June 16th, 2011 by Glenn Laffel, M.D., Ph.D. in Research
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In recent posts on Web-based and mobile behavioral intervention programs, we reviewed evidence suggesting that social support, in one form or another, can improve participants’ adherence and engagement with the program. That didn’t always mean however, that participants achieved better outcomes as a result. In one study for example, an online community increased engagement with and utilization of a Web-based activity program, but it did not increase participants’ actual activity levels.
Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames as an example of such programs, I’ll do that here.
Re-Mission is intended improve medication compliance in teens and young adults with a history of cancer. In the game, players control a nanobot within a 3-dimensional body of a young person that has cancer. Play involves destroying cancer cells and managing chemotherapy-related adverse effects like vomiting and bacterial infections by using antiemetics and antibiotics. The game purports to help users understand Read more »
*This blog post was originally published at Pizaazz*
March 24th, 2011 by Elaine Schattner, M.D. in Research
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A recent issue of the New England Journal of Medicine includes an article with the bland title Cytarabine Dose for Acute Myeloid Leukemia. AML is an often-curable form of leukemia characterized by rapidly-growing myeloid white blood cells. Cytarabine — what we’d call “Ara-C” on rounds — has been a mainstay of AML treatment for decades.
The new report* covers a fairly large, multicenter, randomized trial of adult patients with AML. The researchers, based in the Netherlands, Switzerland, Belgium and Germany, evaluated 860 patients who received either intermediate or high doses of Ara-C in their initial, induction chemotherapy. According to the journal, “this investigator-sponsored study did not involve any pharmaceutical companies.”
The main finding was that at a median follow-up of 5 years there were no significant differences between the groups in terms of complete remission rates, relapses or overall survival. The high-dose Ara-C offered no clear advantage in any prognostic subgroup, including those with genetic changes that bear a poor risk. Not surprisingly, Grade 3 and 4 (severe) toxicities were more common in the patients who received higher doses of Ara-C. Those patients also had lengthier hospitalizations and prolonged reduction in their blood counts.
Why am I mentioning this report, besides that it hasn’t received any press coverage? First, because the findings might matter to people who have AML and are contemplating treatment options. But mainly it’s an example of how carefully dialing down some chemotherapy doses could reduce health care costs and lessen untoward effects of cancer therapy — in terms of early toxicities and, possibly down the line, fewer secondary malignancies – without compromising long-term outcomes.
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*subscription required: N Engl J Med 364: 1027–36 (2011). The free abstract includes some details on the chemo doses.
*This blog post was originally published at Medical Lessons*
February 22nd, 2011 by Felasfa Wodajo, M.D. in News, Research
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The word cancer comes from the greek word for crab “karkinos,” so named by Hippocrates who visualized the tumor and its surrounding vessels looking like a crab, dug stubbornly into the sand with its legs. We know far more about cancer today than the ancient Greeks, but the vision of an entrenched opponent, almost impossible to extract whole, appears to be vividly prescient.
What we have realized over the last half century is that removal of the visible tumor is not enough. Even as we learned how to do bigger and more destructive surgeries, the cancer still managed to sneak back in, growing later at different locations. The crab’s legs are still embedded in the patient.
Thus the discovery that certain chemicals could extinguish these rogue cells opened the modern era of cancer therapy and led to the first “cures” from cancer. Many of these compounds were exquisitely toxic. Early experimenters even used nitrogen mustard, quite literally a poison, as Siddhartha Mukherjee tells in his excellent history of cancer, “The Emperor of All Maladies.”
To many, the battle looked grim. For the founder of CollabRx, who himself was living in the shadow of advanced melanoma, this was the signal to take his expertise in internet information technologies and apply it to cancer. Thus a “biomedical software company” was founded, with the mission:
…to save lives by using information technology to personalize cancer treatments and accelerate research.
The rapid proliferation of knowledge about the molecular underpinnings of different cancers, has brought hope for a new age of “targeted” therapies. These drugs are designed to find and destroy cells with aberrant biochemical pathways, while bypassing the normal body tissues. Immense hopes rest on them. Read more »
*This blog post was originally published at iMedicalApps*
January 2nd, 2011 by Shadowfax in Better Health Network, True Stories
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This year has been a weird one for me and cancer. In the ER, we see cancer patients pretty infrequently. The occasional chemotherapy with fever, but that’s about it. I think the oncologists try hard to keep the patients out of the ER — to everybody’s benefit.
But this year, I’ve had a weird rash of cases where I’ve made primary diagnoses of cancer in the ER — several times over and over and over again. In ten years I don’t think I’ve made as many cancer diagnoses as I have this year alone. Just very strange.
Unfortunately, it came home to roost. My wife was diagnosed with breast cancer last week. Read more »
*This blog post was originally published at Movin' Meat*
December 30th, 2010 by Harriet Hall, M.D. in Better Health Network, Book Reviews, Opinion, Research
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Myths and misconceptions about cancer abound. Oncologists are frequently criticized for torturing patients by burning, cutting and poisoning without making any real progress in the war against cancer. Siddhartha Mukherjee, an oncologist and cancer researcher, tries to set the record straight with his new book The Emperor of All Maladies: A Biography of Cancer.
It is a unique combination of insightful history, cutting edge science reporting, and vivid stories about the individuals involved: The scientists, the activists, the doctors, and the patients. It is also the story of science itself: How the scientific method works and how it developed, how we learned to randomize, do controlled trials, get informed consent, use statistics appropriately, and how science can go wrong. It is so beautifully written and so informative that when I finished it I went back to page one and read the whole thing again to make sure I hadn’t missed anything. I enjoyed it just as much the second time. Read more »
*This blog post was originally published at Science-Based Medicine*
Another study, slightly older than the ones reviewed above, did show that a Web-based program improved outcomes. In this case, the intervention was an online videogame known as Re-Mission. Since I haven’t touched previously on outcome studies for automated lifestyle intervention tools or videogames as an example of such programs, I’ll do that here.
