1/14/2006 New York, NY Jane E. Brody New York Times (nytimes.com) Patients with debilitating pain from chronic illness, accidents, surgery or advanced cancer have long had problems getting adequate medication to control their pain and make life worth living. Now the federal government, and especially the Drug Enforcement Administration, is working overtime to make it even harder for doctors to manage serious pain, including that of dying patients trying to exit this world gracefully. In an article in the current New England Journal of Medicine titled "The Big Chill: Inserting the D.E.A. into End-of-Life Care," two specialists in palliative care, Dr. Timothy E. Quill and Dr. Diane E. Meier, state that despite some physicians' commitment to treat pain and despite the effectiveness of opioid drugs like OxyContin and morphine, "abundant evidence suggests that patients' fears of undertreatment of distressing symptoms are justified." They continue, "Although a lack of proper training and overblown fears of addiction contribute to such undertreatment, physicians' fears of regulatory oversight and disciplinary action remain a central stumbling block." Obstacles to Relief In addition to a case before the United States Supreme Court, Gonzales v. Oregon, that threatens to undermine Oregon's Death With Dignity Act, the D.E.A. has recently increased raids on doctors' offices, confiscating files and arresting doctors on charges of overprescribing narcotics to patients who are addicts or drug dealers. Most of these physicians are compassionate people trying to help suffering patients but are sometimes fooled by clever addicts, drug dealers or undercover agents who [...]

1/13/2006 Ann Arbor, MI Alexandra King Nature Clinical Practice Oncology (2006) 3, 7 Researchers at the University of Michigan have published the first prospective study to compare quality of life (QOL) and xerostomia in patients with head-and-neck cancer receiving standard radiotherapy with those receiving salivary-gland-sparing intensity-modulated radiotherapy (IMRT). Between 1997 and 2002, 10 patients receiving standard radiotherapy were enrolled into this longitudinal case–control study; each was matched with a subgroup of IMRT patients (2–5 IMRT patients per group, median 3; n = 30). Patients were matched for tumor characteristics, radiotherapy status, and age. Xerostomia-specific questionnaires (XQ) and questionnaires specific to head-and-neck cancer QOL (HNQOL) were completed by patients before therapy and at regular intervals after completion of treatment. These questionnaires were designed to assess oral dryness and eating, communication, emotion, and pain, respectively. During the initial months after therapy, questionnaire scores in both treatment groups worsened significantly compared with pretreatment scores. After 6 months, however, patients receiving IMRT showed significant improvement over time in XQ and HNQOL scores (P = 0.01 and P = 0.04, respectively). The improvement was most marked for HNQOL, particularly in the scores for pain and emotion. There was no trend toward improvement over time in those receiving standard radiotherapy. At 12 months' follow-up, the post-therapy scores in both groups were significantly correlated with pretreatment scores (XQ, P = 0.02 and HNQOL, P <0.01). The authors conclude that IMRT results in better post-treatment QOL and reduced xerostomia when compared with standard radiotherapy, but that these benefits [...]

1/13/2006 Great Britain staff Medical News Today (www.medicalnewstoday.com) Doctors can learn how to help tackle the growing problem of mouth cancer thanks to a new course delivered free by onmedica.net, the educational website for GPs. The course, developed with Cancer Research UK, is designed to help doctors identify signs and symptoms of mouth cancer and discover more about risk factors, prevention and detection of the disease and its treatment. Cancer Research UK's Open Up to Mouth Cancer campaign was launched in November last year. And resulting feedback from GPs showed there was a need to encourage greater awareness of mouth cancer within primary care - as the disease that is now more common in the UK than both cervical and testicular cancer together. Cases of mouth cancer have risen by a quarter over the last 10 years - from 3411 in 1992 to 4285 in 2001. In 2003 mouth cancer resulted in almost 1600 deaths. Cancer Research UK's campaign focuses on detection and awareness of signs and symptoms. Known risk factors for the disease are smoking, alcohol and chewing tobacco or betel nut. Smoking and drinking are together estimated to cause more than 75 per cent of mouth cancer cases in developed countries. The new free online course on onmedica.net covers different types of mouth cancer which include cancers of the tongue, gums, tonsils, lining of the mouth, lips, oropharynx and hypopharynx. There are sections, each with question and answer sub-sections, on incidence and survival, risk factors, signs and symptoms, [...]

1/13/2006 England staff EurekAlert (www.eurekalert.org) Many radiotherapy departments in UK hospitals are heavily overstretched, resulting in long waits for cancer patients which may be jeopardising treatment, says a paper in this week's BMJ. Radiotherapy treatment can be as successful at tackling some cancers as radical surgery, and often has the advantage of organ preservation. But waiting lists are severe in many radiotherapy departments, and although radiotherapy services in the UK offer high quality treatment, say the authors, they are often less able to cope with the volume of patients needing radiotherapy than other developed countries, and indeed many poorer countries. For patients with a realistic chance of beating cancer, studies show that delaying treatment hampers doctors' ability to tackle the disease, report the authors. With cervical cancer, for instance, a longer waiting time for radiotherapy reduces the chance of the patient's survival. And for head and neck cancer, patients waiting more than six weeks for post-operative radiotherapy are three times as likely to have the cancer recur. For breast cancer, patients are at a 60% increased risk of the disease returning if the delay between surgery and radiotherapy goes beyond eight weeks. Despite considerable investment in radiotherapy equipment in recent years, a shortage of specialist staff - radiographers, physicists, and dosimetrists (specialists in radiation dosage) - means that hospitals cannot cope with the rising demand for radiotherapy treatment. More training places are being created, but that does nothing to remedy current staff shortages. Many hospitals have already done all they [...]

1/11/2006 Bethesda, MD staff CancerConsultants (patient.cancerconsultants.com) In a study published in the journal Cancer, oral mucositis developed in over 80% of patients undergoing radiation therapy for head and neck cancer. Patients who developed oral mucositis were more likely to have unplanned breaks in radiation therapy and were also more likely to be hospitalized. Approximately 40,000 people in the U.S. are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancer affecting the nasal cavity, sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. The American Cancer Society estimates that 11,000 people will die from head and neck cancer in 2005. Oral mucositis refers to inflammation of the oral mucosa (lining of the mouth) that results from chemotherapy or radiation therapy. Symptoms may include redness, swelling, and ulceration. When oral mucositis is severe, patients cannot swallow food or liquid and often have to be given nutrients through a vein. In addition, oral mucositis can cause severe pain, increase the risk of infection, and may limit a patient’s ability to tolerate further treatment. Oral mucositis is known to be a common side-effect of radiation therapy for head and neck cancer, but relatively little is known about factors that increase or decrease the risk of developing oral mucositis. In order to explore the frequency, predictors, and consequences of oral mucositis in patients with head and neck cancer, researchers conducted a study among 450 head and neck cancer patients who had [...]

1/11/2006 London, England press release PR Newswire (www.prnewswire.com) New technological advances in diagnostic imaging have resulted in a highly sophisticated technique called fusion imaging that uses special software to combine both anatomical and functional images. This novel technique provides previously unattainable levels of precision in detecting numerous conditions such as tumours, Alzheimer's disease and neural disorders. "Hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT (SPECT/CT) are revolutionising the field of diagnostic imaging," notes Technical Insights (http://technicalinsights.frost.com) Research Analyst Preethi Vaidyanathan. "Several PET/CT devices with different features have already been introduced and are available commercially." Combined PET/CT delivers better results than PET or CT, because it offers more accurate localisation of flurodeoxyglucose (FDG) uptake, distinguishes pathological from physical uptake and enables improved monitoring treatment. Other significant advantages of PET/CT imaging include better diagnostic accuracy, treatment planning and response evaluation as well as enhanced guided biopsy methods. This imaging modality is particularly useful for new indications and applications that cannot be satisfactorily performed with individual PET or CT and retrospective image alignment. Combined SPECT with high-powered CT scanners are finding application in multiple new research and clinical arenas such as in vivo small animal studies and CT angiography in the emergency department. Researchers are already investigating several new tracers specifically to target cancers of the brain, thyroid, prostate, breast, lung, ovaries, kidneys, and liver as well as diseases of the heart and bones. "By combining high-speed CT scanners with SPECT's highly accurate definition of [...]

1/11/2006 India staff MedIndia.com Oral and pharyngeal cancers are by far the leading cancers in the world today. The problem is that these are not discovered until too late and thus the treatment, which includes radiation and surgery, involves sacrificing a large amount of tissue leading to disfigurement. Now two Virginia Tech researchers are collaborating with the American Dental Association (ADA) to build "a tissue engineered composite material for oral reconstruction." Brian Love, Virginia Tech professor of materials science and engineering, and principal investigator in this project stresses that they could provide "substantially better clinical outcomes for all oral constructions could result if a more viable scaffold material were used that was capable of faster and higher quality bone formation." His team is monitoring how amorphous calcium phosphates (ACPs) can play a role in the rebuilding of the lost tissue. "By constructing tissue engineered composites containing ACPs, living osteoblasts, and donor materials," Love said. The Paffenbarger Research Center of the ADA is providing the ACP required for this study. Aaron Goldstein of Virginia Tech's chemical engineering department, Drago Skrtic of the ADA Paffenbarger Research Center and Peter Shires of Virginia-Maryland Regional College of Veterinary Medicine are collaborating with Love in this particular venture. The details of this study are appearing in the forthcoming issues of the Journal of Biomaterials Science, Polymers Edition, and the Journal of Biomedical Materials Research. Contact: Lynn Nystrom [email protected] 540-231-4371 Virginia Tech

1/11/2006 Gaylord, MI Mary Jergenson Gaylord Herald Times (www.gaylordheraldtimes.com) Having a dental exam every six months is not just a good idea, it can save your life, according the Dr. Margo Forsyth of Forsyth Family Dentistry in Gaylord. Dentists are able to diagnose more than gingivitis and tooth decay when they look into your mouth because periodontal disease may be an indicator of hormonal changes, diabetes, cardiovascular problems and even cancer. “When we see bleeding gums, we look for an underlying cause, such as a change of habits, or medications,” Forsyth explained. “A hormone change such as puberty, pregnancy or menopause can cause gums to bleed.” Conditions such as bulimia, acid reflux and meth amphetamine use cause breakdown in tooth enamel leading to tooth decay. Another leading cause of decay is regular pop consumption. “Mountain Dew is the worst, but all soft drinks can lead to tooth decay,” Forsyth said. Certain conditions such as sore throats, mononucleosis, and even HIV have certain telltale symptoms which can be discovered during an oral exam, according to Forsyth, who noted the presence of white or red spots (lesions) on the tongue, lip or gum, or a cold sore that won't heal often indicate a more serious health condition. “During a routine check-up I noticed a small white lesion on the throat of a patient who I knew to be a smoker. We immediately sent him to his doctor for a biopsy,” related Forsyth. Though, in this case the biopsy showed no sign of [...]

1/10/2006 Tasmania, Australia Linda Smith The Mercury News (www.themercury.news.com.au) A few months ago, Ron Fazackerley had a gaping hole under his chin as a result of tongue and mouth cancer. But using a new microscope -- which helps connect tiny blood vessels half a millimetre in diameter -- doctors at the Royal Hobart Hospital were able to rebuild Mr Fazackerley's face and give him a chance at a normal life. Mr Fazackerley, who is now recovering well from surgery he underwent in November, was the first elective patient to be treated using the $152,000 machine. The 57-year-old smoker was diagnosed with a large, inoperable tongue cancer in 1999 and although radiotherapy killed the cancer, complications led to part of his chin becoming dead and infected. A hole then formed in the bottom of his chin. Using skin from his leg, part of his fibula bone and some chunks of his tissue, doctors rebuilt Mr Fazackerley's face in a 10-hour operation, re-attaching the blood vessels and tissue using the delicate microscope. Associate Prof Frank Kimble, who undertook the plastic microsurgery, said without such surgery a large section of Mr Fazackerley's jawbone would have had to be cut out of his face leaving him severely deformed. The machine is also used in trauma cases to repair small vessels and nerves which wouldn't be able to be repaired with the naked eye and to move large blocks of tissue from one part of the body to another Associate Prof Kimble said the microscope, [...]

1/10/2006 New Haven, CT Paul M. Weinberger et al. Journal of Clinical Oncology, 10.1200/JCO.2004.00.3335 Purpose: We sought to determine the prevalence of biologically relevant human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OSCC). Retinoblastoma (Rb) downregulation by HPV E7 results in p16 upregulation. We hypothesized that p16 overexpression in OSCC defines HPV-induced tumors with favorable prognosis. Methods: Using real-time polymerase chain reaction for HPV16, we determined HPV16 viral load in a cohort of 79 OSCCs annotated with long-term patient follow-up. A tissue microarray including these cases was also analyzed for p53, p16, and Rb utilizing in situ quantitative protein expression analysis. Seventy-seven tumors were classified into a three-class model on the basis of p16 expression and HPV-DNA presence: class I, HPV-, p16 low; class II, HPV+, p16 low; and class III, HPV+, p16 high. Results: Sixty-one percent of OSCCs were HPV16+; HPV status alone was of no prognostic value for local recurrence and was barely significant for survival times. Overall survival was improved in class III (79%) compared with the other two classes (20% and 18%; P = .0095). Disease-free survival for the same class was 75% versus 15% and 13% (P = .0025). The 5-year local recurrence was 14% in class III versus 45% and 74% (P = .03). Only patients in class III had significantly lower p53 and Rb expression (P = .017 and .001, respectively). Multivariable survival analysis confirmed the prognostic value of the three-class model. Conclusion: Using this system for classification, we define the molecular profile [...]