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Cigarette smoking caused 14 million serious diseases in 2009

Tue, Oct 14, 2014


Author: Larry Hand

Cigarette smoking remains a major cause of preventable diseases in the United States, with at least 14 million serious medical conditions attributable to smoking in 2009, according to an article published online October 13 in JAMA Internal Medicine.

“These estimates demonstrate that smoking accounts for millions of serious medical conditions in the United States that could be avoided in the absence of cigarette use,” write Brian L. Rostron, PhD, from the Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland, and colleagues. “Our results also indicate that previous estimates may have substantially underestimated smoking-attributable morbidity in the United States.”

The researchers analyzed multiple sources of data from 2006 to 2012, including 2009 population data from the US Census Bureau, smoking prevalence and disease risk from the National Health Interview Survey of US adults for 2006 to 2012, and data from the National Health and Nutrition Examination Survey of US adults for 2007 to 2010.

Current and former smokers were significantly more likely to have at least one smoking-attributable disease and multiple smoking-related conditions compared with never-smokers. Specifically, almost half of surveyed men and women (47.5% and 44.9%, respectively) aged 65 years and older reported having one or more smoking-related disorder, and almost 17% of men and more than 14% of women reported having multiple such disorders. In contrast, among never-smokers, 34.9% of men and 33.2% of women reported at least one such condition and 9.1% and 7.5%, respectively, reported two or more conditions.

Rates of smoking-related conditions were also elevated among current and former smokers aged 35 to 64 years compared with never smokers. For example, almost 12% of adults at least 35 years old reported having diabetes. The adjusted prevalence ratio compared with never-smokers was between 1.17 and 1.30. The researchers also found high prevalence ratios for lung cancer (range, 4.45 – 9.35) and chronic obsessive pulmonary disorder (COPD; range, 2.02 – 4.00).

Extrapolating from National Health and Nutrition Examination Survey data on COPD prevalence, the researchers estimated 14 million “lifetime major medical conditions” could be attributed to the effects of cigarette smoking in 2009 (95% confidence interval, 12.9 – 15.1 million).

The Centers for Disease Control and Prevention previously published estimates of 8.6 million adults having 12.7 million smoking-attributable conditions in 2000.

The recent US Surgeon General’s report “concluded that previous estimates of the disease burden of smoking could be substantial underestimates, given the absence of several major medical conditions caused by smoking,” the researchers write.

Updated, Expanded
The current report is based on data from about 180,000 people surveyed between 2006 and 2012 compared with previous Centers for Disease Control and Prevention estimates based on data from about 20,000 adults surveyed between 1988 and 1994. The current report is also based on calculations for full variance, which is not generally done, the researchers write. The new report also corrects for underreporting of COPD in self-reported survey data, they add.

“Our study confirms that cigarette smoking remains a major cause of preventable disease in the United States,” the authors conclude. “The resulting estimate indicates that the number of major smoking-attributable medical conditions in the United States is larger than has been previously reported, demonstrating the need for vigorous smoking prevention efforts. The disease burden of cigarette smoking in the United States remains immense, and updated estimates indicate that COPD may be substantially underreported in health survey data.”

Work Remains
In an accompanying commentary, Steven A. Schroeder, MD, from the Division of General Internal Medicine at the University of California, San Francisco, writes that in general, the prevalence of smoking has declined, but that this “decline is excruciatingly slow, and there are still more than 40 million smokers in the United States.” Much of current smoking is among “hard-to-reach” populations, he adds.

He concludes, “Tobacco control has been called one of the most important health triumphs of the past 50 years. Yet, although we have come a long way, there is still much more to be done, with the number of smokers worldwide now just short of 1 billion people.”

Source: JAMA Intern Med. Published online October 13, 2014

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Hospital Cancer Program Confronts The Existential

Mon, Oct 13, 2014


Author: Sasha Bronner

People who battle stage 4 cancer are familiar with words like chemotherapy, radiation and metastasize. But words they may not hear at a hospital as often are existentialism, mindfulness, legacy and humor.
Dr. Arash Asher at Cedars-Sinai Medical Center in Los Angeles is dedicating his life to changing that.

Asher, 38, is a physiatrist — a rehab doctor. Before his new program, Asher focused his training on the physical aspects of cancer treatment — things like cogitative rehab, and the management of pain and nausea. But a good number of patients kept coming back to him to talk about their deep and persistent fears. “We can treat someone’s physical pain, but I just felt like we weren’t doing enough as a system,” Asher says. “An antidepressant will not solve the issue.”
So Asher decided to create a rehabilitation program that focuses on the emotional fallout of cancer treatment. He recruited patients for the first course that began in mid-July and is currently in the fourth cycle of the program, called Growing Resiliency and Courage with Cancer, or GRACE.

Two hours a week, for five weeks, seven to nine patients meet in a conference room at Cedars-Sinai with Asher and Jeffrey Wertheimer, a neuropsychologist who co-developed the program. The group focuses discussions on themes or lessons — like wisdom, gratitude, humor, courage and legacy-creation. Patients are assigned homework reading, learn meditation techniques and conclude class with a piece on mindfulness.

The emphasis on mindfulness has a basis in research: it lowers the stress hormone cortisol and helps the brain control pain and emotions. That makes mindfulness a perfect tool for sick patients. Gratitude, a hallmark pillar of any mindfulness practice, has even been said to make us feel happier. Much of the GRACE programming is experimental, based on Asher’s instinct and clinical experience.

A book Asher read at age 17, by Austrian neurologist and psychiatrist Viktor Frankl, who also was a Holocaust survivor, has been a guiding inspiration for the Cedars-Sinai program.

Asher holds up an old copy of the book he’s kept since he was a teenager, the pages dog-eared and the edges frayed. “Frankl noticed that the people who survived the Holocaust weren’t necessarily the strongest or the most physical. They had this capacity to say, ‘I’m going to endure this pain and endure this humiliation because I have to write my book or I have to tell my story or I have to go back to my art.’”

Asher says his greatest lesson from Frankl’s memoir was this: “Nobody can take away the last of the human freedoms — which is one’s ability to choose his or her attitude in any given set of circumstances.”

This is the premise of Asher’s work — helping people cope with the inevitable and often painful conclusion of their lives. There are certain things you can’t treat with medications, Asher explains bluntly.

“When people come to you with fear — and these aren’t psychologically abnormal fears — these are people with stage 4 cancer and they are facing their own mortality, there’s a deep sense of loss of control,” Asher says. “Because you have no control over what your next CT scan will show or your next tumor marker.”

Instead of relying solely on anxiety medications, Asher uses tools like meditation and mindfulness, looking at how to find gratitude as a way to regain perspective.

“We’re never trying to be Pollyannaish, like, ‘Thank goodness for cancer because now you’re not materialistic.’ Or, ‘Thank goodness for cancer because now you know who your friends are,’” Asher says. “That’s just crap. But to say, ‘Okay, cancer is here. We are making the best of our circumstances. Are there things that we could gain that you were not really focusing on before?’”

So far, 22 patients have participated in the program. By early November, the total will be 31. Asher is keeping the groups small so that everyone gets attention and all voices are heard.

“We are used to prescribing meds and ordering tests and having control. But human nature is unpredictable and these are perceivably cheesy, non-scientific topics that we are covering,” he says.

For that very reason, Asher wasn’t always so convinced the program would be a hit. It took him nearly five years just to present the idea to colleagues.

“These are people with advanced-stage illnesses and my worst fear was wasting someone’s time when they don’t have a lot of time,” he says.

Matthew Morgan, 51, recently completed the GRACE program with Asher. After being diagnosed with head and neck cancer at the end of 2012, Morgan, a former television producer for shows like “Saved By The Bell” and “California Dreams,” had surgery to remove a portion of his tongue where a tumor was found. Despite a successful surgery, the cancer metastasized to his lungs, which made him a stage 4 cancer patient.

“Cancer is such a big umbrella. It covers a lot of different illnesses, different symptoms, different treatments, different prognoses,” Morgan explained in a quiet corner of the expansive waiting room at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai. “But there’s [always] something existential about it that is frightening.”

Morgan has a little trouble speaking, but manages well considering his surgery, which involved partial reconstruction of his tongue. “Over time, you learn how to work with what you have,” he says. “I had no idea that the surgery was going to be as dramatic as it was.”

Morgan has been through surgery, radiation and chemotherapy, facing the unknown at every stage. As he spoke to HuffPost, he awaited new scans that would help show his prognosis. “I think it’s helpful to do more than just sit at home and scratch your head about it,” he says.

Morgan was an eager recruit when he first heard of the GRACE program in its nascent stage from Asher. He claims to have had no expectations, but was excited to participate.

GRACE is not a just a support group. It’s more than a venue for patients to share experiences with cancer. In fact, Asher asked GRACE patients if they would have participated if he had billed it as a support group. Almost no one said yes. “Most of these patients are tired of being in a situation where everyone is just kind of bitching,” he says.

The group discusses assigned poems and essays, watches “Seinfeld” clips to facilitate a conversation about humor, and learns meditation methods. With a lesson plan and structured discussion, the program is more college course than group therapy.

One of Asher’s favorite lessons is on legacy creation. He observes that people often have the idea that a legacy is something tangible to be handed down to children.

“But we really reframe it as, ‘What do you want to be known for?’ ‘What is your identity?’ Because if you know where you want to go, you can live your life now working towards those goals,” Asher says.

The GRACE program also is shorter than a support group — just five weeks. For some participants, that’s about all the time they have left.

“Several people who have done the class have already passed,” Asher says. “I think it gave them something to focus on and think about. It gave them a sense of control.”

Morgan says he identified most deeply with the concept that he can choose his response to his situation. “This can be a very powerful tool for dealing with something like cancer,” he says. “The notion that you’re not responsible for it, but you’re response-able to deal with it.”

The sense of ownership has larger implications for the larger conversation about cancer. When asked what he feels is missing from the national dialogue about cancer, Asher doesn’t hesitate. “The idea that it’s possible to heal even if you can’t be cured,” he says.

That feeling was echoed in a recent email from one of Asher’s patients who had reached the end of his treatment options. Asher was eager to share the note, albeit anonymously. It read:

“As someone expressed at our last class ‘we are as one.’ However anyone else responded to treatment, I responded differently. To hear ‘me too,’ from everyone in the group was unbelievably bonding.”

“So much of the focus tends to be on the cure. And our patients identify themselves with that: cured or not cured,” Asher says.

He recalls his original inspiration in Frankl, who was able to keep his full identity in mind, despite his circumstances in the concentration camp. This ability, Asher believes, allowed Frankl to persevere, cope — and find solace in others.

“For the first time in many years,” the dying patient concluded his email. “I did not feel alone.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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Proteomic analysis of oral/head and neck cancer

Fri, Oct 10, 2014


Author: Shen Hu, Lifeng Zhang, Jiang Jiang, Martha Arellano-Garcia, and David Wong

Abstract: The stagnant survival rates over the past few decades for patients with oral/head and neck squamous cell carcinoma (OSCC/HNSCC) emphasize the need for identifying novel diagnostic and therapeutic targets based on molecular profiling of the tumor. In this study, we have conducted patient-based proteomic analysis towards the discovery of potential serum and tissue protein targets associated with OSCC/HNSCC. First, we have utilized quantitative proteomics based on gel electrophoresis and stable isotope labeling/tandem mass spectrometry (MS/MS) to identify differentially expressed serum proteins between lymph-node metastatic and non-metastatic OSCCs. Proteins in PAGE gel bands were digested and the resulting peptides were labeled with iTRAQ reagents and subsequently quantified with liquid chromatography (LC) with quadrupole time-of-flight MS or linear ion trap MS (LTQ). The differentially expressed proteins included transthyretin, alpha-fibrinogen, tetranectin, hemopexin, ficolin, HGF activator, plasminogen, clusterin, etc. Second, we have performed comparative proteomic analysis of human papillomavirus (HPV)-positive and HPV-negative HNSCCs because HPV has been recognized as an important risk factor for a subset of OSCC/HNSCC. Differentially expressed proteins were revealed by 2-D gel electrophoresis and then identified using in-gel tryptic digestion followed by LC-MS/MS (linear ion trap). Interesting targets associated with HPV-positive HNSCC included NHEJ1, PARK7 (oncogene DJ-1), superoxide dismutase, heat shock protein beta-1, fatty acid-binding protein, etc. NHEJ1 is a DNA repair protein involved in DNA nonhomologous end joining whereas PARK7 acts as a positive regulator of androgen receptor-dependent transcription and has cell-growth promoting and transforming activities. In addition, we have profiled the E6- and E7-binding proteins within HPV-positive and HPV-negative HNSCC tissues using immunoprecipitation and LC-MS/MS. Apart from helping us to understand the molecular mechanism of the cancer diseases, these protein targets may also have potential clinical applications such as biomarkers if further validated.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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Early detection of head and neck cancer: development of a novel screening tool using multiplexed immunobead-based biomarker profiling

Fri, Oct 10, 2014



Authors: Faina Linkov, Alex Lisovich, Zoya Yurkovetsky, Adele Marrangoni, Lyudmila Velikokhatnaya, Brian Nolen, Matthew Winans, William Bigbee, Jill Siegfried, Anna Lokshin, and Robert Ferris

Abstract: Squamous cell carcinoma of the head and neck cancer (SCCHN) is an aggressive disease which has been linked to altered immune, inflammatory, and angiogenesis responses. A better understanding of these aberrant responses might improve early detection and prognosis of SCCHN and provide novel therapeutic targets. Previous studies examined the role of multiplexed serum biomarkers in small cohorts or SCCHN sera. We hypothesized that an expanded panel comprised of multiple cytokines, chemokines, growth factors, and other tumor markers, which individually may show some promising correlation with disease status, might provide higher diagnostic power if used in combination. Thus, we evaluated a novel multi-analyte LabMAP profiling technology that allows simultaneous measurement of multiple serum biomarkers. Concentrations of 60 cytokines, growth factors, and tumor antigens were measured in the sera of 116 SCCHN patients prior to treatment (active disease group), 103 patients who were successfully treated (no evidence of disease, NED, group), and 117 smoker controls without evidence of cancer. The multi-marker panel offering the highest diagnostic power was comprised of 25 biomarkers, including EGF, EGFR, IL-8, tPAI-1, AFP, MMP-2, MMP-3, IFN-α, IFN-γ, IP-10, RANTES, MIP-1α, IL-7, IL-17, IL-1Rα, IL-2R, G-CSF, mesothelin, IGFBP-1, E-selectin, cytokeratin (CK)19, V-CAM, and CA-125. Statistical analysis using an ADE algorithm resulted in a sensitivity of 84.5%, specificity of 98%, and 92% of patients in the active disease group correctly classified from a cross-validation serum set. The data presented show that simultaneous testing using a multiplexed panel of serum biomarkers may present a promising new approach for the early detection of head and neck cancer.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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Alcohol drinking in never-tobacco users and cigarette smoking in never drinkers: pooled analysis in the International Head and Neck Cancer Epidemiology (INHANCE) consortium

Fri, Oct 10, 2014


Authors: Paolo Boffetta, Mia Hasibe & On Behalf Of INHANCE Consortium

Abstract: Cigarette smoking and alcohol drinking account for at least 75% of head and neck cancers. A precise understanding of the independent effect of each of these factors in the absence of the other has important implications, in terms of elucidating the mechanisms of head and neck carcinogenesis and assessing the effect of interventions aimed to control either risk factor.We determined the extent to which head and neck cancer is associated with cigarette smoking among never-drinkers and alcohol drinking among never-tobacco users. We pooled individual-level data across 15 individual case-control studies including 10,244 head and neck cancer cases and 15,227 controls.There were 1,072 cases and 5,775 controls who never used tobacco, and 1,598 cases and 4,051 controls who never drank alcohol. Cigarette smoking increased the risk of head and neck cancers [odds ratio (OR)=2.10, 95% confidence interval (CI) 1.49-2.95] among never-drinkers, with clear dose-response relationships for frequency, duration and packyears of cigarette smoking. Approximately 24% of head and neck cancer cases among non-drinkers would have been prevented if these individuals had not smoked cigarettes. Among never-tobacco users, an increasing risk of head and neck cancer was detected for increasing alcohol drinking frequency (p for trend<0.001), but the effect was apparent only at high doses.Our results represent the most precise estimate available of the independent effect of each of the two main risk factors of head and neck cancer and exemplify the strengths of large-scale consortia in cancer epidemiology. 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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E-cigarette laws may be harder to regulate than originally thought

Tue, Oct 7, 2014


Source: or
Author: Summer Ballentine & Michael Felberbaum

JEFFERSON CITY, Mo. (AP) – In a rush to keep electronic cigarettes out of children’s hands while the federal government creeps forward with a proposed national ban for minors, experts say that many states are passing laws that could mean fewer restrictions on the nicotine devices later.

Lawmakers last month made Missouri the 41st state to outlaw selling e-cigarettes to minors. Age restrictions have wide support, but Gov. Jay Nixon and public health advocates opposed a piece of the legislation that prevents tobacco taxes or regulations from being imposed on the electronic devices, which heat liquid nicotine into an inhalable vapor.

E-cigarette makers have been in a tug-of-war with state and federal governments since the battery-powered devices first were sold in the U.S. in 2007.

A 2009 law gave the U.S. Food and Drug Administration the power to regulate a number of aspects of tobacco marketing and manufacturing. It first said it planned to assert authority over e-cigarettes in 2011, but it hasn’t yet done so.

In April, the FDA for the first time proposed a set of regulations for e-cigarettes, including banning sales to minors and requiring health warning labels, as well as approving new products. The agency has said its proposal sets a foundation for regulating the products but the rules wouldn’t immediately ban the wide array of flavors of e-cigarettes or curb marketing on places like TV.

In the absence of regulation, members of Congress, state leaders and public health groups have raised concerns over e-cigarettes and questioned their marketing tactics. An FDA official said the agency has similar concerns and acknowledged that it has taken the agency too long to act.

“Part of what is driving those elected officials are public health concerns that we share about any aspect of the marketing of this emerging technology that is appealing to kids,” Mitch Zeller, director of the FDA’s Center for Tobacco Products, said in a recent interview with The Associated Press at the agency’s sprawling campus in suburban Maryland. “It took us too long to get the proposed rule out and we don’t intend a repeat of that as we go from proposed to final.”

Zeller did not give a timeline for when the final regulations would be in place, but has said any rules will have to be grounded in scientific evidence.

Scientists haven’t finished much research on e-cigarettes, and the studies that have been done have been inconclusive. The government is pouring millions into research to supplement independent and company studies on the health risks of e-cigarettes and other tobacco products – as well as who uses them and why.

Most lawmakers, as well as e-cigarette manufacturers, agree that they don’t belong in children’s hands. Yet as states enact age restrictions, experts say lawmakers could also be making it more difficult to regulate and tax e-cigarettes down the road if the FDA determines they’re unhealthy.

Of the states that have banned e-cigarette sales to minors, 31 have specified that e-cigarettes are “alternative nicotine” or vapor devices, not traditional tobacco cigarettes, according to the National Conference of State Legislatures.

Some lawmakers say these definitions would prevent e-cigarettes from later being treated as a tobacco product, but others disagree. Missouri’s law apparently is the first to explicitly state that e-cigarettes can’t be regulated or taxed as a tobacco product, said Michael Eriksen, dean of the School of Public Health at Georgia State University.

Regulations that currently apply to tobacco would restrict where the electronic cigarettes can be used, and how and where they can be advertised, among other things. Such regulations also would likely end the use of candy-flavored nicotine solutions, Eriksen said.

Laws skirting those restrictions have the blessing of e-cigarette companies, which contend that the devices aren’t the same as regular paper-and-tobacco cigarettes and don’t pose the same public health risks, so taxing and regulating them the same way doesn’t make sense.

Just six states classify e-cigarettes as a tobacco product, the NCSL reports. Only two states, Minnesota and North Carolina, have approved taxes on e-cigarettes, while three others, Michigan, Ohio and New York, are considering it.

Instead of adding e-cigarettes to existing tobacco laws that ban smoking indoors or tax the products, lawmakers in Missouri and possibly other states will have to create new tax structures and write regulations from scratch, said Mark Gottlieb, executive director of the Public Health Advocacy Institute at Northeastern University School of Law in Boston.

It’s a lot of work, he said, and unlikely to happen.

“In practice,” Gottlieb said, “this can hamstring the state and what it can do.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
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Number of immune cells in tumors could soon help predict and treat cancers

Fri, Sep 26, 2014


Authors: Emma King, University of Southampton and Christian Ottensmeier, University of Southampton

Immune cells in the blood primarily defend us against infection. But we’re now learning that these cells can also keep us free from cancer. Patients with less efficient immune systems such as organ transplant recipients or those with untreated HIV, for example, are more susceptible to cancers. It is also becoming increasingly apparent that we can use immune cells to predict survival in people who do develop cancer. And that, in fact, there are immune cells within cancers.

Head and neck cancer underway

Head and neck cancer underway

The number of immune cells inside a tumor can hugely vary: some patients have vast numbers while some have very few. In a recent study, we showed that in head and neck cancers, the survival of a patient depends on how many immune cells are within the tumor. This could be a valuable way of individualizing cancer treatments.

Patients with lots of immune cells, for example, could be offered less toxic cancer treatment while those with few immune cells may need more aggressive treatment to improve their chances of survival.

Not all immune cells within the tumor are able to “attack” the cancer. By looking at specific cell markers – proteins on the cell exterior that allow us to see whether, for example, cells are exhausted – we can determine which individual immune cells in the tumor will be effective in tackling the cancer, or if they are exhausted and not able to perform any useful function. It’s possible that these exhausted cells could be reinvigorated to become useful again with targeted immunotherapy treatments currently in development.

These include vaccines, so if a cancer has been caused by a virus, we can vaccinate the patient with a short segment of the same virus to encourage the immune system to react to it. Around 30% of head and neck cancers, for example, are the result of human papillomavirus (HPV). There has been a 225% increase in these types of cancers over the past 15-20 years and in the US, HPV will cause more of these cancers than cervical ones. In these cases, cancer cells continue to express part of the HPV on their surface. The hope is that following vaccination, immune cells will be better able to identify these HPV cancer cells and kill them.

For people who simply don’t have many immune cells in tumors, specific, targeted immunotherapy could be one option. But also broader “brush stroke” treatments. These broader treatments cover all immunotherapies that encourage a patient’s immune system in a fairly non-specific way. Our immune cells are normally very tightly regulated and include many fail-safe systems to prevent them from over-reacting primarily to infections. General immunotherapy takes the brakes off and allows the immune cells to react to the cancer cells.

It may be that a combination of specific vaccine and non-specific immune treatments could be enough in combination to tip the balance in favor of the patient’s immune system so that it is able to overcome the cancer.

We’re going to further investigate how immune cells might help us to fight cancer and two head and neck cancer immunotherapy trials are due to start at the University of Southampton in the next six months.

One of these trials will look at a HPV cancer vaccine, while the other will investigate a non-specific immunotherapy molecule for those 70% of patients that develop head and neck cancer independent of HPV. Our hope is that within five years the results of these trials could influence the way we treat cancers.The Conversation

Note: This article was originally published on The Conversation.

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E-Cigarettes fail to help cancer patients quit smoking

Wed, Sep 24, 2014


Author: Anna Azvolinsky, PhD

Among cancer patients who smoke, electronic cigarette (e-cigarette) users had greater nicotine dependence compared with traditional cigarette smokers, and e-cigarettes did not help patients quit smoking, according to the results of a study published in Cancer.


E-cigarettes have been touted as possible tools for smoking cessation.

According to the study authors, these are the first published results on e-cigarette use and smoking cessation among cancer patients and put into question the potential benefits of using e-cigarettes as part of a smoking cessation program for cancer patients.

Those diagnosed with cancer who continue to smoke are advised to quit. The uptick in the use of e-cigarettes has raised the question of whether these newer types of cigarettes can facilitate or hamper the ability to quit smoking for good.

In the new study, Jamie Ostroff, PhD, of the Memorial Sloan Kettering Cancer Center in New York, examined 1,074 cancer patients who smoked and were enrolled in a tobacco treatment program between 2012 and 2013 at the cancer center.

Using a complete case analysis, e-cigarette users were equally likely to still smoke as those who did not use e-cigarettes (odds ratio of 1). Using an intention-to-treat analysis, e-cigarette users were twice as likely to be smoking at the time of follow-up (odds ratio = 2, P < .01).

The 7-day abstinence from smoking was 44.4% for e-cigarette users compared with 43.1% for non-users.

Patients who were e-cigarette users at study enrollment were likely to be more nicotine-dependent and had more prior attempts at quitting smoking compared to traditional cigarette smokers. E-cigarette users were also more likely to be diagnosed with lung cancer or cancers of the head and neck.

The researchers observed a threefold increase in e-cigarette use, from 10.6% to 38.5% from 2012 and 2013. “Consistent with recent observations of increased e-cigarette use in the general population, our findings illustrate that e-cigarette use among tobacco-dependent cancer patients has increased within the past 2 years,” said Ostroff in a statement.

Follow-up data on cessation was available from 59.5% of the patients on study. Moreover, a significantly higher percentage of e-cigarette users quit the tobacco treatment program or were lost to follow-up compared to those who did not use e-cigarettes (66.3% vs 32.4%, P < .01).

Fifty-seven percent of the patients on study were female, mean age was 56 years, and 69.2% of the patients had tried to quit smoking at least twice prior to enrolling in this study. About one-third of the patients reported a high dependence on nicotine. The highest percentage of patients had thoracic cancer (19.8%), 14.9% had breast cancer, 9.7% had head and neck cancer, and 8% had genitourinary cancer.

First introduced in the United States in 2007, e-cigarettes are battery powered cigarette-like devices that mimic the same sensory experience as traditional cigarettes and provide nicotine for the user.

Still, further studies of broader geographic cohorts and controlled study conditions, are needed. The current study relied on patient responses to assess cessation and was only conducted at a single cancer center.

Controlled research is needed to evaluate the potential harms and benefits of e-cigarettes as a potential cessation approach for cancer patients. In the meantime, said Ostroff, oncologists should advise all smokers to quit smoking traditional combustible cigarettes, encourage patients to use US Food and Drug Administration (FDA)-approved cessation medications, refer patients for smoking cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.

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Baseball, youth, and smokeless tobacco

Wed, Sep 24, 2014


Authors: Richard Pieters, M.D. & Anthony Giambardino, D.M.D.

The headlines first came with baseball Hall of Famer Tony Gwynn. His all-too-early death at 54 was attributed to the long-term use of smokeless tobacco. Now it’s former Red Sox pitcher Curt Schilling, who revealed on Aug. 20 that he was diagnosed in February with mouth cancer. “I do believe without a doubt, unquestionably,” said Schilling when making his condition public, “that chewing [tobacco] is what gave me cancer … I did it for 30 years. It was an addictive habit.” His physician agreed.

Many of us who grew up with the game are used to seeing players chewing tobacco, but a new generation of children watching in the stands and on television may be seeing smokeless tobacco used for the first time. They are the ones most influenced by what baseball players do both on and off the field. And that behavior by professional athletes can be more powerful in shaping behavior than any advertising campaign by the tobacco industry.

Although cigarette smoking in the U.S. continues to decline, a report from the U.S. Centers for Disease Control and Prevention (CDC) indicates that the use of smokeless tobacco has held steady over the past nine years. CDC says 14.7% of high-school boys, and 8.8% of all high-school students, reported using smokeless products in 2013.

The CDC further states that smokeless tobacco contains 28 carcinogens, which can cause gum disease, stained teeth and tongue, a dulled sense of taste and smell, slow healing after a tooth extraction, and, worst of all, oral cancer.

Smokeless tobacco is not harmless. According to the National Institute on Drug Abuse, it delivers more nicotine than cigarettes and stays in the bloodstream longer. Clearly, tobacco use is both a serious medical problem and an oral-health problem.

In a letter to baseball commissioner Bud Selig following the death of Tony Gwynn, nine leading healthcare organizations, including the American Medical Assoc. and the American Dental Assoc., stated that “use of smokeless tobacco endangers the health of major-league ballplayers. It also sets a terrible example for the millions of young people who watch baseball at the ballpark or on TV and often see players and managers using tobacco.”

Oral cancer continues to be a serious problem in the U.S. More than 30,000 new cases are diagnosed each year, and the five-year survival rate is only around 50%. While a batting average of .500 would be considered outstanding in baseball, 50/50 odds aren’t very good in the game of life.

The connection between oral health and overall health is well-documented. What happens in the mouth can affect the entire body. Physicians are now being trained to examine the mouth and work with dentists to make patients more aware of the importance of oral health as it affects their overall health and well-being.

Programs such as the Mass. Dental Society’s Connect the Dots, in which physicians and dentists work together in the community, and the Mass. Medical Society’s establishment of a Committee on Oral Health mark the beginning of a growing relationship between physicians and dentists to promote oral health in the Commonwealth.

But oral cancer isn’t the only health risk from smokeless tobacco. Users have an increased risk of heart disease, high blood pressure, heart attacks, and strokes. Many health issues are preventable, especially those related to tobacco use. The medical and dental professions can play a key role by providing education and screening for oral cancer.

Major-league baseball players have an important opportunity to contribute to this educational process by aiding in prevention efforts, particularly aimed at impressionable young people. For the past four years, the Mass. Dental Society, in partnership with NESN and the Boston Red Sox, has produced TV campaigns on the dangers of smokeless tobacco.

The Mass. Medical Society and the Mass. Dental Society are committed to reducing tobacco use in all its forms and welcome the continued participation of the Red Sox and all of major-league baseball. In 2014, chewing tobacco continues to be as much a symbol of baseball as the actual action on the field.

For the health of our children, shouldn’t this image of our national pastime now be considered past its time? The cases of Tony Gwynn and Curt Schilling should serve as a warning to us all.

Dr. Richard Pieters, a radiation oncologist at UMass Memorial Medical Center in Worcester, is president of the Mass. Medical Society. Dr. Anthony Giamberardino practices general dentistry in Medford and is president of the Mass. Dental Society.

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Medical Grade Honey Found Not Effective in Radiation Esophagitis

Mon, Sep 22, 2014


Author: Pam Harrison

SAN FRANCISCO ― A medical grade honey from New Zealand (Manuka), which is known to be effective in wound healing, does not reduce pain from radiation esophagitis more effectively than standard supportive care, phase 2 research shows.

“Reducing esophagitis is important so that patients can continue eating their normal diet,” Lawrence Berk, MD, chief of radiation oncology, Morsani School of Medicine, University of South Florida, Tampa, told Medscape Medicine News.

“And since there is no proven treatment for the prevention of esophagitis during concurrent chemotherapy and radiation therapy, we decided to try honey, because of the reported success in head and neck mucositis in several small studies.

“And neither liquid honey nor honey lozenges worked better than standard supportive care in reducing pain from esophagitis, so I would not encourage patients to take Manuka honey, because it didn’t work and it’s expensive.”

The study was presented at the annual meeting of the American Society of Radiation Oncology, held in San Francisco, California.

Investigators included 163 lung cancer patients who were undergoing concurrent chemotherapy and radiation therapy. Approximately 30% of patients had received 60 Gy of radiation to the esophagus.

Patients were randomly assigned to 1 of 3 treatment arms: 56 patients received standard supportive care; 53 patients received 10 mL of Manuka honey orally, 4 times a day; and 54 patients received 1 lozenge consisting of 10 mL of dehydrated Manuka honey, 4 times per day.

The honey was taken on the first day of treatment and continued to be taken throughout the course of radiation therapy.

After 4 weeks of treatment, patients were asked to assess pain during swallowing using the Numerical Pain Rating Scale (NPRS) scale. Zero on the NPRS scale indicates no pain, 5 indicates moderate pain, and 10 indicates worst possible pain.

No patients in the standard supportive care arm developed grade 3 or higher adverse events (AEs) related to the treatment protocol, whereas 11 patients in the liquid honey arm did, as did 2 patients in the honey lozenges group.

At the end of 4 weeks of radiation therapy, the mean change in the NPRS score was 2.7 in the standard supportive care group vs 2.1 for both groups who took either the liquid or lozenge form of Manuka honey, a difference that was not statistically significant.

There was also no difference between the 3 groups in secondary endpoints, including trend of pain over time, opioid use, AEs, weight loss, or quality-of-life measurements.

Previous Studies With Local Honey

The previous studies showing that honey decreased head and neck mucositis were small, randomized trials carried out in Malaysia, Egypt, Nepal, and Iran, and they all used locally produced honey, Dr Berk noted.

However, another study (Support Care Cancer. 2014;22:751-61) conducted in Canada, which used Manuka honey, found no significant impact on the severity of radiation-induced mucositis in head and neck cancer patients. Furthermore, patients did not tolerate the honey well.

A British study (Br J Oral Maxillofac Surg. 2012;50:221-6) again found that Manuka honey did not improve mucositis in head and neck cancer patients, although the reserachers noted that it did seem to be associated with a reduction in bacterial infections.

“Studies with natural products are difficult to do because compounds vary from batch to batch, and the honey will depend on what flowers the bees pollinated,” Dr. Berk said.

“The reason we chose Manuka honey is that it is widely available and it’s a well-studied, well-quantified honey, and it’s pretty much the only honey there that is well defined.

“But it’s pretty clear from 3 studies now that Manuka honey has no effect, and currently, there are no proven methods of preventing radiation esophagitis except minimizing the dose of radiation, which we frequently have to do,” he said.

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


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