For Men with Prostate Cancer, Emotional Distress May Lead to More Aggressive Treatment

Newswise, January 14, 2017 – The anxiety many men experience after being diagnosed with prostate cancer may lead them to choose potentially unnecessary treatment options, researchers from the University at Buffalo and Roswell Park Cancer Institute report in a new study.

“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment, such as choosing surgery over active surveillance,” said UB’s Heather Orom, the lead author on the study, published in the February issue of the Journal of Urology.

“It underscores what we have been pushing a long time for, which is, ‘Let’s make this decision as informed and supported as possible.’ If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety. We hope this will help improve the treatment decision making process and ultimately, the patient’s quality of life,” added Orom, PhD, associate professor of community health and health behavior in UB’s School of Public Health and Health Professions.

The study involved 1,531 men with newly diagnosed, clinically localized prostate cancer, meaning the disease hadn’t spread to other parts of the body.

Researchers measured participants’ emotional distress with the Distress Thermometer, an 11-point scale ranging from 0 (no distress) to 10 (extreme distress). The men were assessed after diagnosis and again as soon as they had made their treatment decision.

The majority of study participants had either low- or intermediate-risk disease, and were more likely to have been treated with surgery, followed by radiation and active surveillance.

“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” the researchers report.

“Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided.”

While prostate cancer is a major disease in the U.S., it is not a death sentence, according to the American Cancer Society, which estimates there are nearly 3 million prostate cancer survivors alive today.

However, overtreatment is a concern, and surgery and radiation therapy have side effects that include erectile dysfunction and incontinence, which, for the majority of men diagnosed with low-risk prostate cancer, can be avoided by instead choosing active surveillance to monitor the cancer and considering treatment if the disease progresses.

“There’s an interest in driving the decision-making experience to prevent overtreatment and ensure that men have full information about all the side effects so they can make a choice that’s preference and value driven,” Orom said. “We don’t want men to make a decision that they’ll regret later on.”

“The goal of most physicians treating men with prostate cancer is to help their patients and family members through a difficult process and help their patients receive appropriate treatment,” said Willie Underwood III, MD, MS, MPH, an associate professor in Roswell Park’s Department of Urology, and a paper co-author.

“To do so, it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret,” Underwood added.

Caitlin Biddle, a PhD candidate in community health and health behavior at UB, is also a co-author on the paper.

Glaucoma Risk Increases in Families: Spread the Word

Newswise, January 14, 2017 — One way to reduce vision loss from glaucoma is to make sure your family members understand that they are at increased risk - if you have glaucoma.

Glaucoma is a worldwide problem that can lead to blindness. It is especially problematic because there are often no symptoms in its early stages. It is estimated that up to 50 percent of people with glaucoma don't realize they have it.

Numerous population-based studies have demonstrated that one of the greatest risk factors for glaucoma is a family history of the disease. That means that one of the most important things you can do is to talk about glaucoma with your family and encourage them to take steps to preserve their vision.

When your family is visiting, or at family gatherings, talk about glaucoma and encourage your family members to have their eyes checked by getting a comprehensive eye exam - it can make a real difference.

Glaucoma may have no symptoms at first, but the earlier glaucoma is caught, the easier it is to treat. Encouraging family members to get checked is a way to make sure they don't lose vision, because once they do, they can't get it back.

The Importance of Heredity

Genetic studies have suggested that more than 50 percent of glaucoma is familial. It's very strongly hereditary, especially among siblings; the rate of glaucoma can be 10 times higher among individuals with a sibling who has glaucoma.

 It's likely that at least 15 percent of glaucoma patients have at least one sibling who has glaucoma, and that individual may be totally unaware of the disease. But remember - anyone who is a blood relative is at increased risk.

Make Sure Family Members Get Screened

When you share your health information with family members - letting them know you have glaucoma and that they may be at risk - you are potentially giving them the gift of sight, even if it feels like a burden to bring it up.

Family gatherings are a good opportunity, not only to spread the word, but to get valuable family health history information when multiple family members are present and can contribute to the family knowledge.

January is Glaucoma Awareness Month

This month,  make a commitment to reaching out to your family members and encouraging them to get screened. I'm already working with a number of individuals and organizations to further this cause. If a significant portion of patients and eye-care professionals also make a commitment, we can have a major impact on reducing the number of individuals with undiagnosed glaucoma.

Organ Transplants, Deceased Donors Set Record in 2016

Newswise, January 14, 2017 – Organ transplants performed at the University of Alabama at Birmingham and across the United States in 2016 reached record highs, according to preliminary data from UAB and the United Network for Organ Sharing.

UAB performed 385 transplants in 2016 — up more than 4 percent from 2015 — including a 25 percent jump in the volume of liver transplants performed at UAB Hospital.

UAB’s numbers are up in part because of the Alabama Organ Center’s record year, which saw 153 organ donors donate 425 organs upon death — a 24 percent increase from 2015. Nationwide, 33,606 transplants were reported to UNOS, representing an 8.5 percent increase over the 2015 total, and an increase of 19.8 percent since 2012.

Devin Eckhoff, M.D., director of UAB’s Division of Transplantation, part of the Department of Surgery and School of Medicine, says exceeding local and national records is not possible without the selfless decision thousands of people made to become either a living organ donor or an organ donor upon death.

“Truly, these aren’t numbers,” Eckhoff said. “They are people, and they are people here in Alabama and around the country who physicians have had the privilege of helping return to health, in some cases for the first time in years because of the generosity of another human being.

“As a transplant surgeon, it’s a tremendous honor to help carry on the legacy of those who made a decision to give so others can have a chance to live.”

“The Alabama Organ Center has been focused on transforming itself to better meet the needs of the community, and we are seeing the positive results of those efforts,” said Chris Meeks, executive director Alabama Organ Center, which became only the eighth procurement organization in the country to open its own in-house recovery center in 2016. 

“We exceeded the national growth performance in 2016 and are now focusing on continued growth and sustaining our service to our mission. 

“We are grateful to our hospital and community partners that help to make this possible. We are especially humbled by the generous nature of the residents of Alabama who register their decision to be donors, and to all of the families who support organ, eye and tissue donation.”

Today, more than 123,000 candidates are on the national organ transplant waiting list, with nearly 3,200 waiting in Alabama. UAB’s transplant program has performed more than 14,000 transplants during the past 50 years. UAB Medicine offers transplant surgery for heart, liver, lung, pancreas and kidneys.

Eckhoff says the UAB’s Liver Transplant Program’s increase in the volume of transplants by 25 percent from 2015 to 2016 was due to several factors, including UAB’s aggressive pursuit of livers that have been turned down at other centers for a variety of reasons.

“We pursue increased-risk donors, for example, where the risk of dying on the transplant list is far greater than the risk these donors may present for the recipients,” Eckhoff said.

“We also had two donors this past year where the CT scan showed a fatty liver, which is not transplantable. But we will go look at these donors closely, and our experience is that fatty liver is frequently over-diagnosed and, in fact, the livers were normal.”

Eckhoff says UAB’s liver program hopes to at least sustain its volume and, hopefully, increase it slightly if the current allocation system remains in place.

UAB is the only liver transplant center in Alabama and one of only 20 nationally that average 100 or more liver transplants annually. Liver transplants are complex, lengthy surgeries that involve several surgeons, anesthesiologists and nurses, and they require a donor whose size and blood type are similar to the recipient’s.

UAB’s Heart Transplant Program is one of the most distinguished programs of its kind in the nation since the first heart transplant in the Southeast was performed at UAB in 1981.

Since then, hundreds of heart transplants have been performed at UAB. Patients also are cared for in a state-of-the-art, 23-bed Heart Transplant Intensive Care Unit, which is one of only a few of its kind in the nation.

The Lung Transplant Program at UAB is one of approximately 65 active programs in the United States. Since 1989, UAB has performed more than 600 lung transplants, which places it among the 10 busiest centers in the nation.

UAB’s Kidney Transplant Program began in 1968 and is one of the busiest in the nation. The program averages almost 300 transplants per year. It boasts an incompatible transplant program and recently performed the Deep South’s first HIV-positive to HIV-positive kidney transplant. The program also continues its UAB Kidney Chain, which began with a single, altruistic donor to grow into the longest chain of transplants ever performed. It is currently at 67 transplant recipients with more planned for 2017.

“From performance of its first transplant in 1968 through implementation of the new ECMO program for lung transplant candidates and ABO- and HLA-incompatible kidney transplantation — both landmark advances realized in 2013 — UAB has a rich tradition in solid organ transplantation,” said Robert Gaston, M.D., executive director of UAB’s Comprehensive Transplant Institute, which was founded in 2011. 

“Several therapies now used around the world to prevent transplant rejection were first offered to patients at UAB. We strive to produce a culture of excellence for our patients at UAB, promoting state-of-the-art care and research across all organ systems.”

Read more about all of UAB’s transplant services here.

According to UNOS, the growth in overall transplants nationwide for 2016 was driven largely by an increase of 9.2 percent in the number of deceased donors from 2015 to 2016, continuing a six-year trend of annual increases.

Many deceased donors provide multiple organs for transplantation. Approximately 82 percent (27,628) of the transplants involved organs from deceased donors. The remaining 18 percent (5,978) were performed with organs from living donors.

In addition, an increasing number of deceased donors in 2016 had medical characteristics or a medical history that, in prior years, may have been considered less often by clinicians.

These include people who donated after circulatory death as opposed to brain death, as well as donors who died of drug intoxication or those identified as having some increased risk for bloodborne disease.

What kind of impact can one person make as an organ donor? According to the U.S. Government Information on Organ Donation and Transplantation, one organ donor can save as many as eight lives.

A single tissue donor can save and heal 50 others through needed heart valves, corneas, skin, bone and tendons that mend hearts, prevent or cure blindness, heal burns, and save limbs.

Kidneys, heart, lungs, liver, pancreas and intestines can be donated along with stem cells, tissue, blood and platelets.

Register with the Alabama Organ Center today to be an organ, eye and tissue donor. To register or find out more information on how to be a living kidney donor, fill out UAB Medicine’s Living Kidney Donor Screening Form.

Hopkins Project Shows House Calls and Good Neighbors Can Benefit Patients and Hospitals

Four-year "J-CHiP" study helps hospitals operate more efficiently while helping patients in their homes...When people with chronic health problems couldn't get around town to their doctors' appointments, a four-year Johns Hopkins program brought the appointments to them

Newswise, January 3, 2017 — Johns Hopkins cardiologist and senior director for accountable care Scott Berkowitz, M.D., has published an extensive report of a four-year, $19 million Centers for Medicare and Medicaid Services grant in the journal Healthcare.

The grant, which wrapped up in late summer, was aimed at providing more efficient, less expensive care for people living with multiple chronic conditions in the Baltimore neighborhoods closest to The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. Over the course of the grant, the Johns Hopkins Community Health Partnership (J-CHiP) provided East Baltimore residents care in community clinics, acute care hospitals, emergency departments, skilled nursing facilities and even people's homes.

J-CHiP had two components: one community-based and one acute-care based. The acute-care based program targeted the 40,000 adult patients admitted annually to The Johns Hopkins Hospital and the Johns Hopkins Bayview Medical Center. 

Those patients were screened for risks of hospital readmission. The community-based component scored 2,000 Medicare and 1,000 Medicaid patients on their risk of hospitalization.

The community-based program centered on community health workers — specially trained neighborhood residents — who helped identify “super users” of health care in the area and intervene. People who used the emergency department frequently, as well as those identified as high risk for hospital admission, were the program’s main targets.

Reducing hospital readmissions is a goal of government, payers and hospitals alike. Many government and private insurance payers are now refusing to pay for second hospital stays for the same condition. Thus, many hospitals are devising strategies to get patients more engaged in their own care, keeping them healthier and out of the hospital.

"The complex health and social needs of an urban community pose many challenges in the delivery of high-quality care," says Berkowitz, who led the study. "We've learned a lot over four years, and we look forward to learning even more, as the data rolls out in the months to come."

In the J-CHiP model, community health workers, paid by the grant, helped super users break down their barriers to paying regular visits to primary care providers. In addition to a community health worker, each super user was assigned a custom team of physicians, nurses, pharmacists and social workers. 

And finally, J-CHiP worked with skilled nursing facilities on standardizing transitions and keeping patients engaged and motivated.

Among Medicaid patients in the J-CHiP program, 38 percent listed transportation as the main barrier they faced to staying engaged with their own health care. In response, JCHiP provided bus tokens, cab vouchers or shuttle support to 550 patients.

Patients also faced barriers like unstable housing situations and an inability to pay for medicines or care. J-CHiP provided social workers, pharmacy assistance programs and pre-programmed mobile phones to patients who faced critical financial barriers.

Berkowitz says that J-CHiP aligned with Johns Hopkins Medicine goals for transforming care and improving population health. "We focused heavily on East Baltimore's health needs, as well as on innovation of care delivery across the settings where care takes place," he says.

In the report, Berkowitz cites Baltimore City Health Department statistics on life expectancy in the city. "The nearly 200,000 residents of East Baltimore, where life expectancy can be as many as 20 years shorter than nearby more affluent Baltimore neighborhoods, face many challenges to health and well-being," he says.

Berkowitz's article includes examples of J-CHiP team members helping patients overcome barriers to care. In one example, a patient with diabetes who made regular visits to her primary care doctor could no longer see well enough to read her insulin prescription. 

Embarrassed, the patient hid this fact from her doctor, who couldn't determine why her diabetes was so poorly managed. A community health worker visited the patient and saw the trouble she had measuring her insulin. 

After switching to a pre-measured pen system for insulin delivery, the patient also got an eye exam. After three months of her new regimen, both her blood sugar and her eyesight improved significantly.

The J-CHiP program was supported by grant number 1C1CMS331053-01-00 from the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. The content of this press release is solely the responsibility of the authors and does not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

To read the full report, click here.

Cedars-Sinai Neurologist Warns of Increased Risk of Strokes During and after the Holidays

Stroke Expert Explains How to Recognize Symptoms and Prevent Life-Threatening Complications by Acting Quickly

Newswise, January 3, 2017 — Along with increased cheer and festivities during the holidays comes an increased risk of stroke, one of the leading causes of death and disability in the U.S.

Patrick D. Lyden, MD, chair of the Cedars-Sinai Department of Neurology, said he sees a significant increase in stroke incidents during December and January, particularly on Christmas Day and New Year’s Day.

Lyden attributes the surge to holiday stress, sleep deprivation, dehydration, smoking, overindulging, and seasonal colds and influenza. He also says that changes in barometric pressure and lower temperatures can play a role.

“Holiday strokes can be an unexpected and even fatal problem because they often arrive with little warning,” said Lyden, director of the Cedars-Sinai Stroke Center. “The good news, however, is that with advanced tools and technology available to us, we may prevent life-threatening complications and even reverse the effects of a stroke if we administer treatment within six hours.”

Lyden says the number of stroke cases treated at Cedars-Sinai rises to about 100 from about 80 per month during the winter season. Stroke is the fifth-leading cause of death in the U.S. and a leading cause of disability, according to the American Stroke Association.

To recognize symptoms, leading stroke experts recommend memorizing an easy-to-remember acronym: FAST!

Face (drooping of the face)
Arm (arm weakness)
Speech (slurred speech)
Time (time counts -- call 911 immediately)

To reduce the risk of strokes, Lyden recommends that individuals reduce stress, eat and drink in moderation, be vigilant about taking prescribed medications, exercise, get rest and stop smoking.

“Studies show that 80 percent of strokes can be prevented,” said Lyden. “But if it occurs, the key is calling 911 fast. Every minute a stroke is untreated, the average patient loses about 1.9 million brain cells.”

Cedars-Sinai has been designated a Comprehensive Stroke Center by The Joint Commission, an independent, not-for-profit organization that accredits and certifies nearly 21,000 health care organizations and programs in the United States.

This advanced certification for comprehensive stroke centers recognizes the significant resources in staff and training that these centers must have to treat complex stroke cases. Cedars-Sinai was proud to be among the first five hospitals in the nation, and the first in Southern California, to receive this designation.

Ovarian Cancer Survival Rates Improve in Sanford Study

Sanford Research lab exploring role of protein in disease progression

Newswise, January 3, 2017– A Sanford Research lab is studying a protein’s role in improving survival in ovarian cancer patients. Findings published in Oncogenesis indicate a higher level of a specific protein correlates with an increased survival rate and decrease in the spreading of cancer cells.

Kristi Egland, Ph.D., an associate scientist in the Cancer Biology Research Center at Sanford Research, led the study, which retroactively looked at tumor samples from ovarian cancer patients. 

Her team noticed that patients with higher levels of the Sushi Domain Containing 2 protein, or SUSD2, experienced less metastasizing of cancer cells and thus survived an average of 18 months longer.

“We want to better understand how SUSD2 played a role in inhibiting the spread of cancer from the ovaries to other parts of the body,” said Egland. “Ovarian cancer is usually diagnosed in late stages and after it has spread, which makes it difficult to cure. The mechanisms that underlie SUSD2’s ability to reduce metastasizing of cancer cells could help us identify drugs that mimic its function and provide a target for therapy options that prolong survival.”

SUSD2 is a protein common in cancers that is responsible for telling cells where to attach to other cells. In ovarian cancer, cancer cells often attach to the lining of the abdominal cavity and spread to other organs in or adjacent to that area. Higher levels of SUSD2, according to Egland, seemed to stop the attachment of cancer cells to other organs.

The American Cancer Society reports that ovarian cancer accounts for more deaths than any other cancer of the female reproductive system and ranks fifth in cancer deaths among women. A woman's risk of getting ovarian cancer during her lifetime is about 1 in 75, and her lifetime chance of dying from ovarian cancer is about 1 in 100.

Egland’s lab at Sanford Research specializes in studying proteins for use as diagnostic markers and immunotherapy targets. In addition to exploring ovarian cancer, her lab also does work with breast cancer.

Oncogenesis is a peer-reviewed online journal focusing on the molecular basis of cancer and promoting diverse and integrated areas of molecular biology, cell biology, oncology and genetics.

About Sanford Research

Sanford Research is a non-profit research organization and is part of Sanford Health, an integrated health system headquartered in the Dakotas. Sanford Health is one of the largest health systems in the nation with a presence in nine states and four countries. 

More than $600 million in gifts from Denny Sanford has provided for an expansion of research initiatives in type 1 diabetes, breast cancer and genomics in internal medicine.

With a team of more than 200 researchers, Sanford Research comprises several research centers, including Children’s Health Research, Edith Sanford Breast Center, Cancer Biology, Center for Health Outcomes and Population and Sanford Sports Science Institute.

Regular Aspirin Use May Reduce Risk for Pancreatic Cancer

Newswise, January 3, 2017 — Regular use of aspirin by people living in Shanghai, China, was associated with decreased risk for developing pancreatic cancer, according to data published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Data from the new study and meta-analysis of data from 18 other studies suggest that over the past two decades, as the general population’s use of aspirin has increased, the effect of aspirin in decreasing pancreatic cancer risk has become more pronounced.

“Pancreatic cancer is one of the deadliest types of cancer—fewer than 8 percent of patients survive five or more years after diagnosis—so it is crucial that we find ways to prevent it,” said Harvey A. Risch, MD, PhD, professor of epidemiology in the Department of Chronic Disease Epidemiology at the Yale School of Public Health, Yale School of Medicine, and Yale Cancer Center in New Haven, Connecticut.

“We found that regular use of aspirin by a large group of people in Shanghai cut risk of pancreatic cancer almost in half."

“These new data are consistent with what has been seen in other populations around the world,” continued Risch. “Pancreatic cancer is relatively rare—just 1.5 percent of U.S. adults will be diagnosed with it at some point during life—and regular aspirin use can cause appreciable complications for some.

“Therefore, a person should consult his or her doctor about aspirin use. Nevertheless, the balance of evidence shows that people who use aspirin to reduce risk for cardiovascular disease or colorectal cancer can feel positive that their use likely also lowers their risk for pancreatic cancer.”

Risch and colleagues recruited patients newly diagnosed with pancreatic cancer at 37 Shanghai hospitals from December 2006 to January 2011. They also randomly selected controls from the Shanghai Residents Registry.

The 761 patients with pancreatic cancer and 794 controls were interviewed in person to determine when they started using aspirin, the number of years they used aspirin, and when they stopped using aspirin, among other things. Almost all aspirin users used aspirin daily.

Among the patients with pancreatic cancer, 11 percent reported regular use of aspirin. Eighteen percent of the controls reported regular use of aspirin.

After adjusting for a number of factors, including body mass index, smoking history, and history of diabetes, the researchers found that ever having used aspirin regularly was associated with a 46 percent decreased risk for pancreatic cancer. Risk decreased by 8 percent for each year of aspirin use.

In reviewing the literature, Risch and colleagues found 18 other studies that had investigated aspirin use and pancreatic cancer risk.

Meta-analysis of the data from these studies showed that if the studies were considered by the year at which the midpoint of when the aspirin exposures were ascertained in the study, the odds ratios for regular use of aspirin and pancreatic cancer risk significantly decreased by 2.3 percent per year through the present.

According to Risch, the main limitation of the Shanghai study is that it is a case-control study that relied on participants accurately reporting past aspirin use.

The study was supported by grants from the U.S. National Cancer Institute, the Science and Technology Commission of Shanghai Municipality, and the Shanghai Cancer Institute. Risch declares no conflicts of interest.