Source: HealthDay Reporter

Author: Steven Reinberg

By 2010, cancer will be the leading killer in the world, surpassing heart disease, causing more deaths than AIDS, malaria and tuberculosis combined.

Unless new treatments are found, there could be 27 million people with cancer by 2030, and 17 million cancer deaths annually. And, there could be 75 million people living with cancer within five years after diagnosis, according to a new report, 2008 World Cancer Report, released Tuesday by the World Health Organization.

“The burden of cancer is shifting from developed countries to developing nations,” Dr. Otis Webb Brawley, chief medical officer of the American Cancer Society, said during a teleconference. “And with a growing and aging population, we must take steps to address this problem now.”

Last year, there were about 12 million new cases of cancer and 7.6 million cancer deaths reported. Of these, 5.6 million were in developing countries with an estimated 4.7 million cancer deaths.

“The global burden of cancer has more than doubled in the past 30 years,” Peter Boyle, director of the International Agency for Research on Cancer and co-author of the report, said during the teleconference. “Right now, there are 25 million people alive with cancer five years after diagnosis.”

Cancer rates are growing in developing countries as people adopt western lifestyles, including smoking, high-fat diets, fast food and less physical activity.

These countries typically don’t have the resources to cope with this dramatic increase in cancer. Populations in these countries are expected to grow by 38 percent by 2030. And, these countries will have a high number of older people as populations age, increasing the incidence of cancer.

Smoking is the major avoidable risk for cancer and cancer deaths around the world. Currently, some 1.3 billion people smoke. The true burden of cancers and deaths from smoking are yet to seen. This “smoking epidemic” will be influencing cancer in developing countries for many years, according to the report.

In addition to increases in smoking-related cancers such a lung cancer, breast cancer has been increasing up to 5 percent a year in developing countries. Cervical cancer, which is preventable and treatable in developed countries, is a major cause of cancer deaths among women in the developing world. Stomach, liver, oral and cervical cancers also take a heavy toll in developing countries, according to the report.

Cancer treatment in developing nations is out of reach for many people; palliative care is the only therapy offered to more than 80 percent of cancer patients, Boyle said.

“There are currently 30 low-resource countries without a radiotherapy machine. There are 29 countries in Africa where it is legally forbidden to import morphine and opiate drugs for severe pain control,” he said. “Every cancer patient has the human right to have access to all aspects of supportive and palliative care and the absolute right to die a pain-free death with dignity.”

In developing countries, most cancer is attributable to chronic infections. But, 12 percent of the disease is caused by smoking, and that number is growing, according to the report.

Cancer cases and cancer deaths are expected to grow 1 percent a year, with the biggest increases in China, Russia and India.

There are major differences in cancer rates and types of malignancies around the world. For example:

• Breast cancer rates have doubled or tripled over the past 40 years in Japan, Singapore and Korea. In China, breast cancer rates have increased 20 percent to 30 percent in the past decade.
• Lack of refrigeration has caused an increase in stomach cancer in some Asian countries. In the United States, refrigeration and improved hygiene have reduced stomach cancer by 89 percent in men and 92 percent in women since 1930.
• In Africa, there were an estimated 667,000 cases of cancer and 518,000 cancer deaths in 2008. Cervical cancer is the leading cause of cancer deaths in women. HIV-related cancers are also prevalent.

In the United States, for the first time since such statistics were released in 1998, the number of men and women getting and dying from cancer has dropped, according to a report released earlier this month in the Journal of the National Cancer Institute. The drop was mostly due to fewer cases of lung, prostate and colorectal cancers among men, and fewer cases of breast and colorectal cancer among women. Also, death rates from lung cancer have leveled off among women since 2003, the American Cancer Society report found.

To stem the global tide of increasing cancer rates, the American Cancer Society is recommending several steps, Brawley said.

First, vaccines that prevent cancer-causing infections — such as human papillomavirus, which causes cervical cancer — need to be made available to low-income countries. Second, there needs to be greater support for U.S. and international tobacco-control programs. Third, health officials and governments must promote culturally sensitive risk-reduction programs and invest in cancer research and early detection.

Source: www.reuters.com
Author: Reporting by Maggie Fox, editing by Will Dunham and Philip Barbara

The human wart virus HPV caused 25,000 cases of cancer in the United States between 1998 and 2003, including not only cervical cancer but also anal and mouth cancers, the U.S. Centers for Disease Control and Prevention reported on Monday.

The study suggests a broad need for screening both men and women for human papillomavirus, or HPV, another team of researchers, who did a similar survey, said.

HPV includes about 100 different viruses, and they are the leading cause of cervical cancer. The viruses, transmitted sexually and by skin-to-skin contact, can also cause anal and penile cancers, as well as cancers of the mouth and throat. HPV also causes common warts.

Both Merck and Co. and GlaxoSmithKline make vaccines against some of the strains of HPV most strongly linked with cervical cancer. They are recommended for girls and young women who have not begun sexual activity.

“This gives us baseline data to measure the impact of HPV vaccine and cervical cancer screening programs in reducing the incidence of cervical cancer and other HPV-associated cancers and precancers,” the CDC’s Dr. Mona Saraiya, who led the study, said in a statement.

Dr. Maura Gillison of Johns Hopkins University in Baltimore, who has studied the link between HPV and oral cancers, said the findings suggest a wider use of the cervical cancer vaccines may be justified.

“Currently available HPV vaccines have the potential to reduce the rates of HPV-associated cancers, like oral and anal cancers, that are currently on the rise and for which there is no effective or widely applied screening programs,” Gillison said in a statement.

Last month researchers said their computer model indicated that vaccinating women as old as 45 could prevent some cases of cervical cancer, even though the vaccines do not protect anyone who has already been infected with one of the strains of HPV.

An estimated 11,070 new cases of cervical cancer will be diagnosed in 2008 in the United States, and 3,870 women will die of it.

Cervical cancer is even more widespread globally where regular Pap smear and HIV tests are not available. An estimated 500,000 women globally are diagnosed with cervical cancer each year and 300,000 die of it.

The CDC survey of 38 states and Washington, D.C., found nearly 7,400 cancers of the mouth and throat that could be linked with HPV — nearly 5,700 among men and about 1,700 among women

“There were more than 3,000 HPV-associated anal cancers per year — about 1,900 in women and 1,100 in men,” the CDC said.

Source: www.mayoclinic.org
Authors: Robert Wolk et al.

Use of smokeless tobacco raises short-term adrenaline levels in the bloodstream by more than 50 percent and also causes the heart rate and blood pressure to surge, according to findings of a Mayo Clinic study published this week in Journal of the American College of Cardiology. The results suggest that snuff tobacco has a powerful stimulant effect but that it also dampens the body’s normal protective responses to blood pressure elevation.

The study of 16 young men who were habitual spit tobacco users measured their responses 30 minutes after dipping snuff. These readings were compared with measurements from another session involving the same participants after they had used a placebo product that was similar in taste, color and texture but did not contain tobacco or nicotine. The study was randomized and double-blinded; neither the researchers nor the subjects were told when they were taking the placebo and when they were using the tobacco product.

After snuff use, heart rate increased by about 15 beats per minute (25 percent), systolic blood pressure went up by 12 mmHg (10 percent), and measurements of adrenalin in the bloodstream increased by more than 50 percent.

“These results suggest a very significant excitatory effect of substances contained in spit tobacco on the part of the nervous system regulating the heart and blood vessels,” says Virend Somers, M.D., Ph.D., the Mayo Clinic cardiologist who led the study. “Although we did anticipate some increase in blood pressure, we were surprised at the magnitude of the increase, as well as the very striking increases in heart rate and plasma epinephrine, or adrenalin. We anticipated that since these individuals were young and healthy and were accustomed to using spit tobacco, that any responses that we measured would be blunted. This makes the degree of increases even more noteworthy.”

Robert Wolk, M.D., Ph.D., lead author on this study, noted that these results have implications both for long-term users and for individuals with established heart disease.

“The degree of speeding up of heart rate and increase in blood pressure, as well the increase in adrenalin (epinephrine) levels, suggest that if similar changes occur in people with established heart disease, who use spit tobacco, there may be reason to expect adverse consequences,” Dr. Wolk says.

“Dipping” is Rising
More than five million adults - and more than 750,000 adolescents - use smokeless tobacco in the United States. Snuff use is increasing, especially in young males who participate in athletics. Its cardiovascular effects are not as clear or well understood as those of cigarettes, partly because fewer studies have been done, and partly because many spit tobacco users are relatively young and the bad effects may not be apparent unless use continues for prolonged periods.

Blunting a Protective Mechanism
By placing electrodes into the sympathetic nerves of the participants, the researchers also obtained a window on the message from the brain to the blood vessels on a moment-by-moment basis.

Normally, when blood pressure is increased by an external substance, the body seeks to protect the cardiovascular system by decreasing heart rate and dilating the blood vessels. It does this by “shutting down” the sympathetic nervous system, so that heart rate is slower, and the widening of blood vessels starts to bring blood pressure down.

The researchers demonstrated this by giving another group of subjects an intravenous medication, phenylephrine, to raise blood pressure about as much as they saw when spit tobacco was used. In response, those subjects’ heart rates decreased by more than 10 beats a minute and the activity of the sympathetic nervous system went down to very low levels.

“This is an example of how the body tries to protect itself from the higher blood pressures,” Dr. Somers explains. “However, when the blood pressure is raised by spit tobacco, the heart rate actually speeds up dramatically and there is no decrease in the sympathetic nervous system activity. This tells us that the normal protective mechanisms which help dampen down spikes in blood pressure are blunted when using spit tobacco.”

“Spit tobacco is a very potent cause of acute increases in blood pressure, heart rate, and adrenalin levels,” Dr. Somers concludes. “Since many athletes, who are already under a fair amount of stress in competitive situations, also use spit tobacco, the blood pressure and heart rate increases need to be recognized and understood. And since spit tobacco not only raises blood pressure but also blunts the body’s normal defense response to blood pressure increases, long-term dipping would seem likely to increase the risk of cardiovascular disease.”

Other authors on the study include: Abu S. M. Shamsuzzaman, MBBS, Ph.D., Anna Svatikova, BA, Christina Huyber, Corey Huck, BA, Krzysztof Narkiewicz, M.D., Ph.D.

Source: www.dentistry.co.uk
Author: staff

Dentists are overcharging patients by up to £109 million a year, by calling them back too often and splitting up treatments, according to the Conservatives.

Analysis of appointments earlier this year suggested too many healthy patients were being recalled for check up and that treatments were being separated into separate courses, with separate costs. Calculations by the Conservatives suggest that the extra cost paid in patient charges last year was £109 million.

The figure is 23% of the £475 million overall that patients pay in dentist charges every year.
Andrew Lansley, the Shadow Health Secretary, said: ‘Labour’s management of NHS dentistry has been appalling. Not only have millions been left without a dentist, but now we learn that those who do have one are often being charged more money than they should be.

‘The blame here lies with Labour’s botched dental contract, which incentives dentists to increase the number of charges to patients and has led to such drastic cuts in the number of people being able to find an NHS dentist.

‘The Government urgently needs to admit that the dental contract has been a monumental failure, get a grip and put an end to these practices immediately. At the moment we’re all losing out – those who do have a dentist are paying wrongful charges and those who don’t are being blocked from finding one because there aren’t enough appointments left.’

Asking every Primary Care Trust (PCT) in the country how many patients had been called back to their dentist within 12 weeks, the Conservatives found that the average proportion across England was 18%.

Based on the average NHS patients pay for dental care, they calculate that the unnecessary cost was £109 million. However, the figure was disputed by the Department of Health.

Health Minister Ann Keen said: ‘The suggestion that patients are being overcharged by up to £109 million a year is ludicrous. The vast majority of these patients will have been called back for a genuine clinical need such as disease management or emergency treatment.

‘As we discovered earlier this year, only a small minority of dentists are recalling patients unnecessarily for treatment. In October, we helped local health authorities to identify these dentists and the NHS is working with local dentists to resolve the issue.

‘The new contract has made all NHS dentists accountable to their local Primary Care Trust for quality of care. This means that if a dentist recalls patients unnecessarily or charges too much, local health services are able to withhold his or her funding or terminate his or her contract.

‘This is one of the issues that will be investigated by the independent review team we appointed last week to advise how we can best work with the NHS to ensure good access and high quality of NHS dentistry across the country.’

Meanwhile, the British Dental Health Foundation (BDHF) advises patients not to be put off dental check-ups after the Tory claims.

The charity now warns politicians to concentrate on finding a solution to problems.
Foundation chief executive Dr Nigel Carter said: ‘A million fewer people are visiting the dentist since the new contracts came into effect four years ago. Clearly dentists are not targeting contracts for easy money.

‘The Government must address the issues, and the independent review is a start. The Opposition and the political elite should get behind this review and support a positive change.

‘Negative messages run the risk undermining Britain’s oral health. For nearly 40 years we have campaigned with the key message advising people to visit their dentist regularly – as often as they recommend.

‘It is vital to get regular check-ups from an expert. This is so important to dental health, its systemic links to overall health issues such as diabetes, and in checking for mouth cancer, which kills one person every five hours in the UK.’

Source: www.ivanhoe.com
Author: staff

Doctors found a new weapon in the fight against an incurable form of leukemia, and it’s a drug that was once dismissed as ineffective in battling the disease.

Flavopiridol has shown promising results in phase I and II clinical trials that involved 116 patients with advanced chronic lymphocytic leukemia (CCL), according to researchers at The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute.

Responses were seen in about half of the patients, many of whom had chromosomal abnormalities that made it unlikely that they would be helped by standard therapies. In recent years, treatment of CLL has improved, but the disease, which strikes 15,000 people each year and is the most common type of adult leukemia, remains incurable. Patients often suffer significant infections caused by the disease and treatment.

Flavopiridol showed promise as a potent cancer-fighter in the 1980s when it was tested on animals, but when it was given to humans in repeated trials, it proved ineffective and was essentially forgotten, researchers said.

Ohio State researchers said they later discovered that flavopiridol binds to proteins in human blood, which ties up much of the available drug and leaves less free drug in the bloodstream to kill cancer cells. So, in the earlier trials, humans were not getting enough of the drug for it to be effective.

The Ohio State researchers developed a new dosing schedule, and it increased the drug’s blood level enough to kill cancer cells in humans, they said.

“Flavopiridol has bridged the way for several CCL patients to receive a curative stem cell transplant,” said Dr. John Byrd, associate director of translational research and the principal investigator in the phase II trial.

The drug is now being tested at other cancer centers to see if similar results are reported, and at Ohio State, researchers are testing the drug’s effectiveness in battling acute myloid leukemia, non-Hodgkin’s lymphoma, Hodgkin’s lymphoma and head and neck cancers.

Source:
Study presented at the 50th Annual Meeting of the American Soceity of Hematology in San Francisco on Dec. 7, 2008

Source: The Lancet Oncology. 2008;9:629-635
Authors: Prado CMM et al.

Body composition appears to be of key importance when it comes to surviving
cancer, as researchers have found that cancer patients with more lean muscle
mass live longer.

The study of 250 obese cancer patients revealed that patients with depleted
muscle mass ­ a recently recognized condition known as sarcopenic obesity ­
lived, on average, for 10 months less than obese patients with more muscle
mass. Participants with sarcopenic obesity were also more likely to be
bedridden. Study leader Professor Vickie Baracos says muscle mass could even
effect how patients respond to chemotherapy.

The authors concluded: ³This study provides evidence of the great
variability of body composition in patients with cancer and links body
composition, especially sarcopenic obesity, to clinical implications such as
functional status, survival, and potentially, chemotherapy toxicity.²

Authors:
Prado CMM, Lieffers JR, McCargar LJ, et al.

Source:
“Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study”. The Lancet Oncology. 2008;9:629-635.

Source: www.medicalnewstoday.com
Author: staff

Viralytics Limited has received approval to undertake a new phase I intratumoural (direct injection of accessible solid tumours) trial in Head and Neck Cancer, a cancer previously unchallenged with Cavatak™. Approximately 45,000 new cases of head and neck cancer are diagnosed each year in the US (approximately six percent of all cancers).

The primary objective of the study is to determine the safety of Cavatak™ given by intratumoural injection in the treatment of recurrent, inoperable tumours of the head and neck. Three groups of patients will receive single or multiple (3 or 6) intratumoural injections of Cavatak™. There will be three patients in each group.

Secondary objectives include the evaluation of Cavatak™ replication, immune response to Cavatak™ and any evidence of anti-tumour activity. The trial will be conducted in an Australian hospital and details of the trial will be available shortly at http://www.clinicaltrials.gov.

Data obtained from this new trial, together with that already accumulated from existing clinical evaluations of Cavatak™ in patients with late stage melanoma, breast and prostate cancer (solid tumours) will expand the product profile of tolerance, bio-availability and anti-cancer mode of action in solid tumours.

Direct injection of accessible solid tumours, like head and neck cancer, achieves localized delivery of high concentrations of Cavatak™, maximizing the potential for rapid tumour cell death and activation of favourable host anti-tumour immune responses. Such a delivery strategy also permits more accurate tumour measurement and scientific evaluation of the potency of Cavatak™. Supporting data from the monitoring of virus levels in the blood and size of remote tumours provides additional clinical insight into the distribution and bio-activity of virus produced following Cavatak™ replication in the treated tumour. The Company believes this data will facilitate the earliest route to commercialization.

Cancers of the head and neck, which include cancers of the buccal cavity (cavity between the jaw and the cheeks), head and neck subset, larynx, pharynx, thyroid, salivary glands and nose/nasal passages. If caught early, the prognosis is excellent. However, about half of all cases of head and neck cancer are not identified until the disease is at an advanced stage

Source: patient.cancerconsultants.com
Author: Eleanor Mayfield

With research pointing to pros and cons of vitamin and mineral supplements, these dietary decisions become increasingly complex. Here’s a quick quiz:
1. Are you a cancer patient or survivor?
2. Do you take any dietary supplements such as vitamins, minerals, or herbs?
3. Have you discussed with your doctor the pros and cons of using these supplements?

If you answered yes to questions 1 and 2 and no to question 3, you’re not alone. A recent review in the Journal of Clinical Oncology found that supplement use is widespread among cancer patients and longer-term survivors and that most don’t discuss their supplement use with their doctors. In fact, in different studies 64 to 81 percent of respondents reported using vitamin or mineral supplements. Up to 68 percent of doctors were unaware of supplement use by their patients. Cancer patients and survivors tend to use dietary supplements at higher rates than the rest of the U.S. population, the review found. Supplement use was highest among women, breast cancer survivors, and people with higher levels of education.

People who take supplements generally believe that doing so will benefit their health. In studies included in the review, the reported reasons for supplement use included strengthening the immune system, helping cope with stress, improving the chance of a cure, and helping the user feel better.

Users may assume that the supplements they take can’t do them any harm. Research findings suggest, however, that supplements can sometimes be harmful. In cancer patients who are receiving radiation or chemotherapy, some dietary supplements may interfere with treatment effectiveness while others may accelerate cancer growth. This article summarizes what you need to know to make an informed decision about supplement use as a cancer patient or survivor.

What exactly is a dietary supplement?
The Dietary Supplement Health and Education Act, passed by Congress in 1994, defines a dietary supplement as “a product (other than tobacco) that…contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and other substances) or their constituents [and] is intended to be taken by mouth as a pill, capsule, tablet, or liquid.”

Dietary supplements must be safe or they wouldn’t be on the market, right?
Not exactly. Under the 1994 law, manufacturers of dietary supplements are not required to test their products in clinical trials to prove them safe and effective before putting them on the market, as drug manufacturers must do. The law considers supplements safe unless they are found to cause harm. The U.S. Food and Drug Administration (FDA) may stop a company from marketing a dietary supplement only if it proves that the product poses a significant health risk.

Since 1994 the FDA has found problems with some dietary supplements. Some products have been contaminated; others have not contained the ingredients listed on the label or have contained a lower or higher dose of the active ingredient than the label stated. Some supplements have caused damage to the liver, kidneys, or other organs. The supplement ephedra, often sold as a weight-control remedy and an energy booster, was taken off the market in 2003 after being linked to such health problems as high blood pressure and irregular heart rhythm.

Some supplements may pose particular risks for cancer patients. For example, St. John’s wort—an herb marketed as helpful for depression—has been shown to interfere with the body’s metabolism of the cancer drug Camptosar® (irinotecan). Folic acid—a vitamin that reduces the risk of some birth defects—may have biologic effects that promote the progression of colorectal cancer.1

“The term dietary supplements may lead people to think that these products can be used as you would use a spice to garnish your food,” says Patrick J. Mansky, MD, a medical oncologist and researcher at the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health in Bethesda, Maryland. “But many products termed ‘supplements’ contain biologically active components that may be beneficial but are also potentially harmful if they interact adversely with medications or have other undesirable biologic effects.”

What about antioxidant supplements?
One category of supplements whose use by cancer patients is particularly controversial is antioxidants, such as beta-carotene, lycopene, selenium, and vitamins A, C, and E. These substances work in the body to slow or prevent damage to cells caused by unstable molecules known as free radicals. Antioxidants are found in many foods, including fruits, vegetables, grains, and nuts as well as some red meats, poultry, and fish.

Some cancer patients take high-dose antioxidant supplements in the hope that these products will help their bodies better tolerate treatment side effects or boost treatment effectiveness. Laboratory and animal studies have shown that antioxidants can protect cells against radiation and chemotherapy and may therefore reduce the adverse effects of radiation treatment and chemotherapy. Some lab studies suggest that antioxidants enhance the effectiveness of chemotherapy and radiation. Other studies, however, suggest that antioxidants may reduce the anticancer activity of these treatments.

“Radiation and many kinds of chemotherapy work by damaging the DNA of both tumor cells and normal cells,” explains Brian D. Lawenda, MD, a radiation oncologist at Naval Medical Center San Diego. “When you put high doses of antioxidants into the cellular environment, it has been shown that they can repair DNA damage and prevent cell death.” The bottom line: high doses of antioxidants may reduce the ability of radiation or chemotherapy to kill tumor cells, potentially reducing the effectiveness of treatment.

Dr. Lawenda is the first author of a recent review article published in the Journal of the National Cancer Institute, which concludes, “the use of antioxidant supplements during chemotherapy and radiation treatment should be discouraged because of the possibility of tumor protection and reduced survival.” The researchers base this conclusion on a review of all the randomized clinical trials they could identify in which patients received antioxidant supplements concurrently with radiation or chemotherapy.

Many of the trials they found enrolled fewer than 50 patients, Dr. Lawenda says, and therefore lack the statistical power to support conclusions about the benefits or risks of antioxidant supplements. In the largest trial they identified, 540 patients with head and neck cancer received radiation therapy plus either antioxidant supplements or placebo pills. Compared with those in the placebo group, patients who received the antioxidant supplements had fewer severe side effects from treatment, but their tumors were more likely to come back and their overall survival was poorer. ,

The results of this trial don’t prove that it’s unsafe for cancer patients to take antioxidant supplements, says Dr. Lawenda, but they suggest it may be unsafe. “The studies done so far don’t provide a definitive answer,” he says. “What we need are more large clinical trials designed specifically to look at survival and tumor control endpoints in cancer patients who receive high-dose antioxidant supplements. We recommend that patients not take high-dose supplemental antioxidants during treatment until we have better research that shows this is safe.”

This advice is consistent with that issued in 2006 by an expert panel convened by the American Cancer Society. “Whether antioxidants or any other dietary supplements are beneficial or harmful is…without a clear scientific answer at this time,” the panel wrote. “Given this uncertainty, until more evidence is available that suggests more benefit than harm, it is prudent for cancer survivors receiving chemotherapy or radiation therapy to avoid exceeding more than 100 percent of the daily value for antioxidant-type vitamins such as vitamins C and E during the treatment phase.”

Antioxidant supplements may offer no health benefits to those who are cancer-free, either. In a recent review of 67 randomized trials, participants who took high doses of beta-carotene, vitamin A, or vitamin E had a higher risk of death than those who took either no supplements or a placebo. Vitamin C supplements had no effect on death rates. In some studies selenium supplements seemed to reduce death rates, but the evidence was not conclusive. Some participants were healthy while others had various diseases, but this made no difference to death rates.

So what about antioxidants in food?
Many fruits and vegetables—especially berries, tomatoes, and dark green leafy vegetables—are rich in antioxidants. If antioxidants might interfere with cancer treatment, should patients avoid eating these foods? Absolutely not, says Dr. Lawenda. So why are antioxidant-rich foods okay if antioxidant supplements are potentially harmful?

The answer is that the body makes better use of antioxidants that are “packaged” along with many other nutrients in a fruit or vegetable than it does of isolated antioxidants consumed as supplements, says Karen Collins, MS, RD, nutrition adviser to the American Institute for Cancer Research (AICR). “When antioxidants are consumed in food, you get a wide variety of other nutrients as well and they work synergistically—their healthful effects are stronger together than alone; plus you don’t get too much of any single nutrient,” she explains. “More is not always better—you can have too much of a good thing.”

Why should I tell my doctor what supplements I take?
Much has been learned over the past few years about how supplements—particularly herbs and other supplements derived from plants—can interact with prescription medications, says Dr. Mansky: “Not just cancer drugs, but blood pressure medications, antibiotics, antiviral drugs, blood thinners, and cholesterol-lowering agents. As a physician you want to be aware of a patient’s whole situation so that you can provide the best care. Patients should be as informed and aware as possible about supplements they are taking or considering taking. You want an informed patient talking to an informed healthcare provider.”

Are any supplements recommended during cancer treatment?
A regular multivitamin (not a “megavitamin”) may be helpful and is unlikely to be harmful, those interviewed for this article agree. If a patient has lost weight or has no appetite, a protein or calorie supplement might be appropriate, says Collins. If someone is deficient in a specific nutrient, supplementation of that nutrient may help eliminate the deficiency. “Recommendations for supplementation should be individualized based on what type of treatment a patient is receiving and how well they’re able to get the nutrients they need through food,” she adds.

Can supplements prevent cancer or stop it from coming back?
In a comprehensive report published by AICR in November 2007, scientists concluded—after reviewing more than 7,000 studies on diet and cancer prevention—that no dietary supplement can currently be recommended to prevent cancer.

Some supplements may reduce the risk of certain types of cancer but increase it for others, says Collins. “Calcium supplements probably lower colon cancer risk, but in excessive doses they may increase the risk of prostate cancer. Selenium supplements may help reduce prostate cancer risk but may increase the risk of skin cancer. Right now we can’t identify who is likely to be helped by these supplements and who might be harmed. Until we can do that, it’s premature to recommend any supplements for cancer prevention.”

How can I be a savvy supplement user?
Be aware that supplements may be helpful in some circumstances but possibly harmful in others. If you’re receiving treatment for cancer, inform yourself about the pros and cons of using supplements. If you’re hoping to prevent cancer, don’t count on supplements to do it. Don’t use supplements as a substitute for a healthy diet. Finally, always talk with your doctor about supplements you’re taking or considering taking.

References:
Velicer CM, Ulrich CM. Vitamin and mineral supplement use among US adults after cancer diagnosis: A systematic review. Journal of Clinical Oncology. 2008;26(4):665-73.

Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration. Dietary Supplement Health and Education Act of 1994. Available at: http://www.cfsan.fda.gov/~dms/dietsupp.html. Accessed September 19, 2008.

Dietary Supplements: How to Know What Is Safe. American Cancer Society Web site. Available at: http://www.cancer.org/docroot/ETO/content/ETO_5_3x_How_to_Know_What_Is_Safe_Choosing_and_Using_Dietary_Supplements.asp. Accessed September 19, 2008.

Marwick C. Adverse reactions to dietary supplements under investigation by FDA. BMJ. 2002;325(7359):298.

Meadows M. Ensuring the Safety of Dietary Supplements. FDA Consumer. July-August 2004. Available at: http://www.fda.gov/fdac/features/2004/404_supp.html. Accessed September 19, 2008.

Mathijssen RH, Verweij J, de Bruijn, Loos WJ, Sparreboom A. Effects of St. John’s wort on irinotecan metabolism. Journal of the National Cancer Institute. 2002;94(16):1247-49.

D’Andrea GM. Use of antioxidants during chemotherapy and radiotherapy should be avoided. CA: A Cancer Journal for Clinicians. 2005;55(5):319-21.

Lawenda BD, Kelly KM, Ladas EJ, Sagar SM, Vickers A, Blumberg JB. Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? Journal of the National Cancer Institute. 2008;100(11):773-83.

Bairati I, Meyer F, Gélinas M, et al. Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. Journal of Clinical Oncology. 2005;23(24):5805-13.

Bairati I, Meyer F, Jobin E, et al. Antioxidant vitamins supplementation and mortality: A randomized trial in head and neck cancer patients. International Journal of Cancer. 2006;119(9):2221-24.

Doyle C, Kushi LH, Byers T, et al. Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. CA: A Cancer Journal for Clinicians. 2006;56(6):323-53.

Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews. 2008;(2):CD007176.

Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. American Institute for Cancer Research/World Cancer Research Fund Web site. Available at: http://www.dietandcancerreport.org. Accessed September 19, 2008.

Source: Radiation Oncology, December 9, 2008; 3(1): 41.
Authors: C M van Rij, W D Oughlane-Heemsbergen, A H Ackerstaff, E A Lamers, A Jm Balm, and C Rn Rasch

ABSTRACT: Background and purpose: To assess the impact of intensity modulated radiotherapy (IMRT) versus conventional radiation on late xerostomia and Quality of Life aspects in head and neck cancer patients. Patients and methods: Questionnaires on xerostomia in rest and during meals were sent to all patients treated between January 1999 and December 2003 with a T1-4, N0-2 M0 head and neck cancer, with parotid gland sparing IMRT or conventional bilateral neck irradiation to a dose of at least 60 Gy, who were progression free and had no disseminated disease (n= 192). Overall response was 85 % (n = 163); 97 % in the IMRT group (n = 75) and 77 % in the control group (n = 88) the median follow-up was 2.6 years. The prevalence of complaints was compared between the two groups, correcting for all relevant factors at multivariate ordinal regression analysis. RESULTS: Patients treated with IMRT reported significantly less difficulty transporting and swallowing their food and needed less water for a dry mouth during day, night and meals. They also experienced fewer problems with speech and eating in public. Laryngeal cancer patients in general had fewer complaints than oropharynx cancer patients but both groups benefited from IMRT. Within the IMRT group the xerostomia scores were better for those patients with a mean parotid dose to the “spared” parotid below 26 Gy. CONCLUSIONS: Parotid gland sparing IMRT for head and neck cancer patients improves xerostomia related quality of life compared to conventional radiation both in rest and during meals. Laryngeal cancer patients had fewer complaints but benefited equally compared to oropharyngeal cancer patients from IMRT.

Source: Arch Otolaryngol Head Neck Surg. 2008;134(12):1299-1304
Authors: Maria-Mercedes Suarez-Cunqueiro, DDS, PhD et al.

Objectives:
To assess the prevalence of speech and swallowing impairment after radical surgery for oral and oropharyngeal cancer from the patient’s viewpoint and to examine the association of these functional alterations with selected clinical characteristics regarding patients, tumors, and oncologic treatment.

Design:
Cross-sectional, multicenter study using a self-administered questionnaire.

Setting:
Forty-three hospitals in Germany, Switzerland, and Austria.

Patients:
A total of 3894 questionnaires about rehabilitation problems after treatment for oral and oropharyngeal squamous cell carcinoma were sent to patients. Of these, 1652 were filled out and returned, and 1334 (80.8%) met the inclusion criteria.

Main Outcome Measures:
Morbidity associated with treatment of oral and oropharyngeal cancer.

Results:
Speech problems were reported by 851 patients (63.8%), and swallowing problems were reported by 1006 patients (75.4%). The variables that presented a significant association with speech and swallowing impairment were sex, tumor location, pTNM stages, stage of tumor, treatment modality, and reconstruction type.

Conclusions:
This survey, based on patient perception, suggests that those who undergo radiotherapy associated with the surgical removal of a tumor, have late-stage tumors (III-IV), or have tumors located in the floor of the mouth should be informed of the greater risk of persistent severe speech and swallowing problems.

Authors:
Maria-Mercedes Suarez-Cunqueiro, DDS, PhD; Alexander Schramm, DDS, MD, PhD; Ralf Schoen, DDS, MD, PhD; Juan Seoane-Lestón, DDS, MD, PhD; Xosé-Luis Otero-Cepeda, PhD; Kai-Hendrik Bormann, DDS; Horst Kokemueller, MD, DDS; Marc Metzger, MD, DDS; Pedro Diz-Dios, DDS, MD, PhD; Nils-Claudius Gellrich, DDS, MD, PhD

Author Affiliations:
Department of Oral and Maxillofacial Surgery, Hannover Medical School, Hannover, Germany (Drs Suarez-Cunqueiro, Bormann, Kokemueller, and Gellrich); Department of Oral and Maxillofacial Surgery, German Federal Armed Forces Hospital, Ulm, Germany (Dr Schramm); Departments of Stomatology (Drs Suarez-Cunqueiro, Seoane-Lestón, and Diz-Dios) and Biostatistics (Dr Otero-Cepeda), University Santiago de Compostela, Santiago de Compostela, Spain; and Department of Oral and Maxillofacial Surgery, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg, Germany (Drs Schoen and Metzger).