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How often should you see a dentist?

Source: www.bbc.com
Author: staff


Margie Taylor says seeing a dentist once a year – or even once every two years – is enough for many patients. Some dentists argue this could make it harder for them to spot diseases such as mouth cancer. And they say it could see the wealthy paying for private dental care – while the poor have less access to a dentist.

Ms Taylor met representatives of the British Dental Association (BDA) in Stirling on Wednesday afternoon to discuss their concerns.

What is the Scottish government proposing?
The Scottish government published its Oral Health Improvement Plan earlier this year, which says NHS dental services should focus on preventing oral health disease, meeting the needs of the ageing population, and reducing oral health inequalities between Scotland’s rich and poor.

The document says there is no clinical evidence that all patients need basic check-ups every six months – regardless of their oral health – as is currently the case. It quotes National Institute for Health and Care Excellence (NICE) guidelines, which state that “patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.”

Risk assessment
Under the new system outlined by the government plans, an Oral Health Risk Assessment (OHRA) would be introduced for every patient – with the frequency of check-ups determined by their overall score.

This may mean that people will no longer have to attend every six months if they have good oral health and a healthy lifestyle. But patients who have poorer oral health and higher risk factors are likely to be seen more frequently.

The improvement plan also says that the traditional theory that the scale and polish procedure prevents gum disease has been thrown into considerable doubt in recent years. Instead, it says that “the most effective option for routine care is adequate oral hygiene by the patient themselves”.

What does Ms Taylor say about the plans?
The chief dental officer told BBC Scotland that medical evidence suggests many people can leave two years between basic check-ups without any problem. But she stressed that it was important to be realistic – and that it was not reasonable to expect people who are accustomed to having two check-ups a year to suddenly start seeing a dentist just once every two years.

She said: “At the moment, quite a lot of people come yearly and that’s fine for patients who are not at risk and who know how to look after their mouth and who have got a healthy diet.

“But it will be absolutely dependent on the risk as assessed by their own dentist, and there is no suggestion that everybody is to move to two-yearly checkups.

“And in fact we may want to see some patients more often than six months”.

Ms Taylor also insisted there was no intention to take NHS money from dentists in wealthier areas and giving it to those in poorer areas.

She added: “What we are talking about is making sure people in the poorer areas are able to get treatment”.

Ms Taylor stressed that everybody who needs a scale and polish – such as those suffering from periodontal disease – will still get one. But she conceded that the government had “more communicating to do” on the changes, which she said were about “evolution and not revolution”.

What do dentists say?
Ahead of their meeting with Ms Taylor, BDA Scotland released the results of a survey which it said suggested many of its members had “deep concerns” over the Oral Health Improvement Plan.

According to the survey:

  • Nearly two thirds of NHS dentists (62%) who responded had a “negative” or “very negative’ impression of the overall plan.
  • Three quarters had concerns about financial viability, and how the plan will be funded.
  • Almost 70% of respondents viewed the proposals to reduce the frequency of dental checks negatively.
  • About 80% had concerns about the proposed reduction in scale and polish treatments.

The BDA’s chairman in Scotland, Robert Donald, said: “Talk from government on prevention and tackling health inequalities is long overdue, but will remain warm words until they are backed up with needed investment.

“Vulnerable older patients deserve oral health care tailored to their needs, but this plan fails to spell out how it can be provided safely and effectively, or how it will be paid for. Sadly while officials have sketched out the big issues, they have skimped on the detail.”

Meanwhile, dentist John Davidson, who runs a practice in Edinburgh, told BBC Scotland that oral cancer is on the increase in Scotland and “the more often we see patients, the more likely we are to pick that up”.

He added: “We feel it is important that patients are seen more regularly, and it may get to the stage where patients pay themselves to come in and have their routine examinations and scale and polishes done.

“For a lot of patients it will not make a lot of difference for them (financially), but there are patients who just cannot afford to do that”.

The rise of HPV-related cancers in men

Source: www.tmc.edu
Author: Alexandra Becker

Scott Courville admired his full beard and round belly in the mirror: He was ready for the upcoming holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw.

By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsillitis and prescribed antibiotics.

“They sent me home and said, ‘In two weeks everything should clear up,’” Courville recalled.

But his symptoms only worsened. Courville made an appointment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more antibiotics and steroids, but two weeks later there were no improvements. Courville was referred to a dentist—“In case they see something we don’t”—but that, too, was a dead end.

Courville’s dentist insisted he return to his ENT, where he ultimately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him.

Courville always gets choked up retelling this part of his story.

“The hardest part for me is always remembering when the doctor said, ‘I’m sorry, but you’ve got cancer.’”

Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors confirmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV.

11 million men
Courville’s story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previously believed.

“This has implications, because pretty much everyone is exposed to HPV,” said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. “When we’re talking about the prevalence of oral HPV infection, we’re talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that’s what sets you up for cancer later in life—it may happen decades after you were exposed to HPV.”

That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing.

“What makes this cancer interesting is that it’s one of the only cancers in the body that we’re actually seeing more cases of year over year,” explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. “In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It’s alarming.”

Holy grail
HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most people who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine.

The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men.

Currently, there is no annual screening test for men to determine whether they have the virus. Women, on the other hand, are advised to get regular pap smears.

The Papanicolaou test, commonly known as the pap smear, involves collecting cells from inside a woman’s cervix to detect pre-cancerous changes. It is performed during a woman’s annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oropharyngeal cancer—another reason cited for its steady rise.

“We’re at a huge disadvantage,” said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. “The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had cancers because of it. We have nothing like that for men.”

Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of “nooks and crannies,” he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue.

“It’s sort of a holy grail for researchers in the field,” Sikora said. “It would be a game-changer in terms of prevention and early detection of cancer.”

Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer.

The HOUSTON study, an acronym for “HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men,” is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson’s oral pre-cancer clinic.

“A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer,” Sturgis explained. “We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyngeal cancer compared with those who do not have the antibodies.”

The hope is that this study will reveal that serological HPV antibody testing is an effective screening tool for HPV-related cancer in men: the equivalent to a pap smear.

A lump in the neck
If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck.

“There’s often a very small, primary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes,” Sikora explained. “Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it’s often detected much later than we would like.”

Even more troubling, many individuals who have these symptoms are commonly misdiagnosed and handed antibiotics, as in Courville’s case.

“The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor,” Karni said, emphasizing the importance of an informed diagnosis and specialized care.

Treatment for oropharyngeal cancers varies depending on the case and often involves a multidisciplinary team of clinicians, as well as some form of combined modality therapy such as radiation and chemotherapy. In the future, Sturgis sees novel therapies, including immunotherapy options, changing the landscape of treatment protocols.

Karni hopes UTHealth’s dedicated HPV-related throat cancer program will carry patients through the entire arc of treatment by offering minimally invasive robotic surgery for qualifying cases, as well as annual community-wide screening clinics, rehabilitation therapists, and numerous other specialists.

“We want to think about cancer the way Target thinks about shopping or the way the best airlines think about flying,” Karni said. “We designed a program that is patient-centered. We asked, ‘What does the patient need on their fourth week of radiation? What do they need on their third month post-radiation? How can we get that into one clinic space?’ It’s a large team and it’s all centered around this one disease.”

47th in the nation
In 2006, an HPV vaccine named Gardasil hit the market. It was originally intended to prevent HPV in females and, ultimately, HPV-related cervical cancer. But as scientists learned more about HPV—first that males could be carriers and later that it causes cancer in men, as well—public health professionals and clinicians unanimously recommended the vaccine to everyone. The CDC recommends all young women through the age of 26 and all young men through age 21 receive two doses for the vaccine to be effective.

And it is. A recent report published in May by Cochrane, a global independent network of clinical researchers and health care professionals, concluded that the HPV vaccine protects against cervical cancer in young women, especially when they are vaccinated between the ages of 15 and 26.

Which begs the question: Will the vaccine protect young men against the development of oropharyngeal cancers?

“There is a lot more data on cervical cancer in women and the vaccine than there is on head and neck cancer in men and the vaccine, but what data exists suggests that it is going to be a very effective intervention,” Sikora said.

Yet despite scientific evidence that prophylactic HPV vaccination of children and young adults will drastically reduce HPV-related cancers, vaccination rates in the U.S. remain alarmingly low—and Texas ranks 47th. Even more, several generations did not have the vaccine available to them and are currently at risk for HPV-related cancer.

As Karni said, it is alarming.

“Because the median age of oropharynx cancer related to HPV is about 55 and, in some studies, 60, and because the vaccine does not seem to work in individuals who have already been exposed, the benefits of vaccination on HPV-related cancer will not be realized for several decades,” Sturgis said. “Even if we vaccinate 100 percent of our boys and girls tomorrow, we have a whole generation or two who are at risk for this cancer and cannot do anything about it.”

Courville endured six rounds of chemotherapy and 33 daily rounds of radiation to treat his cancer. He lost a year of his life, 100 pounds, his taste buds and salivary glands, and can no longer grow his full beard— but his therapy was successful. He has now made it his life’s mission to inform the public about the importance of the vaccine as well as ongoing advocacy and research surrounding HPV-related cancers.

“If you can educate the public and educate the parents, they will vaccinate their kids,” Courville said. “And if we can vaccinate this generation, we could eliminate these types of cancers.”

Ask the Dentist: Cancer patients should be aware how radiotherapy can affect saliva

Source: www.irishnews.com
Author: Lucy Stock

SALIVA – we normally give little thought to our spit but we definitely notice when it’s not there. Every day in the UK 31 people are diagnosed with a head and neck cancer. With increasing numbers of people undergoing radiotherapy for head and neck cancers there are more people living with the side-effects of not having enough saliva.

Dry mouth, termed xerostomia, is common after radiotherapy. It’s not only extremely uncomfortable, it makes speaking and swallowing more difficult and alters how things taste. Food can taste saltier, metallic; you can lose your sense of taste totally; and perhaps even worse, foods can taste foul, like sour milk.

Not being able to chew and swallow easily can reduce how much you eat and how well you eat, leading to weight loss and poor nourishment.

Saliva performs numerous jobs. It starts digestion by breaking down food and flushes food particles from between the teeth. Crucially, saliva contains minerals such as calcium and phosphate that keep teeth strong. So no saliva means that teeth decay rapidly and extensively. Even voice quality can change.

Without enough saliva, bacteria and other organisms in the mouth take the opportunity to grow uncontrollably. Nasty sores and mouth infections, including yeast thrush infections, are run-of-the-mill.

Luckily a dry mouth is usually a temporary nuisance that clears up in about two to eight weeks but it can take six months or longer for the salivary glands to start producing saliva again after radiotherapy ends.

In a 2017 study, out of several treatments tested, the drug pilocarpine gave the most significant improvement in dry mouth following radiotherapy. However, you may experience a side effect, albeit short lived, from this medication and it can take a couple of months to work.

Artificial salivas are available as lozenges, sprays and gels, the downside being that their benefits last only a few hours. The Biotene range is specially designed to help relieve dry mouths and includes toothpastes, mouthwashes and gels to give comfort and protect the teeth.

You can buy small atomiser spray bottles from most chemists and fill them with water or fluoride mouthwash. If you cannot swallow, your nurse or doctor can give you a nebuliser to moisten your mouth and throat. Always visit your dentist before cancer treatments to maximise the health of your mouth.

Relieve a dry mouth by:

  • Sipping water often
  • Avoiding drinks with caffeine which dry out the mouth
  • Chewing sugarless gum
  • Avoiding spicy or salty foods, which may cause pain
  • Avoiding tobacco or alcohol
  • Using a humidifier at night.

Plasma-laser combo method for treating cancer is minimally invasive

Source: www.bioopticsworld.com
Author: Lee Dubay, Associate Editor, BioOptics World

Knowing that chemotherapy, radiation, and surgery can be expensive, weaken the immune system, and not work well for all cancer patients, a team of researchers at Purdue University (West Lafayette, IN) has developed a minimally invasive technique that may help doctors better explore and treat cancerous cells, tissues, and tumors without affecting nearby healthy cells.

The method, called PLASMAT (Plasma Technologies for a Healthier Tomorrow), combines cold atmospheric plasma (CAP) with electroporation and/or photoporation to kill cancerous cells without harming nearby healthy ones. The method has proven effective in the laboratory against several types of cancerous cells and cancer lines, including types of breast cancer, mouth/cervical cancer, and prostate cancer.

CAP, a near room-temperature ionized gas, is used to introduce active oxygen or nitrogen species into the cancerous cells, tissues, or tumors. An electric field or a laser is used to open the membranes of the cells for introduction of the species. This introduction leads to apoptosis (killing) of cancer cells once a critical level of reactive species is reached. Nearby healthy cells are either unaffected or minimally affected to a point they are able to easily restore themselves to a normal level.

 


“Using these three techniques in a combined method has been shown to be 70% to 90% more effective in killing cancerous cells than other treatments,” says Prasoon Diwakar, a postdoctoral research associate in the Purdue School of Nuclear Engineering, who developed PLASMAT along with Ahmed Hassanein, the Paul L. Wattelet Distinguished Professor of Nuclear Engineering.

Diwakar says PLASMAT does not introduce chemicals into the body during treatment and is significantly less expensive than chemotherapy or radiation. The technique is also more mobile than traditional cancer treatments because the required equipment is small and easily accessible in most medical settings.

“Our method is easy to integrate with existing method technologies,” Diwakar says. “PLASMAT can be combined with nanomedicines for further effective cancer treatment.”

A patent application has been filed by the Purdue Office of Technology Commercialization, and the method is available for licensing.

Eight-time GRAMMY® winner Ziggy Marley partners with the Oral Cancer Foundation

Source: ww.prnewswire.com
Author: press release

The Oral Cancer Foundation has a new relationship with eight-time GRAMMY® winner, Emmy winner, humanitarian, singer, songwriter and producer, Ziggy Marley. Mr. Marley has generously offered to allow CharityBuzz to auction off three (3) VIP events for two (2) on his REBELLION RISES TOUR. The winner(s) will enjoy this highly anticipated tour that only a select few get to experience up close and personal, meeting Mr. Marley. After the concert at a tour city of the winners choosing, a photo opportunity will be provided during their meet & greet with Ziggy Marley himself. The tour starts in America and travels to several European cities. Raising funds for the oral cancer issue via OCF, this auction will help support awareness campaigns, research, early discovery initiatives, and outreach that will help save lives. The auction begins today; May 20, 2018. Available tour dates are here: https://bit.ly/2dZPCcR (Dates may be subject to change).

Grammy winning artist Ziggy Marley partners with the Oral Cancer Foundation to raise awareness of the disease, and funds for its many missions to reduce impact of oral cancers. (PRNewsfoto/Oral Cancer Foundation)

Reggae icon Ziggy Marley will release his seventh full-length solo studio album, Rebellion Rises, on May 18th through Tuff Gong Worldwide. Fully written, recorded and produced by Marley, this passionate and indelible new collection of music encourages people to stand together in activism through love.

Ziggy Marley has released many albums to much critical acclaim. His early immersion in music came at age ten when he sat in on recording sessions with his father, Bob Marley. As front man to Ziggy Marley & The Melody Makers, the group has released ten live and studio albums, three of which became GRAMMY-winners with such chart-topping hits as “Look Who’s Dancing,” “Tomorrow People,” and “Tumbling Down.” Then, in an effort to pursue his own creative endeavors, 2003 saw the launch of Ziggy’s solo career with the release of Dragonfly (RCA Records). His second solo effort, Love Is My Religion (Tuff Gong Worldwide), won a GRAMMY in 2006 for Best Reggae Album, as did the subsequent release of Family Time (Tuff Gong Worldwide) in 2009 for Best Children’s Album. 2011’s Wild and Free was also nominated for Best Reggae Album, the same year in which Ziggy debuted his first-ever graphic novel, Marijuanaman. In addition to his music, Marley established the U.R.G.E. (Unlimited Resources Giving Enlightenment) organization to help children in poverty.

You can go directly to the auction item and start bidding at the following link: https://www.charitybuzz.com/catalog_items/meet-ziggy-marley-with-2-vip-tickets-to-his-rebellion-1527300

About the Oral Cancer Foundation
While the financial support for the many missions OCF engages in is important, our view of this amazing opportunity is focused elsewhere. The foundation represents a deadly disease that in the US too many people have not even heard of until it directly impacts their lives. That lack of visibility, that lack of the disease having a significant voice, has far reaching implications. The most obvious is that without national awareness, the knowledge of avoidable risk factors that might bring you to it does not exist. Further, absent a well-established national screening program, the early discovery of pre-cancers, and early stage disease does not currently take place often. This means poorer long-term outcomes, a much higher morbidity from the treatments patients must undergo to cope with an advanced stage disease, and a high 5-year death rate.

While OCF may be the largest of the oral cancer charities and within that group have the greatest reach, we still are small when compared to charities that represent larger incidence cancers whose names are household words. These large charities impact hundreds of thousands each year in the US alone, and take in tens, if not hundreds of millions of dollars a year in donations to advance their agendas and serve the populations they represent. We do not have those assets to work with, but we can develop strategic partners that help us in other ways. OCF’s thoughts are on what this relationship means to that paradigm. We may be at a tipping point in the disease if we can raise the awareness of it. When people with this much visibility become associated with a problem, it cascades into CHANGE.

We hope all of you who read this, especially those who have had this disease touch their lives, will Share on FaceBook, Tweet, and post on Instagram about this relationship, the auctions, and spread the word; so that this opportunity of increased visibility for oral cancer, and a change from late to early discovery and diagnosis can be realized.

An AI oncologist to help cancer patients worldwide

Source: www.sciencedaily.com
Author: staff, University of Texas at Austin, Texas Advanced Computing Center

Comparison between predicted ground-truth clinical target volume (CTV1) (blue) and physician manual contours (red) for four oropharyngeal cancer patients. The primary and nodal gross tumor volume is included (green). From left to right, we illustrate a case from each site and nodal status (base of tongue node-negative, tonsil node-negative, base of tongue node-positive, and tonsil node-positive).
Credit: Carlos E. Cardenas, MD Anderson Cancer Center

Before performing radiation therapy, radiation oncologists first carefully review medical images of a patient to identify the gross tumor volume — the observable portion of the disease. They then design patient-specific clinical target volumes that include surrounding tissues, since these regions can hide cancerous cells and provide pathways for metastasis.

Known as contouring, this process establishes how much radiation a patient will receive and how it will be delivered. In the case of head and neck cancer, this is a particularly sensitive task due to the presence of vulnerable tissues in the vicinity.

Though it may sound straightforward, contouring clinical target volumes is quite subjective. A recent study from Utrecht University found wide variability in how trained physicians contoured the same patient’s computed tomography (CT) scan, leading some doctors to suggest high-risk clinical target volumes eight times larger than their colleagues.

This inter-physician variability is a problem for patients, who may be over- or under-dosed based on the doctor they work with. It is also a problem for determining best practices, so standards of care can emerge.

Recently, Carlos Cardenas, a graduate research assistant and PhD candidate at The University of Texas MD Anderson Cancer Center in Houston, Texas, and a team of researchers at MD Anderson, working under the supervision of Laurence Court with support from the National Institutes of Health, developed a new method for automating the contouring of high-risk clinical target volumes using artificial intelligence and deep neural networks.

They report their results in the June 2018 issue of the International Journal of Radiation Oncology*Biology*Physics.

Cardenas’ work focuses on translating a physician’s decision-making process into a computer program. “We have a lot of clinical data and radiation therapy treatment plan data at MD Anderson,” he said. “If we think about the problem in a smart way, we can replicate the patterns that our physicians are using to treat specific types of tumors.”

In their study, they analyzed data from 52 oropharyngeal cancer patients who had been treated at MD Anderson between January 2006 to August 2010, and had previously had their gross tumor volumes and clinical tumor volumes contoured for their radiation therapy treatment.

Cardenas spent a lot of time observing the radiation oncology team at MD Anderson, which has one of the few teams of head and neck subspecialist oncologists in the world, trying to determine how they define the targets.

“For high-risk target volumes, a lot of times radiation oncologists use the existing gross tumor disease and apply a non-uniform distance margin based on the shape of the tumor and its adjacent tissues,” Cardenas said. “We started by investigating this first, using simple distance vectors.”

Cardenas began the project in 2015 and had quickly accumulated an unwieldy amount of data to analyze. He turned to deep learning as a way of mining that data and uncovering the unwritten rules guiding the experts’ decisions.

The deep learning algorithm he developed uses auto-encoders — a form of neural networks that can learn how to represent datasets — to identify and recreate physician contouring patterns.

The model uses the gross tumor volume and distance map information from surrounding anatomic structures as its inputs. It then classifies the data to identify voxels — three-dimensional pixels — that are part of the high-risk clinical target volumes. In oropharyngeal cancer cases, the head and neck are usually treated with different volumes for high, low and intermediate risk. The paper described automating the target for the high-risk areas. Additional forthcoming papers will describe the low and intermediate predictions.

Cardenas and his collaborators tested the method on a subset of cases that had been left out of the training data. They found that their results were comparable to the work of trained oncologists. The predicted contours agreed closely with the ground-truth and could be implemented clinically, with only minor or no changes.

In addition to potentially reducing inter-physician variability and allowing comparisons of outcomes in clinical trials, a tertiary advantage of the method is the speed and efficiency it offers. It takes a radiation oncologist two to four hours to determine clinical target volumes. At MD Anderson, this result is then peer reviewed by additional physicians to minimize the risk of missing the disease.

Using the Maverick supercomputer at the Texas Advanced Computing Center (TACC), they were able to produce clinical target volumes in under a minute. Training the system took the longest amount of time, but for that step too, TACC resources helped speed up the research significantly.

“If we were to do it on our local GPU [graphics processing unit], it would have taken two months,” Cardenas said. “But we were able to parallelize the process and do the optimization on each patient by sending those paths to TACC and that’s where we found a lot of advantages by using the TACC system.”

“In recent years, we have seen an explosion of new projects using deep learning on TACC systems,” said Joe Allen, a Research Associate at TACC. “It is exciting and fulfilling for us to be able to support Carlos’s research, which is so closely tied to real medical care.”

The project is specifically intended to help low-and-middle income countries where expertise in contouring is rarer, although it is likely that the tools will also be useful in the U.S.

Cardenas says such a tool could also greatly benefit clinical trials by allowing one to more easily compare the outcomes of patients treated at two different institutions.

Speaking about the integration of deep learning into cancer care, he said: “I think it’s going to change our field. Some of these recommender systems are getting to be very good and we’re starting to see systems that can make predictions with a higher accuracy than some radiologists can. I hope that the clinical translation of these tools provides physicians with additional information that can lead to better patient treatments.”

Story Source:

Materials provided by University of Texas at Austin, Texas Advanced Computing Center. Note: Content may be edited for style and length.

Journal Reference:

1. Carlos E. Cardenas, Rachel E. McCarroll, Laurence E. Court, Baher A. Elgohari, Hesham Elhalawani, Clifton D. Fuller, Mona J. Kamal, Mohamed A.M. Meheissen, Abdallah S.R. Mohamed, Arvind Rao, Bowman Williams, Andrew Wong, Jinzhong Yang, Michalis Aristophanous. Deep Learning Algorithm for Auto-Delineation of High-Risk Oropharyngeal Clinical Target Volumes With Built-In Dice Similarity Coefficient Parameter Optimization Function. International Journal of Radiation Oncology*Biology*Physics, 2018; 101 (2): 468 DOI: 10.1016/j.ijrobp.2018.01.114

Supportive care for patients with head and neck cancer

Source: www.oncnursingnews.com
Author: Melissa A. Grier, MSN, APRN, ACNS-BC

Supporting a patient during cancer treatment is a challenge. From symptom management to psychosocial considerations, each patient’s needs vary and must be reevaluated frequently. This is especially true for patients with head and neck cancer.

Head and neck cancers often result in serious quality of life issues. Surgical resection of the affected area can cause disfigurement that not only affects function (eating, drinking, speaking, etc) but also leads to self-image concerns and depression. Radiation therapy and chemotherapy may cause a variety of unpleasant adverse effects, including burns, xerostomia, dental caries, and mucositis. Below are some considerations to help guide nursing care for this patient population.

CALL FOR REINFORCEMENTS
National Comprehensive Cancer Network guidelines recommend early involvement of a dentist, a dietitian, and a speech therapist to help address pre- and posttreatment concerns and preserve quality of life for people with head and neck cancer. The benefits of multidisciplinary collaboration for these complex cases are many but may also result in confusion and information overload for your patient. As the healthcare team provides care, you can help explain the rationale for interventions and assist them with keeping track of recommendations. Additionally, you have a team of experts you can call on when specific issues present themselves during treatment.

KEEP AN EYE OUT
A lot goes on in the life of a patient with head and neck cancer, which means everyday activities like oral and skin care may fall a little lower on their priority list. Performing frequent assessments and assisting with hygiene is vital to preserving and improving quality of life, for example:

  • Help your patients use a handheld mirror to examine their mouth and throat.
  • Ensure that oral care products don’t contain alcohol or other ingredients that can irritate sensitive tissue.
  • Educate your patients about self-care, and guide them toward performing independent dressing changes and surgical site care.
  • Encourage your patients to report any new adverse effects or concerns so they can be addressed promptly.

MEET IN THE MIDDLE
Several factors contribute to malnutrition associated with head and neck cancers. Pain related to mucositis or radiation burns decreases the likelihood that a patient will maintain adequate oral intake. Functional changes following surgery can lead to dysphagia that impairs a patient’s ability to safely receive nutrition and medication by mouth.

To ensure adequate nutrition, many patients with head and neck cancer receive a percutaneous endogastric (PEG) tube prior to beginning treatment. It’s imperative that the patient, the dietitian, and the nursing staff maintain an open line of communication and work together to meet nutritional needs. The patient will likely struggle with losing the ability to taste food and the satisfaction of choosing what they want to eat, so it’s important to allow them to control when they want to receive tube feedings and to follow up frequently to ensure the feedings are being tolerated.

When administering medication via PEG, pay close attention to administration instructions and drug interactions. Extended-release and sustained-release medications should never be crushed and given via PEG. Each medication should be crushed and administered individually, followed by a flush of room-temperature or lukewarm water. If a patient has several medications scheduled at the same time, assess whether administration times can be changed or allow enough time to administer them slowly to avoid patient discomfort related to a high volume of fluid. Lastly, pay attention to whether medication should be administered on a full or empty stomach and coordinate medication administration with tube feedings accordingly.

Although nurses can’t eliminate the hardship that patients will face during treatment for head and neck cancer, we can support them by providing compassionate and thorough care.

Melissa A. Grier, MSN, APRN, ACNS-BC, is a clinical content developer for Carevive Systems, Inc.

Restaging raises hope against HPV oral cancer

Source: atlantajewishtimes.timesofisrael.com
Author: Cady Schulman

Jason Mendelsohn was diagnosed with Stage 4 tonsil cancer from HPV in 2014 after finding just one bump on his neck. He survived thanks to a variety of treatments, including a radical tonsillectomy and neck dissection to remove 42 lymph nodes, seven weeks of chemotherapy, radiation and a feeding tube.

But if Mendelsohn’s cancer had been discovered today, just four years later, it would have been classified as Stage 1. That’s because HPV-related oral cancers now have a high survival rate through a better response to treatment, said Meryl Kaufman, a speech pathologist specializing in head and neck cancer management who worked for Emory University’s department of head and neck surgery for 10 years.

“Cancer staging is taking into account the HPV-related cancers,” said Kaufman, who now owns her own practice. “It was kind of all lumped together. The survival rates for people who have HPV-related cancers are much higher than the typical head and neck cancers associated with smoking and drinking.”

For Mendelsohn, finding out that patients with HPV-related cancers likely face easier treatments and higher success rates made him extremely happy.

“If I was diagnosed and I heard Stage 1 instead of Stage 4, while it’s still cancer, it would make me feel like I could beat it,” said Mendelsohn, who made a video for his children a month after his diagnosis with advice for their lives after he was gone. “When I hear Stage 4 to Stage 1, I think people have hope they can beat it. My hope is that it will give people hope that they can beat this.”

As a cancer survivor, the Florida resident wants to give hope to other patients. He talks to people throughout the world every month and is creating a worldwide survivor patient network to connect cancer survivors with patients.

“While cancer is scary, Stage 1 is a lot less scary than Stage 4,” Mendelsohn said. “Stage 4 was overwhelming. When I was looking for information, there was nothing out there that made me feel like I was going to be OK. What I’m trying to do is give people hope and let them know that it’s all temporary.”

Another way Mendelsohn is trying to reach those affected by cancer is through his website, supermanhpv.com. He shares his story, news articles featuring him and oral cancer caused by HPV, and information for survivors, patients and caregivers.

The site also features Mendelsohn’s blog, putting himself out there so people can see that someone who, just four years ago, was diagnosed with Sage 4 cancer is now a Peloton-riding, travel-loving cancer advocate.

“People see me and say (they) can’t believe (I) had cancer three to four years ago,” Mendelsohn said. “I was in bed 18 hours a day for a month. I was choking on my saliva for a month. I was consuming five Ensures a day and two Gatorades a day through a feeding tube in my stomach. If people going through that can see me working out, going on the bourbon tour in Louisville. I’ve been on an Alaskan cruise. I’ve been to the Caribbean. I’ve been to the Grand Canyon.”

Mendelsohn, who started his campaign to raise awareness of HPV and oral cancer by raising money for the Ride to Conquer Cancer in Washington, now serves on the board of the Head and Neck Cancer Alliance. The organization’s goal is to advance prevention, detection, treatment and rehabilitation of oral, head and neck cancers through public awareness, research, advocacy and survivorship.

“I feel like it’s gone from me raising money for a bike ride to me on two boards helping create awareness and raise inspiration and creating a survivor patient network,” Mendelsohn said. “Now it’s not about me and my three doctors. Now it’s about helping people with diagnosis globally. There are great doctors. I think we’re going to do great things.”

One way to help prevent children from getting cancer caused by HPV when they grow up is the Gardasil vaccine, which protects against HPV Strain 16, which causes oral cancer. Mendelsohn said 62 percent of college freshmen and three-quarters of adults by age 30 have HPV.

But he doesn’t tell people to get the vaccine. Instead, he advises parents to talk to their kids’ doctors about the benefits and risks.

“I talk about the importance of oral cancer screenings when they’re at the dentist,” he said. “And if you feel a bump on your neck, go to your ENT. I had no symptoms and just a bump on my neck, but I was diagnosed with Stage 4. I’ve had so many tell me that they didn’t know the vaccine is for boys. They thought it was just for girls.”

Kaufman said that the HPV vaccine is recommended for use in boys and girls and that it’s important for the vaccine to be given before someone becomes sexually active. The vaccine won’t work if a person has already been exposed to HPV, as most sexually active adults have been, she said.

Men are much more likely to get head and neck cancer from HPV.

“Usually your body fights off the virus itself, but in some people it turns into cancer,” Kaufman said. There hasn’t been specific research that the HPV vaccine will protect you from head and neck cancer, she said, “but if you’re protected against the strains of HPV that cause the cancer, you’re probably less likely to get head and neck cancer.”

Treatment for this cancer isn’t easy, Kaufman said. Radiation to the head and neck can affect salivary glands, which can cause long-term dental and swallowing issues. Treatment can affect the skin, taste and the ability to swallow.

“A lot of people have tubes placed,” she said. “It’s not easy. It depends on how well you respond to the treatment.”

While getting the vaccine can help protect against various cancers, awareness about head and neck cancer is the key. And knowing the signs and symptoms — such as sores in the mouth, a change in voice, pain with swallowing and a lump in the neck — is important.

“If one of those things lasts longer than two weeks, you should go to your doctor,” Kaufman said. “This can affect nonsmokers and nondrinkers. It’s not something that people expect. The more commonplace it becomes and the less stigma, the better.”

Flexible robotic surgery opens new paths in cancer treatment

Source: newsok.com
Author: staff

Robotic surgery is continuing to expand and provide patients with a variety of less invasive treatment options – especially when it comes to cancer treatment.

Dr. Brad Mons, a head and neck surgeon at Cancer Treatment Centers of America®in Tulsa, said the Flex Robotic® System, which the hospital added last year, is an especially significant breakthrough for people diagnosed with head and neck cancer.

“With this system, we can get to the small areas of the mouth and pharynx more easily to remove tumors in the region,” Mons said. “This affords us the ability to be much less invasive in head and neck cancer surgeries.”

Robotic surgery is continuing to expand and provide patients with a variety of less invasive treatment options. Photo provided by CTCA.

Currently only available at a small number of hospitals in the United States and designed to overcome line-of-sight limitations, the Flex Robotic System utilizes a uniquely flexible robotic endoscope to give surgeons the ability to navigate a path through challenging areas of the mouth, throat, rectum and colon.

For patients, this means potentially faster recovery time and lower risk of complications or side effects.

Because the Flex Robotic System operates through natural openings rather than requiring large incisions in the body, potential benefits include shorter hospital stays, reduced post-surgical pain, lower risk of infection and complications, less blood loss (and fewer transfusions) and scarring and faster return to normal activities. For throat cancer patients, the technology also means less damage to tissues and muscles critical to eating and daily activities. For colorectal cancer patients, the system provides lower possibility of a colostomy.

“Part of our mission is to continually provide innovative therapies and technology for our patients,” Mons said. “With tools like the Flex Robotic System, we have yet another way to help improve the lives of our patients—and that’s really what it’s all about.”

Cancer Treatment Centers of America has multiple locations across the country, including a state of the art facility in Tulsa. CTCA has been helping patients win the fight against cancer using advanced technology and a personalized approach for more than 30 years.

Source: Cancer Treatment Centers of America

High carbohydrate diet may increase mortality risk in certain cancers

Source: www.specialtypharmacytimes.com
Author: Gina Kokosky

Consuming simple carbohydrates may increase risk of recurrence among patients with head and neck cancer, according to a study published by the International Journal of Cancer. New findings suggest that a patient’s diet could have a significant impact on their ability to combat cancer.

The authors also suggest that patients who moderately consume fats and starches after treatment, such as whole grains, potatoes, and legumes, are less likely to have a recurrence of head and neck cancer, according to the study.

The study followed more than 400 patients for 26 months after their initial diagnoses of squamous cell carcinoma on the head or neck. Most of the patients were treated for oral cancer or oropharyngeal cancer, including cancers of the tonsils, tongue, and surrounding tissue, according to the study.

Patients were most often diagnosed in stage 3 or 4 of cancer at an average age of 61 years old. During the study, cancer recurred 17% of the time, resulting in 42 deaths. Another 70 patients died from other causes during the study.

The researchers examined all food, drink, and dietary supplements consumed by the participants for 1 year prior to treatment and 1 year after treatment, according to the authors.

The authors found that those who consumed the least amount of simple carbohydrates, such as refined grains, desserts, and sweetened beverages, were having 1.3 servings per day, while those who consumed the most were consuming 4.4 servings of simple carbohydrates.

Patients who consumed a high amount of carbohydrates—such as sucrose, fructose, lactose, and maltose—prior to treatment were at a higher risk of mortality than those who consumed less carbohydrates, according to the authors.

While carbohydrate intake may be linked to mortality rate among patients, the associations varied by cancer type and stage, the authors noted. Those with oral cavity cancer were found to have a greater risk of mortality due to a high carbohydrate intake, while those with oropharyngeal cancer were not affected by their carbohydrate intake, according to the findings.

A high carbohydrate intake was also found to be associated with an increased risk of mortality among patients with cancer in stages 1 to 3, while those with stage 4 cancers were not at an increased risk.

The authors noted that moderate consumption of fats and starchy foods—about 67 grams per day—can lower the risk of recurrence and mortality.

The authors also suggest that while there is a clear association among carbohydrate intake and risk of mortality, more research needs to be done to determine whether there is a direct relationship.

“Although in this study we found that higher total carbohydrate and total sugar were associated with higher mortality in head and neck cancer patients, because of the study design we can’t say that there’s a definitive cause-effect relationship,” Anna Arthur, PhD, MPH, RD, lead author, said in a press release.

The findings of this study suggest that diet plays an important role in treating cancer and prompts further research on the relationship between diet and cancer.

“Our results, along with the findings of other studies, suggest that diet composition can affect cancer outcomes,” Amy M. Goss, PhD, RD, co-author, said in the press release. “We’d like to determine if this is true using a prospective, intervention study design and identify the underlying mechanisms. For example, how does cutting back on sugar and other dietary sources of glucose affect cancer growth?”

References
Arthur AE, Goss AM, Demark-Wahnefried W, et al. Higher carbohydrate intake is associated with increased risk of all-cause and disease-specific mortality in head and neck cancer patients: Results from a prospective cohort study. International Journal of Cancer. 2018. DOI: 10.1002/ijc.31413

Study explores carbohydrates’ impact on head, neck cancers [news release]. University of Illinois’ website. https://news.illinois.edu/view/6367/638053. Accessed April 13, 2018.