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Refeeding syndrome – awareness, prevention and management

Source: Head &Neck Oncology 2009, 1:4 Authors: Hisham M Mehanna, Paul C Nankivell, Jamil Moledina and Jane Travis Refeeding syndrome is an important, yet commonly overlooked condition affecting patients. It occurs when feeding is commenced after a period of starvation. Head and neck cancer patients are at particular risk owing to prolonged periods of poor nutritional intake. This may be from general effects such as cancer anorexia or from more specific problems of dysphagia associated with this group of patients. Awareness of the condition is crucial in identifying patients at risk and taking measures to prevent its occurrence. Objectives: The aims of this review are to: 1) Highlight the condition and stress the importance of its consideration when admitting head and neck cancer patients. 2) Discuss the pathophysiology behind refeeding syndrome. 3) Review the literature for the best available evidence and guidelines. 4) Highlight the need for further high quality research. Conclusion: Refeeding syndrome is potentially fatal, yet is preventable. Awareness and identification of at-risk patients is crucial to improving management. Refeeding syndrome is caused by rapid refeeding after a period of under-nutrition, characterised by hypophosphataemia, electrolyte shifts and has metabolic and clinical complications. High risk patients include the chronically under-nourished and those with little intake for greater than 10 days. Patients with dysphagia are at particular risk. Refeeding should commence at 10kcal/kg per day in patients at risk, and increased slowly. Thiamine, vitamin B complex and multi-vitamin supplements should be started with refeeding. New NICE guidelines state that pre-feeding [...]

Perceptronix sponsors UBC dentistry research day

Source: www.earthtimes.org Author: press release Perceptronix is proud to be a silver sponsor for the 2009 UBC Dentistry Research Day on January 27 with its focus on early detection of oral cancer. This event closely parallels the company's agenda in promoting early cancer diagnosis for better patient outcomes. Perceptronix will be showcasing and demonstrating the use of OralAdvance(TM), a new quantitative cytology test for the early detection of oral cancer. With recent advances in visualization techniques for the oral cavity, dentists are encountering more suspicious lesions. OralAdvance(TM), with its soft cyto-brush sample collection kit, provides dentists with an informative new option for assessing these lesions when biopsy is not warranted or possible. It provides an objective measure of gross DNA abnormality that can give important information about the pre-malignant or malignant nature of a lesion. About Perceptronix Medical Inc. Perceptronix Medical Inc. (Vancouver, Canada) is a private laboratory and cancer diagnostics company specializing in the provision of innovative early cancer detection tests based on quantitative cytology. The Company's DNA image cytometry technology was developed in partnership with the British Columbia Cancer Agency (Vancouver, Canada). Quantitative cytology provides physicians with an innovative cytopathology assessment based on an objective measure of large-scale DNA abnormality that can indicate precancerous or cancerous changes. The company has developed proprietary tests for the early detection of lung cancer and oral cancer using its DNA cytometry technology and offers quantitative cytology analysis of various tissues.

HPV testing followed by cytology and repeat HPV testing may improve cervical cancer screening

Source: JNCI Journal of the National Cancer Institute 2009 101(2):69 Author: staff The use of human papillomavirus (HPV) DNA testing as an initial screening step followed by triage with a standard Pap test (cytology) and repeat HPV DNA testing may increase the accuracy of cervical cancer screening, according to a study in the Jan. 13 online issue of the Journal of the National Cancer Institute. Compared to cytology alone, the screening strategy improved detection of precancerous growths without a substantial increase in the number of false-positive tests. Randomized trials have shown that using DNA testing for HPV—which is known to cause cervical cancer—in screening programs would increase detection of cervical intraepithelial neoplasia (CIN) compared with cytology. However, HPV DNA testing also results in a substantial increase in false-positive tests, which lead to unnecessary and costly retesting. In the current study, Joakim Dillner, M.D. of Lund University in Malmö, Sweden, and colleagues compared the efficacy of 11 different screening strategies that used HPV DNA testing, cytology, or a combination of the two. To evaluate the different strategies the investigators retrospectively analyzed data from 6,257 women who were enrolled in the intervention arm of a large randomized screening trial, called Swedescreen, in which HPV DNA testing was used in addition to standard cytology. As seen in previous trials, the use of HPV DNA testing in conjunction with cytology increased the screening efficacy, detecting 35 percent more cases of CIN grade 3 or worse, compared with cytology alone. The strategy, however, doubled the [...]

Noted Hopkins scientist says research indicates need for effective HPV vaccine for women and men and a simple HPV screening test

Source: www.hopkinskimmelcancercenter.org/news Author: press release A call to explore a broader use of HPV (human papillomavirus) vaccines and the validation of a simple oral screening test for HPV-caused oral cancers are reported in two studies by a Johns Hopkins Kimmel Cancer Center investigator. Leading HPV expert Maura Gillison, M.D., Ph.D., the first to identify HPV infection as the cause of certain oral cancers and who identified multiple sex partners as the most important risk factor for these cancers, reports her latest work in the November 3, 2008, journal Clinical Cancer Research and in a Centers for Disease Control and Prevention (CDC) monograph. The CDC report on HPV-associated cancers appears on line November 3 and in the November 15, 2008, supplement edition of Cancer. In the CDC report, believed to be the first and most comprehensive assessment of HPV-associated cancer data in the United States, investigators analyzed cancer registry data from 1998-2003 and found 25,000 cancer cases each year occurred at cancer sites associated with HPV infection. In additional analysis, Gillison and colleagues at the National Cancer Institute identified HPV infection as the underlying cause of approximately 20,000 of these cancers. Gillison and team found approximately 20,000 cases of cancer in the United States each year are caused by HPV infection. Oral cancers are the second most common type of HPV-associated cancers and are increasing in incidence in the U.S., particularly among men. Add to that anal, penile, vaginal, and vulvar cancers that are also linked to HPV infection, and Gillison [...]

Study: Do more to help patients quit smoking

Source: www.timeswv.com Author: Mary Wade Burnside A survey of cancer patients being treated at the Mary Babb Randolph Cancer Center indicates that many of the smokers did not quit the habit in light of their diagnosis and some of them were not even advised to do so by their doctors. “It absolutely benefits patients to quit,” said Dr. Jame Abraham, chief of oncology at WVU Hospitals and the medical director of the Mary Babb Randolph Cancer Center in Morgantown. “No. 1, we know that smoking can potentially alter the effectiveness of chemotherapy. “No. 2, smoking can cause many other conditions, including lung cancer and COPD (chronic obstructive pulmonary disease), and smoking can increase the chance of getting pneumonia and lung disease, which can complicate the ability to take the treatment.” The study was the idea of Lola Burke, now a second-year medical student who performed much of the survey work, Abraham said. Burke sent surveys to 1,000 cancer patients, and 200 of them responded. Of the 200 who responded, 52 percent had a history of smoking, but only 20 percent had been actively smoking at the time of the diagnosis, Abraham said. Of the active smokers, 44 percent quit while 56 percent did not, Abraham said. “Another thing we found was that 40 percent were not told by the doctors to quit,” he added. “They didn’t even hear this from their doctors or their health-care provider.” Bruce Adkins, director of the Division of Tobacco Prevention for the West Virginia Bureau [...]

Developing smokeless tobacco products for smokers: an examination of tobacco industry documents

Source: Tobacco Control 2009;18:54-59 Authors: C M Carpente et al. Objective: To investigate whether development of smokeless tobacco products (SLT) is intended to target current smokers. Methods: This study analysed internal tobacco industry documents to describe research related to the smokeless tobacco market. Relevant documents included those detailing the development and targeting of SLT products with a particular emphasis on moist snuff. Results: Cigarette and SLT manufacturers recognised that shifting demographics of SLT users, as well as indoor smoking restrictions, health concerns and reduced social acceptability of smoking could impact the growth of the SLT market. Manufacturers developed new SLT products to target cigarette smokers promoting dual cigarette and SLT use. Conclusions: Heavy marketing of new SLT products may encourage dual use and result in unknown public health effects. SLT products have been designed to augment cigarette use and offset regulatory strategies such as clean indoor air laws. In the United States, the SLT strategy may provide cigarette companies with a diversified range of products under the prospect of federal regulation. These products may pose significant challenges to efforts by federal agencies to reduce harm caused by tobacco use. Authors: C M Carpenter1, G N Connolly1, O A Ayo-Yusuf2, G Ferris Wayne1 Authors' affiliations: 1 Harvard School of Public Health, Division of Public Health Practice, Boston, Massachusetts, USA 2 Department of Community Dentistry, Faculty of Health Sciences, University of Pretoria, South Africa

Merck Serono launches Erbitux in 1st-line treatment of head and neck cancer in Europe

Source: www.medadnews.com Author: press release Today leading oncology specialists and media gathered at the Antwerp University Hospital to mark the European launch of Erbitux® (cetuximab) for the 1st-line treatment of patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN), following European Commission approval to extend the use of the targeted therapy. Erbitux was previously approved for use in combination with radiotherapy for locally advanced SCCHN. The approval of Erbitux in this new indication was granted in November 2008 and based primarily upon the results of the EXTREMEa study, published in the New England Journal of Medicine in September 2008. The EXTREME study established that adding Erbitux to platinum-based chemotherapy significantly prolonged median overall and progression-free survival, and also significantly increased response rate.1 The principal investigator of the EXTREME trial, Professor Jan Vermorken from the Antwerp University Hospital, a world renowned center of excellence in oncology research and treatment said: “We are pleased to be hosting the international launch of Erbitux in this notoriously difficult to treat cancer type. This is the first treatment regimen in 30 years to show a survival benefit and denotes a significant milestone in the advancement of treatment for head and neck cancer.” The EXTREME study demonstrated that patients treated with Erbitux plus chemotherapy experienced the following improvements, compared to chemotherapy alone:1 • Median overall survival increase of nearly 3 months (10.1 vs. 7.4 months; p=0.04), equating to a 20% reduction in the risk of death (HR: 0.80) during the study [...]

Gruesome warnings doing their job

Source: www.stuff.co.nz Author: staff Even in today's world with its plethora of information-gathering techniques there is probably no way to say for certain how much influence the use of revolting pictures on cigarette packets is having on the smoking rate, The Nelson Mail said in an editorial on Thursday. One thing is fairly certain, though - the images of gangrenous toes, diseased lungs and other rotting body parts are unlikely to bring about an increase. They have surely made some contribution to the latest statistics, which show a marked drop in the smoking rate, down from 25 percent of New Zealanders two years ago to around 20 percent, or 170,000 fewer smokers. The Health Ministry is right to attribute some of that improvement to the pictures, which at a stroke removed any semblance of sophistication from tobacco packaging, an area manufacturers used to put some effort into. It is doubtful that they can identify much revenue potential in that any more. The point has been further emphasised by a series of discomforting television commercials bravely fronted by mouth cancer sufferer Adrian Pilkington. He too shows the true nature of tobacco addiction in a way that forces smokers to confront the dangers of their habit. These two measures, along with the requirement for the Quitline number to be on every cigarette packet, are undoubtedly having an effect, hard as it is to define. There have after all been a number of restrictions introduced that have made it more difficult to pursue [...]

Mouthwash cancer link questioned

Source: www.bupa.co.uk/health_information Author: staff Mouthwashes that contain alcohol should only be available on prescription from a dentist because of a possible link with oral cancer, according to researchers in Australia. Professor Michael McCullough and Dr Camile Farah looked at previous research to see whether using mouthwashes containing alcohol is linked to oral (mouth) cancer. The review highlights the fact that certain mouthwashes contain more alcohol than some alcoholic drinks. Drinking alcohol is one of the main risk factors for oral cancer, along with smoking. Smoking and drinking together increase the risk even further. The researchers recommend that mouthwashes that contain alcohol should only be available on prescription from a dentist, and should only be used for short periods of time to treat specific conditions. However, Dr Nigel Carter, Chief Executive of the British Dental Health Foundation, told the health information team: "The public can continue to use alcohol-containing mouthwashes with the utmost confidence. There is absolutely no proven link with mouth cancer. This is a poor piece of research and has led to unnecessary scaremongering." One of the studies that the researchers looked at showed that mouthwash users were more likely to develop oral cancer, even if they didn't smoke or drink. However, this study was carried out in Latin America where mouthwash isn't routinely used. Those who used it may have been trying to treat problems caused by poor oral hygiene. It may have been this poor hygiene, rather than the mouthwash use, that increased the risk of oral [...]

Chemopreventive agents in black raspberries identified

Source: news.biocompare.com Author: staff A study published in Cancer Prevention Research, a journal of the American Association for Cancer Research, identifies components of black raspberries with chemopreventive potential. Researchers at the Ohio State Comprehensive Cancer Center found that anthocyanins, a class of flavonoids in black raspberries, inhibited growth and stimulated apoptosis in the esophagus of rats treated with an esophageal carcinogen. "Our data provide strong evidence that anthocyanins are important for cancer prevention," said the study's lead author, Gary D. Stoner, Ph.D., a professor in the department of internal medicine at Ohio State University. Stoner and his team of researchers fed rats an anthocyanin-rich extract of black raspberries and found that the extract was nearly as effective in preventing esophageal cancer in rats as whole black raspberries containing the same concentration of anthocyanins. This study demonstrates the importance of anthocyanins as preventive agents in black raspberries and validated similar in vitro findings. It is among the first to look at the correlation between anthocyanins and cancer prevention in vivo. Stoner and his colleagues have conducted clinical trials using whole berry powder, which has yielded some promising results, but required patients to take up to 60 grams of powder a day. "Now that we know the anthocyanins in berries are almost as active as whole berries themselves, we hope to be able to prevent cancer in humans using a standardized mixture of anthocyanins," said Stoner. "The goal is to potentially replace whole berry powder with its active components and then figure [...]

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