U.S. RANKS FIRST IN HEALTH CARE SPENDING, BUT CANCER OUTCOMES DO NOT REFLECT THE INVESTMENT, STUDY FINDS

As published in JNCCN, researchers at The University of Texas MD Anderson Cancer Center found that, at the state level, wealth—not health expenditure—is a determinant for better outcomes in most cancers.

Newswise, August 17, 2016 — FORT WASHINGTON, PA — The U.S. health care system is characterized—on a global level—by its unsustainable health care spending, which does not necessarily correlate to better outcomes in patients with cancer. With $2.9 trillion spent on U.S. health care in 2013, the United States ranks first in health care spending among the world’s leading economies.[1]

To investigate the implications of socioeconomic status (SES) and health expenditures on cancer outcomes and mortality, researchers at The University of Texas MD Anderson Cancer Center, led by Jad Chahoud, MD, conducted an ecological study at the state level for three distinct patient populations: breast cancer, colorectal cancer, and all-cancer populations.

Dr. Chahoud and his associates found that high health care spending did not correlate with better outcomes and lower mortality in colorectal cancer and all cancers, but that state-level SES and wealth does have a positive impact on cancer outcomes and mortality.

The study, “Wealth, Health Expenditure, and Cancer: A National Perspective,” was published this week in the August issue of JNCCN – Journal of the National Comprehensive Cancer Network and is available free-of-charge at JNCCN.org through October 31, 2016.

“Our work provides a new perspective on cancer outcomes disparities in the United States, laying the groundwork for future research to assess the effect of the Affordable Care Act on cancer outcomes across states,” said Dr. Chahoud.

Dr. Chahoud and colleagues extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services (CMS), respectively. Using data from the National Cancer Institute (NCI), the investigators retrieved breast, colorectal, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios for each population.

In addition to the association between GDP and lower M/I, the data showed a rift between northern and southern states in all three patient populations, with patients in southern states faring worse.

“Our study highlights regional disparities in terms of financial and cancer outcomes, indicating a potential inefficient allocation of resources in the efforts against cancer,” said Dr. Chahoud.

According to the study, the only cancer type in which high health care spending led to lower M/I was breast cancer. The authors suggest that this finding potentially indicates the effectiveness of screening mechanisms, navigator programs, and advocacy organizations, among other initiatives at the state level.

However, in one of a pair of complementary point/counterpoint editorials in the same issue, Melissa A. Simon, MD, MPH, and colleagues from Robert H. Lurie Comprehensive Cancer Center of Northwestern University and Rush University, warn against allowing the data to guide—or misguide—policy makers in states that have high health expenditures to cap or decrease spending for certain health issues.

“Increased spending does not necessarily improve quality of care, but capping or cutting spending on health care does not necessarily solve problems either,” Dr. Simon noted.

Dr. Simon and colleagues’ editorial further notes that the data in this study predate the Affordable Care Act and describes the need for further study and analysis to inform the “the complicated interplay of wealth, health expenditures, and their relationship to cancer screening.”

In the counterpoint, Dr. Chahoud and colleagues agree on that need. “The goal of our study is not to misguide policy makers; instead it is to highlight a problem of disparity and to fuel the discussion at the national level,” responded Dr. Chahoud. “We are not recommending the ‘capping’ of health care spending. Instead, we are advocating for smart spending because complementing financial resources with other community-based and low-cost preventive measures is critical, especially in prevalent cancers, such as breast and colorectal.”

To access the August issue of JNCCN, visit JNCCN.org.

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About JNCCN – Journal of the National Comprehensive Cancer Network
More than 23,000 oncologists and other cancer care professionals across the United States read JNCCN–Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about best clinical practices, health services research, and translational medicine. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside Press. Visit JNCCN.org. To inquire if you are eligible for a FREEsubscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.asp

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 27 of the world’s leading cancer centers devoted to patient care, research, and education, is dedicated to improving the quality, effectiveness, and efficiency of cancer care so that patients can live better lives. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers.

The NCCN Member Institutions are: Fred & Pamela Buffett Cancer Center, Omaha, NE; Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute, Cleveland, OH; City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women’s Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Cancer Institute, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Mayo Clinic Cancer Center, Phoenix/Scottsdale, AZ, Jacksonville, FL, and Rochester, MN; Memorial Sloan Kettering Cancer Center, New York, NY; Moffitt Cancer Center, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center, Memphis, TN; Stanford Cancer Institute, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UC San Diego Moores Cancer Center, La Jolla, CA; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Colorado Cancer Center, Aurora, CO; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; The University of Texas MD Anderson Cancer Center, Houston, TX; University of Wisconsin Carbone Cancer Center, Madison, WI; Vanderbilt-Ingram Cancer Center, Nashville, TN; and Yale Cancer Center/Smilow Cancer Hospital, New Haven, CT.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.org/patients. Media, visit NCCN.org/news.

EXERCISE CAN TACKLE SYMPTOMS OF SCHIZOPHRENIA

Newswise, August 17, 2016 — Aerobic exercise can significantly help people coping with the long-term mental health condition schizophrenia, according to a new study from University of Manchester researchers.

Through combining data from 10 independent clinical trials with a total of 385 patients with schizophrenia, Joseph Firth found that around 12 weeks of aerobic exercise training can significant improve patients' brain functioning.

The study by Firth, Dr Brendon Stubbs and Professor Alison Yung is published in Schizophrenia Bulletin, the world's leading journal on Schizophrenia and one of leading periodicals in Psychiatry.

Schizophrenia's acute phase is typified by hallucinations and delusions, which are usually treatable with medication.

However, most patients are still troubled with pervasive 'cognitive deficits'; including poor memory, impaired information processing and loss of concentration.

The research showed that patients who are treated with aerobic exercise programs, such as treadmills and exercise bikes, in combination with their medication, will improve their overall brain functioning more than those treated with medications alone.

The areas which were most improved by exercising were patients' ability to understand social situations, their attention spans, and their 'working memory' - or how much information they can hold in mind at one time.

There was also evidence among the studies that programs which used greater amounts of exercise, and those which were most successful for improving fitness, had the greatest effects on cognitive functioning.

Joe Firth said: "Cognitive deficits are one aspect of schizophrenia which is particularly problematic.

"They hinder recovery and impact negatively upon people's ability to function in work and social situations. Furthermore, current medications for schizophrenia do not treat the cognitive deficits of the disorder.

"We are searching for new ways to treat these aspects of the illness, and now research is increasingly suggesting that physical exercise can provide a solution."

He added: "These findings present the first large-scale evidence supporting the use of physical exercise to treat the neurocognitive deficits associated with schizophrenia.

"Using exercise from the earliest stages of the illness could reduce the likelihood of long-term disability, and facilitate full, functional recovery for patients."

INTERMEDIATE HDL CHOLESTEROL LEVELS MAY BE BEST FOR LONGEVITY

Highlights

• In a large study of male veterans, both low and high HDL cholesterol levels were associated with higher risks of dying prematurely compared with intermediate levels, forming a U-shaped curve.
• The beneficial properties of HDL cholesterol were attenuated, but remained significant, in the presence of kidney disease.

Newswise, August 17, 2016 — A new study indicates that maintaining an intermediate level of high density lipoprotein cholesterol (HDL-C) may help people live longer.

The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), found that both low and high HDL-C levels were linked with a higher risk of premature death. Also, intermediate HDL-C levels were associated with a lower risk of death across all levels of kidney function.

Patients with kidney disease often have reduced levels of HDL-C, which may partly explain their higher risk of dying prematurely; however, the relationship between HDL-C and premature death in patients with kidney disease is unclear. To investigate, a team led by Benjamin Bowe, MPH and Ziyad Al-Aly, MD, FASN (Washington University School of Medicine and VA Saint Louis Health Care System) retrospectively studied 1,764,986 US male veterans with at least one measurement of kidney function and one measure of HDL-C between October 2003 and September 2004. Participants were followed until September 2013.

The researchers found that both low and high HDL-C levels were associated with higher risks of dying during follow-up compared with intermediate HDL-C levels, forming a U-shaped relationship between HDL-C and mortality risk.

The beneficial properties of intermediate levels of HDL-C were attenuated, but remained significant, in the presence of kidney disease.

“The finding that high HDL-C was also associated with higher risk of death was not expected and has not been reported previously in large epidemiologic studies such as the Framingham Heart Study and others,” said Dr. Al-Aly.

“Prior epidemiologic studies significantly advanced our understanding of the relationship between cholesterol parameters and clinical outcomes; however, these studies are limited in that the number of patients in these cohorts is relatively small compared with the current Big Data approach.”

He noted that a Big Data approach allows a more nuanced examination of the relationship between HDL-C and risk of death across the full spectrum of HDL-C levels.

“Our findings may explain why clinical trials aimed at increasing HDL-C levels have failed to show improvement of clinical outcomes,” noted Bowe.

Study co-authors include Yan Xie, MPH, Hong Xian, PhD, Sumitra Balasubramanian, MS, and Mohamed Zayed MD, PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled “High Density Lipoprotein Cholesterol and the Risk of All-cause Mortality among U.S. Veterans,” is online at http://www.cjasn.asnjournals.org/ 

UAB Optometrist Improves Treatment and Care for Patients with Dry Eye

Newswise, August 10, 2016-– The Food and Drug Administration recently approved lifitegrast, a new eye drop for treating signs and symptoms of dry eye in adult patients. 

Kelly Nichols, O.D., Ph.D., a dry eye expert and dean of the University of Alabama at Birmingham School of Optometry, conducted research studies for the parent drug company to explore the efficacy and safety of lifitegrast in treating this eye condition that affects more than 16 million adults in the United States.

Inflammation associated with dry eye may eventually lead to damage to the surface of the eye.

“Dry eye is a common complaint to eye care professionals, with millions of U.S. adults experiencing the symptoms of this often chronic disease,” Nichols said.

“It is critical for eye care professionals to have a dialogue with patients who report symptoms because dry eye can be a progressive ocular surface disease.”

The twice-daily eye drop solution of 5 percent lifitegrast ophthalmic solution is the only prescription eye drop indicated for the treatment of both signs and symptoms of dry eye, and it is the first new dry eye prescription drop approved in the last 13 years.

Nichols and a team of researchers studied 1,181 patients, of whom 1,067 received lifitegrast in four placebo-controlled 12-week trials. Signs and symptoms were assessed at baseline and at weeks two, six and 12.

In all four studies, eye dryness was significantly reduced, with two of the studies showing improvements at week two.

Results from inferior corneal staining tests — used by physicians to detect abrasions on the cornea — showed improvement in three of the four studies.

Nichols continues to push for funding and advancement for dry eye research and treatment.

Prior to FDA approval of the lifitegrast eye drop, Nichols presented a congressional briefing in Washington, D.C., addressing research into dry eye for the National Alliance for Eye and Vision Research. She focused on the cause and potential therapies for dry eye that are being funded through the National Eye Institute and in private industry.

Focusing her research on all aspects of the eye, Nichols discussed the mechanics of the three layers of the tear film and the importance of each from the cornea outward:
• Mucin layer: helps tears adhere to the eye
• Aqueous layer or water layer: nourishes and protects the cornea
• Lipid or oil layer: lubricates and prevents evaporation and provides smooth refractive surface needed for optimal vision.

“We are unsure which of the 200-plus different lipids and 500-plus unique proteins are most important for protecting and lubricating the eye, and the absence or insufficiency of which results in dry eye,” Nichols said.

There are more than 30-plus new dry eye basic, translational and clinical studies being funded by the NEI/National Institutes of Health to further explore these lipids and proteins, with more than 50 papers being published monthly.

“Funding from NIH is helping the optometry world make significant strides in understanding the cause and treatment of dry eye,” Nichols said. “We still have a long way to go, but prevention and early detection are major goals. There is hope for dry eye patients worldwide.”

Diagnosis of dry eye is identified by an eye care professional based on careful evaluation of signs and symptoms, including dryness, discomfort, vision changes and damage to the surface of the eye. Specialty testing for dry eye is performed at the Dry Eye Relief Clinic at UAB Eye Care, in the School of Optometry.

Obesity on the Rise in Adults with a History of Cancer

 Colorectal and breast cancer survivors and non-Hispanic blacks at highest risk for obesity

Newswise, August 10, 2016-- A study at Columbia University's Mailman School of Public Health showed that obesity was more prevalent in patients with a history of cancer than in the general population, and survivors of colorectal and breast cancers were particularly affected. 

The study is among the first to compare rates of obesity among U.S. cancer survivors and adults without a history of cancer. Findings are published online in the Journal of Clinical Oncology.

Results were based on data from a nationally representative sample of 538,969 non-institutionalized adults aged 18 to 85 years with or without a history of cancer who participated in the annual National Health Interview Survey from 1997 to 2014. Obesity was defined as body mass index ? 30 kg/m2 for non-Asians and ? 27.5 kg/m2 for Asians.

Among 32,447 cancer survivors, the most common diagnoses were cancers of the breast followed by prostate, and colorectal cancers. Populations with the highest rates of increasing obesity were colorectal cancer survivors followed by breast cancer survivors. African-American survivors of all three cancers were particularly affected.

"Our study identified characteristics of cancer survivors at the highest risk of obesity, which are important patient populations in which oncology care providers should focus their efforts," said Heather Greenlee, ND, PhD, assistant professor of Epidemiology at the Mailman School, and principal investigator.

From 1997 to 2014, prevalence of obesity increased from 22 percent to 32 percent in cancer survivors and from 21 percent to 29 percent of adults without a history of cancer. During this time, rates of obesity grew more rapidly in women cancer compared to both male cancer survivors and compared to women with no history of cancer.

In female colorectal cancer survivors, those who are young and non-Hispanic black and had been diagnosed within 2 to 9 years had the highest increasing rates of obesity.

Similarly, among female breast cancer survivors, those who are young, were diagnosed within the past year, and are non-Hispanic white had the highest increasing obesity rate.

Among male colorectal cancer survivors, the highest increases in obesity were among older men, non-Hispanic blacks, and those at or greater than 10 years from diagnosis.

In contrast, prostate-cancer survivors with the highest increases in obesity were younger, non-Hispanic whites, and 2 to 9 years from diagnosis.

"While our findings can be partially explained by the growing population of patients with breast and colorectal cancer - the two cancers most closely linked to obesity -- we identified additional populations of cancer survivors at risk of obesity not as well understood and which require further study," observed Dr. Greenlee.

"These results suggest that obesity is a growing public health burden for cancer survivors, which requires targeted interventions including weight management efforts to stave off the increasing obesity trends we are seeing in cancer survivors," noted Dr. Greenlee.

Secrets of Age-Related Diseases May Lie in Cellular Targets Identified

Newswise, August 3, 2016— New insights on age-related diseases may hold the key to both delaying aging and, in the process, reducing the occurrence of diseases including cancer.

These findings have been reported by a team from Roswell Park Cancer Institute and Everon Biosciences in the journal Aging.

“The majority of aging theories agree that chronic inflammation associated with secretions by senescent, or aging, cells are the underlying cause of frailty and of multiple age-related diseases, including cancer,” says senior author Andrei Gudkov, PhD, DSci, Senior Vice President for Basic Science at Roswell Park.

“Our study has redefined a subset of these cells as belonging to the category of macrophages. This finding requires a re-interpretation of the mechanisms underlying these cellular targets and a reconsideration of their potential for anti-aging treatments.”

Scientists have named the subtype “senescence-associated macrophages,” or SAMS.

“Our research allowed us to redefine the nature of cells that are sources of poisonous inflammation associated with aging. These cells appear to be not senescent cells, but are actually part of our natural immune system. This finding allows us to identify targets as well as agents that can eradicate senescence-associated macrophages, with the ultimate goal of finding new ways to treat cancer and other age-related diseases,” adds Dr. Gudkov.

Exercise Results in Larger Brain Size and Lowered Dementia Risk

 Newswise, August 3, 2016--

 RESEARCH ALERT

Exercise results in larger brain size and lowered dementia risk

FINDINGS
 — Using the landmark Framingham Heart Study to assess how physical activity affects the size of the brain and one’s risk for developing dementia, UCLA researchers found an association between low physical activity and a higher risk for dementia in older individuals. This suggests that regular physical activity for older adults could lead to higher brain volumes and a reduced risk for developing dementia.

The researchers found that physical activity particularly affected the size of the hippocampus, which is the part of the brain controlling short-term memory. Also, the protective effect of regular physical activity against dementia was strongest in people age 75 and older.

BACKGROUND
Though some previous studies have found an inverse relationship between levels of physical activity and cognitive decline, dementia and Alzheimer’s disease, others have failed to find such an association. The Framingham study was begun in 1948 primarily as a way to trace factors and characteristics leading to cardiovascular disease, but also examining dementia and other physiological conditions.

For this study, the UCLA researchers followed an older, community-based cohort from the Framingham study for more than a decade to examine the association between physical activity and the risk for incident dementia and subclinical brain MRI markers of dementia.

METHOD
The researchers assessed the physical activity indices for both the original Framingham cohort and their offspring who were age 60 and older. They examined the association between physical activity and risk of any form of dementia (regardless of the cause) and Alzheimer’s disease for 3,700 participants from both cohorts who were cognitively intact. They also examined the association between physical activity and brain MRI in about 2,000 participants from the offspring cohort.

IMPACT
What this all means: one is never too old to exercise for brain health and to stave off the risk for developing dementia.