

June, 2012|Oral Cancer News|

Part of jaw removed after mix-up

Source: 3news.co.nz

 

A lab mix-up is being blamed for an operation on the wrong patient at an Otago dental hospital

A lab mix-up is being blamed for an operation on the wrong patient at an Otago dental hospital

An Otago dental hospital has apologized to a woman who had part of her jaw removed after being wrongly diagnosed with mouth cancer.

The misdiagnosis happened after a laboratory worker at Medlab Dental, part of the University of Otago Dental Hospital, dropped two samples on the floor and mixed them up, the Otago Daily Times reports.

As a result the 63-year-old patient was wrongly diagnosed with cancer and had the right side of her upper jaw removed.

An area on the woman’s lower leg where bone and blood vessels were taken to reconstruct her jaw later became infected and she had trouble walking.

“I can’t for the life of me understand how you can get tissue samples mixed up,” Nelson oral surgeon Iain Wilson, the woman’s dentist, told the newspaper.

“I am astonished and horrified by these lab mix-ups.”

University faculty of medicine dean, Professor Peter Crawford, says the university has apologized to the patient.

“We have taken this incident very seriously, and have already taken all appropriate measures to minimise the likelihood of any such incidents occurring again,” he said.

“The patient was contacted very soon after the incident was discovered, and we offered a full apology at that time.”

The case is being investigated by the Health and Disability Commissioner and the patient has consulted a lawyer about compensation.

The patient was one of six who had been affected by errors made in pathology laboratories, the Herald on Sunday reported.

In May it was reported that a woman had a breast removed after being wrongly diagnosed with cancer by Southern Community Laboratories.

The woman’s results were switched with those of another woman, who was later told she had cancer when the botch-up was identified.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
June, 2012|Oral Cancer News|