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CDC finds coverage for HPV vaccination among teens is still low

Fri, Jul 25, 2014

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Source: medicalnewstoday.com
Author: staff
 

Although there has been a slight increase in human papillomavirus vaccination coverage among adolescents since 2012, a new report from the Centers for Disease Control and Prevention states that vaccine coverage in this population remains “unacceptably low”.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. There are more than 150 types of HPV, 40 of which can be contracted through skin-to-skin contact during vaginal, anal or oral sex.

Low-risk HPV types, such as HPV-6 and HPV-11, can cause warts around the genitals or anus. But high-risk types, including HPV-16 and HPV-18, account for approximately 5% of all cancers worldwide.

Specifically, HPV-16 and HPV-18 account for around 70% of all cervical cancers and almost 50% of all vaginal, vulvar and penile cancers. HPV-16 is also accountable for more than 50% of throat cancers.

There are currently two vaccines available for HPV, which are administered in three shots over 6 months. Cervarix and Gardasil are used for the prevention of cervical cancer, while Gardasil can also protect against anal, vulvar andvaginal cancers and genital warts.

The Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The vaccination is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.

HPV vaccination coverage increased in 2012-13, but remains too low

But despite these recommendations, a new report from the Centers for Disease Control and Prevention (CDC) – published in this week’s Morbidity and Mortality Weekly Report - estimates that in 2013, only 57% of girls and 35% of boys ages 13-17 years received one or more doses of the HPV vaccine.

The figures came from results of the CDC’s National Immunization Survey-Teen (NIS-Teen), which includes vaccine information via telephone surveys for adolescents aged 13-17 years from across the US.

The CDC investigators did, however, find that HPV vaccination coverage increased slightly among girls between 2012-13, from 53.8% to 57.3%, although only a third received the complete three doses. Teenage boys saw a greater increase in vaccination coverage, from 20.8% to 34.6%.

But still, the CDC say HPV vaccination coverage among adolescents is too low, particularly when compared with coverage to other vaccination types. For example, another report from the CDC found that almost 86% of adolescents received one dose of the Tdap vaccine last year, which protects against tetanus, diphtheria and whooping cough.

A 10-year national objective in the US – set in 2010 by Healthy People 2020 – is to reach 80% HPV vaccination coverage among adolescents. These latest statistics suggest there is a lot of work to be done. But lead author of the report, Shannon Stokley, assistant director for science at the CDC’s Immunization Services Division, says they also show the 80% vaccination coverage target is realistic:

“The data on missed vaccination opportunities tells us that it is possible. When we look at the most recent cohort of girls that turned 13, 91% of them had a health care encounter where they could have started the HPV vaccine series before their 13th birthday.

Also, 86% of 13-17 year-olds have received the Tdap vaccine. What these numbers tell us is that preteens and teens are getting to the doctor and they are getting vaccinated, but they aren’t always receiving the HPV vaccine.” 

Why is HPV vaccination coverage still low?

From NIS-Teen, the CDC investigators were also able to establish some reasons as to why HPV vaccination coverage remains low among adolescents.

They found that clinicians’ recommendations significantly influenced a parent’s decision of whether to have their children vaccinated against HPV.

Of parents whose daughters were vaccinated, 74% said they received a recommendation from their doctor, while 52% of parents who did not have their daughters vaccinated received a doctor’s recommendation. Among parents whose sons were vaccinated, 72% received a recommendation, while only 26% of parents whose sons were not vaccinated received a recommendation.

Based on these findings, Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, believes health care professionals are key in boosting HPV vaccination coverage among adolescents in the US.

“Pediatricians and family physicians are uniquely situated to prevent missed opportunities by giving HPV vaccine during the same visit they give Tdap and meningococcal vaccines,” she adds.

Parents also revealed that concerns over the safety of the HPV vaccine deterred them from vaccinating their children. However, the CDC stress that – after analyzing national postlicensure vaccine safety data – no serious safety concerns have been linked to the HPV vaccine in the 8 years it has been available.

The investigators point out that the most commonly reported side effects of the vaccine include dizziness, fainting, nausea and headache, and injection-site reactions – including pain, redness and swelling.

When we asked Stokely what needs to be done to alleviate parents’ concerns about vaccinating their children against HPV, she replied:

“Parents need to see information in mainstream media that HPV vaccination is very effective at preventing infection with the types of HPV that cause the most cancers. Parents also need to hear that the HPV vaccine is safe and that it is recommended to be given when their children are 11 or 12 years old, before their risk of acquiring an HPV infection increases.”

In conclusion to the report, the CDC say they will continue efforts to team up with state and local immunization programs, cancer organizations, professional organizations and other stakeholders in an attempt to educate parents and health care professionals about the importance of the HPV vaccine, adding:

“Collaborative efforts remain critical to promoting HPV vaccination so that the nation’s adolescents are protected against vaccine-preventable, HPV-associated cancers.”

Earlier this year, Medical News Today reported on a study claiming that two thirds of healthy American adults areinfected with one or more of 109 strains of HPV.

 
*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
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Former LA Laker Michael Cooper diagnosed with tongue cancer

Tue, Jul 22, 2014

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Source: insidesocal.com
Author: Mark Medina
 

Former Laker Michael Cooper will take a leave of absence as the head coach of the WNBA’s Atlanta Dream because of early stage tongue cancer. Cooper plans to have a surgical procedure this week at the Winship Cancer Institute of Emory University in Atlanta and is expected to recover in two weeks. Assistant coach Karleen Thompson will assume head coaching duties during Cooper’s absence.

“The doctors and staff at Emory have been tremendous, and I know I’m in good hands,” Cooper said in a statement. “I’m fortunate that my condition was diagnosed early, and this episode illustrates the importance of screening and early detection. I know the team will be in good hands with Coach Thompson at the helm during my absence, and I look forward to returning to the court soon.”

Cooper has guided Atlanta to an Eastern Conference best 15-6 record in his first season. He also coached the East to a 125-124 overtime win at the WNBA All-Star game on Saturday.

Cooper is best known as a defensive specialist with the Showtime Lakers (1978-90) where he won five NBA championships. He also coached the Los Angeles Sparks to two WNBA championships (2001, 2002). Cooper left his second stint with the Sparks to coach the USC’s women’s basketball team. But he resigned in March after finishing 11-20, his first losing record in four seasons.

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

 

 
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Health Insurance providers still take advantage of consumers despite Obamacare

Mon, Jul 21, 2014

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Source: huffingtonpost.com
Author: Jeffrey Young
 

No law has done more to reform health insurance and protect consumers against the industry’s most heinous practices than the Affordable Care Act. But Obamacare didn’t magically transform insurers into benevolent entities solely devoted to taking care of sick people.

Health insurance companies, even those that are not-for-profit, have to collect more money in premiums than they shell out in claims for medical care. That means they have a financial incentive not to pay for things.

And since health insurance companies can no longer shun the sick to maximize profits — either by denying coverage to people based on their medical histories or by rescinding the policies of paying customers who fall ill and rack up bills — insurers are employing other tactics to shift costs to sick people and make it harder to get health care, consumer advocates say.

“One of the things that occurred to me, even as the bill was working its way through Congress, was that once it was passed, insurers would do all they could to try to preserve profit margins,” said Wendell Potter, a former Cigna executive turned industry critic.

Here are a few of the tactics that consumers and advocates have complained about:

Refusing to pay for medical care that should be covered

Nothing in Obamacare says insurance companies have to pay any bill that comes their way. That’s fine, because doctors and patients want things all the time that are wasteful and unnecessary, and everyone shares the cost for that.

Zoë Keating is a musician with more than 1 million followers on Twitter. Her husband, Jeffrey Rusch, had been diagnosed with cancer at the emergency room, hospitalized and given chemotherapy. The insurance company refused to cover it – until Keating told her story to a San Francisco television station, according to reports on KPIX.

While the Affordable Care Act beefed up patients’ right to appeal denials by insurance companies, people still have to fight, which is to the insurer’s advantage. “A lot of people just simply don’t understand their appeals rights and don’t appeal, or think that they just don’t have a chance of getting something overturned,” Potter said. “The insurance companies know that.” Most people don’t have a million Twitter followers, either.

Making patients pick up a bigger share of the bill

To keep premiums as low as possible, insurance companies are pushing more of the cost of actual care on to their customers in the form of things like high deductibles and “coinsurance,” which requires patients to pay a percentage of the cost of their care, instead of making a flat copayment.

And it’s virtually impossible to learn in advance how much medical care will actually cost, meaning patients are left in the dark.

“What this means for someone with cancer is that they may end up being directed away from a plan because they can’t find out whether their doctor is in the network, or whether the plan covers their drugs, on what tier and how much they have to pay out of pocket,” said Kirsten Sloan, senior director policy at the American Cancer Society Cancer Action Network. Sending a cancer patient to a competitor would count as a win in the insurance industry.

Designing benefits to make the sickest patients pay more for drugs

Advocates for patients with serious medical conditions have been incensed by the practice of “tiered” drug lists, which have become a popular way for insurers to limit their expenses. Under this mechanism, the amount patients pay at the pharmacy is generally lower for cheap generic medicines and “preferred” brand-name drugs, higher for other brand-name drugs and higher still for the most expensive specialty medications.

High cost-sharing and top-tier status for drugs that treat ailments like HIV and multiple sclerosis are common in insurance policies bought via the Obamacare exchanges, the consulting firm Avalere Health reported last month. That looks an awful lot like insurers discriminating against sick people, the AIDS Institute claimed in a complaint filed against four Florida insurers with the federal government in May.

“Where we’ve seen the problems is putting every single HIV drug, including generics, on the highest tier, and that with very high coinsurance, like 40 or 50 percent,” said Carl Schmid, deputy executive director of the AIDS Institute. “There’s plenty of plans in Florida that don’t do this, and charge $10, $20 a copay for the same drugs.”

Limiting access to doctors and hospitals

Health insurance plans sold via Obamacare exchanges often have “narrow networks,”or shorter lists of medical providers that accept those plans than people with job-based insurance or Medicare might expect. Insurers need to keep costs down, and tough negotiating with high-priced doctors and hospitals can do that. This ends up saving the whole health care system money, including insurance customers.

The trouble is, when those networks don’t include enough of the specialty care providers that take care of the sickest, most expensive patients – like, say, cancer centers – it has the effect of denying care to those very sick people because they can’t get appointments.

“Insurers might try to avoid people with HIV or cancer or expensive conditions by avoiding the doctors that tend to treat those people, but otherwise their network looks robust,” said Karen Pollitz, a senior fellow at the Henry J. Kaiser Family Foundation. “Whether it’s happening — no way to know yet.” The Obama administration and state regulators are poised to take action to compel insurers to beef up their networks, The New York Times reported.

Rolling out the red tape

To save money, insurance companies will be stricter about approving and paying for medical treatments, said Carmen Balber, executive director of the nonprofit organization Consumer Watchdog. “I have no doubt that claims denials or delays will be the new discriminatory tactic of the industry,” she said.

In Seattle, one doctor said she has to work harder to get treatments approved this year. “There are more hoops that the provider has to jump through,” said Grace Wang, the medical director of the International Community Health Services Holly Park Medical and Dental Clinic.

Wang returned to the clinic after Memorial Day weekend and attempted to follow up on a request she’d made to refer a patient to a specialist. The insurance company said her request already had been rejected because she hadn’t called back quickly enough.

“Their clock started ticking on Sunday. Monday was a national holiday, and so when 48 hours went by, they denied,” said Wang. “A conspiracy theorist would wonder.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
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Florida jury awards $23 billion for punitive damages to widow in lawsuit against R.J. Reynolds

Mon, Jul 21, 2014

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Source: reuters.com
Author: Barbara Liston
 

A Florida jury has awarded the widow of a chain smoker who died of lung cancer punitive damages of more than $23 billion in her lawsuit against the R.J. Reynolds Tobacco Company, the nation’s second-biggest cigarette maker.

The judgment, returned on Friday night, was the largest in Florida history in a wrongful death lawsuit filed by a single plaintiff, according to Ryan Julison, a spokesman for the woman’s lawyer, Chris Chestnut.

Cynthia Robinson of Florida Panhandle city of Pensacola sued the cigarette maker in 2008 over the death of her husband, Michael Johnson.

Johnson, a hotel shuttle bus driver who died of lung cancer in 1996 at age 36, smoked one to three packs a day for more 20 years, starting at age 13, Chestnut said.

“He couldn’t quit. He was smoking the day he died,” the lawyer told Reuters on Saturday.

After a four-week trial and 11 hours of jury deliberations, the jury returned a verdict granting the widow $7.3 million and the couple’s son $9.6 million in compensatory damages.

The same jury deliberated for another seven hours before deciding to award Robinson the additional sum of $23.6 billion in punitive damages, according to the verdict forms.

Lawyers for the tobacco company, a unit of Reynolds American Inc [RAI.N] whose brands include Camel cigarettes, could not immediately be reached for comment.

But J. Jeffery Raborn, vice president and assistant general counsel for R.J. Reynolds, said in a statement quoted by the New York Times that the company planned to challenge “this runaway verdict.” Such industry appeals are often successful.

Chestnut countered, “This wasn’t a runaway jury, it was a courageous one.”

Robinson’s lawsuit originally was part of a large class-action litigation known as the “Engle case,” filed in 1994 against tobacco companies.

A jury in that case returned a verdict in 2000 in favor of the plaintiffs awarding $145 billion in punitive damages, which at the time was the largest such judgment in U.S. history.

That award, however, was tossed out in 2006 by the Florida Supreme Court, which decertified the class, agreeing with a lower court that the group was too disparate and each smoker smoked for different reasons.

But the court said the plaintiffs could file lawsuits individually. Robinson was one of them.

The Florida high court also let stand the jury’s findings that cigarettes are defective, dangerous and cause disease, and that Big Tobacco was negligent, meaning those issues did not have to be re-litigated in future lawsuits.

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

Mon, Jul 21, 2014

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Source: Idaho Press-Tribune/www.idahopress.com
Author: Kelcie Moseley
 

Brian Hill was a self-professed health freak.

He was an outdoorsman who had never used tobacco. He was a fit 230 pounds with 8 percent body fat. But a lump in the side of his neck changed his life in 1997.

Hill is the founder and president of the Oral Cancer Foundation, a small national nonprofit organization based in Newport Beach, California. He is an oral cancer survivor who contracted the disease through human papillomavirus, or HPV, which happens more often than people think, Hill said.

He is now a fierce advocate for more awareness of the disease, which is also often caused by smoking or chewing tobacco — and those two forms of tobacco are about as common with the rodeo crowd as Coors and Budweiser. According to the Centers for Disease Control and Prevention, about 14 percent of boys ages 12 to 17 use smokeless tobacco nationwide, and the rates are higher in rural states.

The newest effort to achieve more awareness and early detection of oral cancer starts with Cody Kiser, the new rodeo representative for the foundation.

Kiser, 23, is a bareback bronco rider who competed in the Snake River Stampede this week on his rodeo circuit. He graduated in May with a civil engineering degree from the University of Nevada-Reno, not far from his hometown of Carson City.

“We’ve wanted to (have a rodeo representative) for about five years, we just never found the right person who was the right voice for the foundation,” Hill said.

That all changed in March, when an employee at the foundation brought up Kiser’s name as a potential candidate for the role. Kiser has never smoked or chewed, which made him an ideal choice.

“I attribute a lot of that to my father and grandfather and family growing up. Nobody chewed,” Kiser said. “It just never was for me, and I just never got into it.”

He added that his family — particularly his mother — would have had plenty to say about it if they found out he was using tobacco.

Kiser agreed to fill the role for the foundation, and the Stampede was his debut. Thursday was the first day he wore a shirt sporting the logo and slogan, “Be Smart, Don’t Start,” down the sleeve. A few of his rodeo buddies had already asked questions about it by Thursday night.

“I tell them we’re just here to give them information about the risks involved and what can happen,” Kiser said.

More than 43,000 Americans will be diagnosed with a type of oral cancer this year, Hill said. It will cause more than 8,000 deaths, killing close to one person every hour. Of those newly diagnosed, only 57 percent will still be alive within five years. Hill is one of the luckier half, even though his diagnosis came when he was already at Stage IV, 18 to 30 months in. And even though he survived, a portion of the right side of his neck needed to be removed.

“It’s a brutal disease to go through,” Hill said. “… We have a death rate that’s just brutal. And if you live, you may not have a tongue, you may not be able to swallow food, people may not be able to understand what you’re saying.”

Though tobacco use is highly popular among rodeo competitors and audiences, Hill said the sport has moved away from tobacco companies in recent years. In 2009, the Professional Rodeo Cowboys Association ended its national sponsorship contract with the U.S. Smokeless Tobacco Company. Hill said that has made the sport more appealing as a family event, and it gives the foundation a good place to start. But he believes there is more work to be done, and the foundation will partner with Kiser to get its message into more rodeo programs and public service announcements.

“We’ll see how it goes,” he said. “We’re feeling our way through rodeo right now, and by the end of the year we’ll have a better idea of what this looks like.”

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

 

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Scar-free surgery for cancer patients

Sat, Jul 19, 2014

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Source: www.todayonline.com
Author: staff

Singapore — When Mdm Tan Chwee Huay told her friends that she had undergone surgery to remove a cancerous lump in her throat, they thought that she was pulling their leg.

“Nobody could tell that I had gone for such a complex surgery because they could not see any scars.

“They only learnt about my cancer diagnosis after the surgery, and they were shocked,” said the 75-year-old housewife, who was diagnosed with advanced-stage throat cancer in late 2010.

Shortly after her diagnosis, Mdm Tan underwent a surgical procedure known as transoral robotic surgery (TORS) to remove a 2cm lump from the base of her tongue.

Traditionally, conventional surgery for head and neck cancer involving the base of the tongue and throat required making large incisions in the neck, or sawing through the jaw to remove the growth, said Adjunct Assistant Professor Tay Hin Ngan, director of HN Tay ENT, Head and Neck, Thyroid, Sleep and Robotic Surgery at Mount Elizabeth Novena Hospital.

Incisions from a typical open-neck surgery can extend beyond 20cm, said ENT/head and neck surgeon Dr Jeeve Kanagalingam, a visiting consultant at Johns Hopkins Singapore.

While a skilled surgeon can conceal the incisions within creases or folds of the skin, Dr Kanagalingam said, patients who are predisposed to keloids could risk developing thick, raised scars.

However, advancements in robot-assisted surgical systems have made it possible for surgeons to perform such surgeries without making a visible incision in the neck or face.

Prof Tay, who performed TORS on Mdm Tan, said the “scar-less” surgery is performed through the mouth using the da Vinci surgical robot via a remote control console.

“The robot allows us to work around corners and operate in areas where the human hand previously could not have reached without cutting through the neck or sawing through the jaw,” he explained.

From Pelvic Surgery to Treating Cancer
Prof Tay said Mdm Tan is one of the first few people in Singapore to have undergone TORS since it was introduced here in 2011.

The da Vinci system was previously used in pelvic surgeries, where access for surgery is limited, said Dr Kanagalingam.

In recent years, the robotic surgical system has extended to head and neck operations. TORS can also be used to treat snoring and obstructive sleep apnoea (OSA) by reducing the bulky tongue base tissue blocking the airways.

To date, Prof Tay has performed about 20 TORS procedures for cancer and obstructive sleep apnoea.

“In general, surgery is often the best choice for thyroid and tongue cancers, and advanced laryngeal (voice box) cancers. For cancers in advanced stages, most patients undergo a combination of treatments,” said Dr Kanagalingam.

With the availability of robotic surgery, chemotherapy and radiotherapy need not be the first-line treatment, added Prof Tay.

“Robotic surgery can remove a tumour first, reducing the amount and area of radiation needed, and allow for less aggressive chemotherapy,” he said.

Fewer Complications
Compared with conventional head and neck surgery, patients who undergo TORS have a lower risk of certain post-surgery complications.

“One of the dreaded complications of open surgery is the risk of saliva leaking through a neck wound. As no neck incision is made during TORS, the risk of this complication is minimal,” said Prof Tay.

Another boon, added Prof Tay, is that patients are able to preserve their swallowing function, as the TORS procedure does not cut through swallowing muscles to reach the tumour. A day after her surgery, Mdm Tan was able to consume a soft diet without much pain during swallowing. With conventional open surgery, patients such as Mdm Tan might require tube feeding for 10 to 14 days before being allowed to try liquids and slowly progressing to solids.

She may not be able to eat solid food for a month, said Prof Tay.

However, not all head and neck tumours can be removed using TORS and every patient needs to be assessed carefully, said Dr Kanagalingam.

As with any surgical procedure, there are also some risks involved in TORS, including bleeding in the tongue and throat.

“This is potentially life-threatening if not handled well, so an experienced robotic surgeon is essential.

“This risk is higher in tumour surgery compared to OSA surgery, as we go deeper and are more likely to encounter these vessels.

“Other risks include damage to the teeth, tongue swelling and change in the sense of taste. But these usually recover on their own with time,” said Prof Tay.

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Docetaxel regimen tops cisplatin in head and neck cancer

Sat, Jul 19, 2014

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Source: www.cancernetwork.com
Author: Anna Azvolinsky, PhD

A phase II study has demonstrated that combining docetaxel-based chemoradiotherapy and the antibody cetuximab postoperatively in patients with high-risk squamous cell carcinoma of the head and neck led to improved disease-free and overall survival, with no unexpected toxicities. The results of the study were published in the Journal of Clinical Oncology.

Two-hundred and thirty-eight stage III and IV patients were randomized to receive radiation therapy (60 Gy) plus cetuximab and either cisplatin (30 mg/m2) or docetaxel (15 mg/m2) once per week as part of the Radiation Therapy Oncology Group (RTOG) 0234 clinical trial.

The 2-year overall survival (OS) was 69% in the cisplatin treatment arm and 79% in the docetaxel treatment arm. The 2-year disease-free survival (DFS) was 57% and 66% in the cisplatin and docetaxel arms, respectively.

Previously, two large phase III trials, the RTOG 9501 and the European Organisation for Research and Treatment of Cancer (EORTC) 22931 trials, both showed a small but significant survival benefit for postoperative head and neck cancer patients who received adjuvant radiation and chemotherapy concurrently, resulting in the incorporation of cisplatin in an adjuvant regimen for high-risk patients. The drawback was that adding cisplatin to radiation therapy increased toxicity. Many of these patients are not candidates for the combination therapy due to poor performance status, older age, and renal insufficiency. The purpose of the current trial was to test whether combining a molecular therapy such as cetuximab with chemotherapy would improve survival with a better toxicity profile, compared with radiation therapy plus chemotherapy.

After a median follow-up of 4.4 years, 48 patients in the cisplatin arm had a DFS event compared with 51 patients in the docetaxel arm. Cisplatin patients had a 24% reduction (P = .05) and docetaxel patients had a 31% reduction (P = .01) in the DFS failure rate compared with a historical control arm (the RTOG 9501 trial).

Patients who had p16-positive oropharynx tumors (43 of 54 patients) had improved survival compared with those who had p16-negative oropharynx disease.

The most common high-grade non-hematologic adverse events were mucositis, dysphagia, and skin rash, seen in both the cisplatin and docetaxel treatment arms. Patients in the cisplatin arm had a greater frequency of high-grade hematologic toxicities compared with those in the docetaxel arm (27.8% vs 14.2%, respectively). More patients in the docetaxel arm had toxicities deemed unacceptable by those conducting the trial (12.3% in the docetaxel arm vs 9.3% in the cisplatin arm).

Cetuximab is a chimeric human monoclonal antibody against the epidermal growth factor receptor (EGFR).

“The delivery of postoperative chemoradiotherapy (using cisplatin or docetaxel once per week plus 60 Gy radiation) with concurrent once-per-week cetuximab for patients with SCCHN [squamous cell carcinoma of the head and neck] who have high-risk pathologic features is feasible and tolerated with predictable toxicity. The radiation-docetaxel-cetuximab regimen shows particularly promising outcome with improvement in DFS and OS relative to RTOG historical controls and appears worthy of further investigation in high-risk patients with SCCHN,” concluded the authors.

Because the conclusions of this trial rely on a historical control comparison, these results need to be further validated in a phase III control-arm clinical trial. The docetaxel plus cetuximab regimen is currently being tested in a phase II/III clinical trial.

In an editorial, Amanda Psyrri, MD, PhD, and Urania Dafni, MD, both of the University of Athens in Greece, noted that, “In an era when next-generation sequencing is becoming increasingly available, identification of mutations that predict therapeutic response or resistance would be a major advance. Therefore, it seems mandatory that we focus our efforts at identifying an ‘EGFR sensitivity signature.’ Until then, it would seem wise not to conduct large phase III studies with cetuximab in unselected patient populations.”

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Oral Cancer Foundation, Cody Kiser partner for Idaho rodeo

Sat, Jul 19, 2014

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Source: www.drbicuspid.com
Author: DrBicuspid Staff

The Oral Cancer Foundation (OCF) is partnering with Cody Kiser, a rodeo cowboy who will serve as a spokesman for the group, at the Snake River Stampede Rodeo, held July 15-19 in Nampa, ID.

Kiser hopes to serve as a positive role model for children and teens that look up to cowboys as their heroes in the rodeo world. Research shows that as many as 15% of high school boys use smokeless tobacco in the U.S. With the nicotine content in a can of dip equaling approximately that of 80 cigarettes, this addiction can be one of the hardest to break, which is why the OCF hopes to educate parents and youth about the dangers before they get started.

“My dad was a cowboy, so I know what it’s like looking up to cowboys as heroes for my whole life,” Kiser stated in a press release. “My dad was a positive role model in my life growing up in that regard, and the idea of using spit tobacco never appealed to me. Right now, I’m pursuing rodeo as a passion of mine, and if at the same time I can do some good in the world and set the right example for young kids who might look up to me, then I’m honored and eager to do so.”

“Every kid has a hero they look up to, and whether it’s a cowboy, baseball player, or other strong figure in their lives; even heroes can still have some aspect of their life that is less than a perfect example to follow,” explained Brian Hill, OCF founder and executive director. “We are excited to partner with Cody and venture into the rodeo arena because we believe we can make a real difference there.”

“Cody is a great partner for us,” Hill continued, “This is the first time a nonprofit is really going into a world that is very much tied to the use of smokeless tobacco and proactively advocating against it. Our messaging to youth is simple: ‘Be Smart. Don’t start.’ “

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Antioxidants May Cause More Harm Than Good in Cancer Patients

Mon, Jul 14, 2014

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Source: medscape.com
Author: Zosia Chustecka
 

While alternative health gurus often encourage increasing antioxidants in the diet and the taking of antioxidant nutritional supplements such as beta-carotene, vitamins A, C, and E, and selenium, new research findings suggest that antioxidants could do more harm than good, especially in cancer patients.

The idea is discussed in a perspective article on the promise and perils of antioxidants for cancer patients in the July 10 issue of the New England Journal of Medicine.

Coauthor David Tuveson, MD, PhD, professor and deputy director of the Cold Spring Harbor Laboratory Cancer Center in New York, explained in an interview with Medscape Medical News that the idea that antioxidants could be useful in cancer goes back to Linus Pauling, and is based on observations that oxidation within cells is needed for cell growth. “As cancer cells growth rapidly, a cancer cell would have more oxidation within it than a normal cell,” he added, and the hope was that antioxidants would interfere with these cellular oxidative processes and would suppress the growth.

“Although some early preclinical studies supported this concept,” the authors write, there have now been several clinical trials that have shown no effect of antioxidants on reducing the incidence of cancer, and there have even been suggestions of harm in persons who are at risk for cancer.

Dr. Tuveson noted a clinical trial from Scandinavia in the early 1990s, which found that high doses of antioxidants, particularly beta-carotene, were associated with more lung cancer rather than less as had been hoped for.

There was a similar finding from the Selenium and Vitamin E Cancer Prevention Trial (SELECT), which found that the antioxidants did not reduce the risk for prostate cancer, as had been hoped, and in fact increased the risk in some men.

Dose-dependent Harmful Effect

The perspectives article was prompted by new findings reported earlier this year, he said. An animal study carried out by Swedish researchers showed that the harm from antioxidants was dose-dependent (Sci Transl Med. 2014;6:221ra15). The study was conducted in a genetically engineered mouse model that mimics early human non-small-cell lung cancer. The researchers studied N-acetylcysteine (which is used in patients with chronic obstructive pulmonary disease) and also derivatives of vitamin E, and they found that these antioxidants “actually increased cancer burden and mortality in a dose-dependent manner.”

“The mice got lung cancer faster and they died more quickly of the disease,” Dr. Tuveson said.

In their perspective article, Dr. Tuveson and coauthor Navdeep Chandel, PhD, from Northwestern University in Chicago, address the question of why.

It turns out that all cells have not only oxidative mechanisms producing reactive oxygen species, they also have a mechanism by which they produce antioxidants, and so there is a balance between the 2 in each cell. “And cancer cells, because they make more oxidants, also make more antioxidants,” Dr. Tuveson explained.

“So when adding an antioxidant as a supplement, all you are doing is increasing a pool of what is already there,” he said. “But you are not actually stopping the oxidative mechanisms, and you are not stopping the production of oxidants in the first place, and the pathways that are fuelling cell growth,” he added.

“All you are doing is helping the cancer cell deal with the toxic effects of the oxidants, and by doing so you may be actually making the cancer cell even stronger,” Dr. Tuveson said.

“The antioxidants that we take as a supplement or in our diet don’t go after the root cause of how oxidants promote cancer cell biology,…and our suggestion is that we need to look much more carefully at these mechanisms if we are to truly develop strategies to prevent cancer,” he said.

In their article, the authors propose 2 strategies for further research — the development of antioxidants that target specific intracellular sites of oxidant production, and also a synthetic lethal strategy directed at antioxidants produced within the cell. Both of these strategies are currently at the research stage, with work focused on developing compounds that could be tested in humans.

As for the clinical implications of the research so far, Dr. Tuveson said: “We don’t firmly say that taking antioxidants is dangerous for cancer patients…but I do believe that our article will cause those discussions to begin.”

However, others have already warned cancer patients not to take antioxidants; for instance, prostate cancer patients have been warned against taking selenium, as previously reported by Medscape Medical News.

In addition, there is a question of whether antioxidants may interfere with common cancer treatments, such as chemotherapy and radiotherapy, as these work by increasing oxidation within cancer cells, Dr. Tuveson commented. This is an area that needs to be studied more, he said.

This issue of antioxidants being harmful to cancer patients was raised last year by Nobel laureate James Watson, PhD, who is chancellor emeritus at the Cold Spring Harbor Laboratory. He described a new hypothesis on reactive oxygen species that he considers is “among my most important work since the double helix.”

Dr. Watson proposed that antioxidant levels within cancer cells are a problem and are responsible for resistance to treatment, and that the untreatability of late-stage cancer might be the result of “its possession of too many antioxidants.”

“The time has come to seriously ask whether antioxidant use more likely causes than prevents cancer,” Dr. Watson said. Nutritional intervention trials have shown no obvious effectiveness in preventing cancer or in lengthening mortality, and, “in fact, they seem to slightly shorten the lives of those who take them.”

Dr. Tuveson, who works at the same institution, commented at the end of the interview that “Dr. Watson is usually a few steps ahead of the rest of us.”

 

 *This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
 
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Salivary gland cancers rare, but sometimes deadly

Sat, Jul 12, 2014

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Source: articles.baltimoresun.com
Author: Andrea K. Walker

Professional baseball great Tony Gwynn Sr., also known as Mr. Padre, died last month of salivary gland cancer, which he believed was caused by years of using smokeless chewing tobacco. The cancer is a rare form that begins in any of the salivary glands in the mouth, neck or throat. Two adults in 100,000 are diagnosed with salivary gland cancer each year. The chances of survival drop if the cancer has spread to other parts of the body. Dr. Patrick K. Ha, with Johns Hopkins Head and Neck Surgery at Greater Baltimore Medical Center, says new types of treatments and therapies are in the works to treat the disease.

What is salivary gland cancer and how common is it?
Salivary gland cancers are a diverse group of rare malignancies that can involve any of the major salivary glands (the parotid, submandibular and sublingual) or minor salivary glands, which are found within the lip, palate, tongue base, nasal cavity or sinuses. There are numerous different cancers that may arise from the salivary glands, and these may behave differently based on their cell of origin.

What causes it, and who is more likely to get it?
Little is known about the causes of salivary gland cancers. Unlike the more common head and neck cancers, which have a clear association with smoking, drinking or even the human papillomavirus (HPV), salivary gland cancers do not have such strong associations. There may be a link between significant radiation exposure (i.e., treatment level doses) in the development of salivary gland cancers, as well as with some environmental exposures such as nickel alloy, asbestos or woodworking materials. Tony Gwynn believed using chewing tobacco throughout his professional baseball career was the cause of his cancer, but salivary gland cancers aren’t as strongly linked to tobacco use as some other types of cancers. Nonetheless, we advise against smoking, using smokeless tobacco or even e-cigarettes. They are all addictive and tobacco products contain carcinogens relevant to other cancers.

We do know that men are more likely to get this type of cancer, with the average age of onset in the mid-60s.

What are the symptoms of salivary gland cancer?
Unfortunately, salivary gland cancers most often present as painless masses in the cheek, neck, or within the sinuses/tongue base. Because most of these masses are slow growing, the development of symptoms occurs relatively late. Depending on which gland is involved, the symptoms may include a visible lump, difficulty breathing, swallowing problems or pain. Late symptoms might include facial weakness/drooping, numbness or visual changes.

How is it diagnosed and is it hard to detect?
The ultimate diagnosis is made with a biopsy. A distinction can often be made between benign and cancerous masses with a small needle biopsy, but sometimes requires complete removal of the mass to make this determination. Imaging with a CT scan or MRI can be helpful, especially for operative planning. Depending on where the tumor is located, detection can be more difficult. For example, a mass on the outer surface of the parotid or submandibular gland will be more easily felt than a mass growing in the sinus.

How is it treated and what is the likelihood of survival?
Most salivary gland cancers are treated with surgery up front for complete removal, and possibly radiation afterwards, depending on how serious the disease appeared at the time of surgery and under the microscope. Chemotherapy is less well proven to be helpful in these cancers but could sometimes be considered as additional therapy along with radiation. While some forms of salivary gland cancer can be aggressive, most are relatively well treated, and the five-year survival rate can be upwards of 75 percent.

What new therapies are on the horizon for salivary gland cancers?
Currently, there are trials available to examine the role of chemotherapy in salivary gland cancer treatment. Additionally, work is being done to look into targeted therapy which can better treat the cancers without the significant side effects. Unfortunately, because these are rare cancers, we need to perform the basic research to understand how these cancers arise before we can really make significant advancements in their treatment.

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