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Measure Seeks More Access To Anti-Cancer Medicine

Posted: February 13, 2012 at 2:53 am

POSTED: 12:44 pm EST February 9, 2012
UPDATED: 3:52 pm EST February 9, 2012

ANNAPOLIS, Md. — Cancer patients, doctors and advocacy groups converged in Annapolis on Thursday to support a measure that increases access to cancer treatment medications.The Kathleen Mathias Chemotherapy Parity Act requires insurance companies to cover oral anti-cancer medications. The medications are now considered standard in a number of cancer treatments, but 11 News reporter David Collins said insurance companies force patients to pay for it themselves.Collins said the bill is a case of legislation catching up with medical science.The act is named after the late wife of Sen. James Mathias, an Eastern Shore Democrat.”The reason for this legislation is that it speaks to those who are paying out-of-pocket costs for oral chemotherapy cancer drugs,” said Baltimore County Democratic Delegate Shirley Nathan-Pulliam. Insurance typically covers injected chemotherapy, but not the pill form, Collins said. Some policies, but not all, cover it under a prescription drug plan.”In fact, many of these treatments have now become the standard of care,” said Dr. Paul Celano of Greater Baltimore Medical Center.Oral chemotherapy treatment is expensive, costing as much as $12,000 a month and putting families in financial turmoil, Collins said.”We maxed out our credit cards, maxed out everything,” said widower Anthony Lacey. “It was just survival. We were going to do anything to get my wife the treatment, to get her what she needed.”The legislation levels the playing field by requiring carriers to cover oral anti-cancer drugs without imposing dollar limits, co-payments or deductibles.”It's not a new benefit,” said Dr. Martin Edelman of the University of Maryland Greenebaum Cancer Center. “This is simply a truth in advertising, that people sign up for health insurance and it will cover cancer care.”Doctors said they are finding that pills work better than chemo injections, and patients notice a better quality of life.”Now I'm so successful, fortunately, that I only take half a dose each month,” said cancer patient Coard Simpler. “I take two capsules every morning before breakfast. The limitation is I can't have food within an hour of the medication. You compare that with chemotherapy, the injection process, the stress, the whole works.”Sen. Mathias said, “It's about hope. The folks who have joined me today respectfully need the benefit of this research, these drugs, now. They need them now.”Health insurance carriers oppose the bill, Collins said.Twelve states and the District of Columbia have passed legislation requiring coverage. A similar measure was introduced in the Maryland General Assembly two years ago, but was withdrawn before a vote was taken, Collins said.

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OSF’s new lung cancer clinic speeds up treatment

Posted: at 2:53 am

Dr. James McGee is not sure why lung cancer rates are so high in Peoria County.

It could be the demographics of an older, historically working class population that came of age when smoking was acceptable.

“There are so many factors,” he says. “Personally, I think environmental factors have a role in cancer rates. It’s just extremely hard to prove.”

But what he knows bothers him.

The debate over expanding a local hazardous waste landfill prompted doctors at OSF Saint Francis Medical Center to look at local cancer rates. “The numbers were very disturbing,” says McGee, medical director of radiation oncology at St. Francis and chairman of the medical center’s cancer committee.  

“Disturbing” is a word McGee uses frequently.

The occurrence of lung cancer in Tazewell and Peoria counties is much higher than the state average, higher even than the national average. The number of deaths related to lung cancer is just as bad — even worse — for African-Americans.

“If you look at the incidence rate for minority males

and the mortality rate, those numbers aren’t very different,” McGee says. “It looks like if you get lung cancer, you’re going to die from lung cancer.”

In comparison, both incidence and mortality rates for lung cancer in Cook County, home of Chicago, are lower than the state average or, in some cases, about the same as the state average, even for African-Americans.  

“Cook County is a bad county, a hot spot for lung cancer. Our rates are considerably higher. For our size, our numbers are really disturbing,” says McGee.  

But lung cancer doesn’t have to be fatal. It can be cured, according to McGee, if it’s diagnosed in the early stages.

He is part of a team undertaking a broad effort to control cancer’s spread while improving cancer’s treatment. The initiative grew out of “Spirit of Hope,” a fundraiser for cancer prevention, and grew into St. Francis’ new Comprehensive Lung Cancer Clinic.  

The clinic is not so much a standing structure as it is a different approach in organizing the care and treatment of lung cancer.

The clinic began in July, the same month Kenneth Jacob’s wife, JoAnn, died of lung cancer.

Jacob, 78, is an easy-going talker who has no qualms showing off the sickle-shaped scar on his right side, the result of his own recent lung cancer surgery. The staff on the ground floor of St. Francis’ Forest Park Building, where the radiation oncology offices are located, still remember him.     

“I just went through cancer with my wife,” Jacob says. “This time it was set up altogether different. They decided they would put all their heads together before they did anything to me.”

Jacob was diagnosed with lung cancer in mid-October. He had surgery on Nov. 29. From all appearances, he’s recovering well since surgeons removed three ribs and the upper two lobes of his right lung. On Christmas Day, he continued the family tradition of walking a mile right after dinner and just before dessert.

He recently started chemotherapy treatments and after that, he’ll undergo radiation treatments, all to assure the cancer doesn’t return.  

His wife’s cancer was more aggressive than his. “Doctors told her up front hers was not fixable,” he says. Though she had been a heavy smoker, Jacob, a retired autobody mechanic, says he never smoked more than a few after-dinner cigars over a lifetime.

Jacob was raised in Deer Creek and now lives in Creve Coeur. His mother and a brother died of lung cancer. They were both heavy smokers, he says. Jacob is optimistic about his recovery.

“They think I’m going to be OK,” he says. “That’s what they keep telling me, and that’s what I’m going on. The surgeon says he’s sure he got it all.”  

The approximate six weeks from his diagnosis to his surgery is one of the successes of the lung cancer clinic.     

The national average from the time of diagnosis to the first treatment, whether surgery, radiation or chemotherapy, is roughly 90 to 120 days. The average for Jacob and some 70 other patients who have gone through the clinic is 15 to 20 days.

Whenever there’s a new patient, a team of cancer specialists, from pulmonologist to surgeon to radiologist and pathologist, meets at 7 a.m. on a Friday at the Forest Park building. While the patient waits outside, the doctors review his tests and decide, as a group, on the best course of action.

“With all their heads together at one time, they probably knew more about exactly how to treat me,” Jacob says.

The difference, explains Jodi Stoner, the nurse navigator assigned to clinic patients, is instead of the patient visiting three or four different specialists before a plan of treatment is determined, the doctors come together and the patients gets a response on the same day.

Coordinated care doesn’t stop there. Stoner, as her title implies, keeps the clinic on course. An advanced practice nurse, she’s the one who makes sure information flows between doctors and from doctor to patient. She makes sure patients keep appointments, and she’s the one patients can reach by telephone easily if they have questions or need help, including transportation, counseling or information about smoking cessation programs.  

“I don’t usually follow them personally,” Stoner says. But, by telephone and computerized records, she knows when and where they have appointments.

Her role, along with the Friday morning meetings among specialists, fits well with healthcare reform’s emphasis on effective, efficient treatment.

“We’ve tried to eliminate a lot of wasted time,” McGee says.

St. Francis also offers affordable CT screenings for lung cancers. It’s part of an effort to catch lung cancer, which increases the chances of a cure and decreases a mortality rate McGee calls “disturbing.”

______

As part of efforts to reduce the incidence of lung cancer in central Illinois, OSF Saint Francis Medical Center now offers low-cost screenings for lung cancer.

The CT Lung Cancer Screening program follows people at risk of developing lung cancer for two years. Participants must undergo a low-dose CT scan each year. The goal is to diagnose lung cancer early, when it is most curable. 

Current or former heavy smokers who smoke, or smoked, a pack of cigarettes a day for 30 years would be an example of those at risk for lung cancer. To participate, they cannot have symptoms such as heavy cough or chest pains.

The cost, $200 for each screening, is not covered by health insurers.

For more information or to schedule a screening, call 624-5864. 

______

Pam Adams can be reached at 686-3245 or padams@pjstar.com.

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Fasting Might Boost Chemo's Cancer-Busting Properties

Posted: at 2:53 am

News | Health

A new animal study suggests that short-term starvation might improve outcomes for cancer patients undergoing chemotherapy

Hunger Gains: A new study in mice suggests that fasting might not only protect human cells against damage from chemotherapy–but that it could also make the treatment more deadly for cancer cells. Image: iStockphoto/Silvrshootr

Cancer treatment can be brutal for patients. Many of the tools we have—chemotherapy, radiation—are big, blunt weapons that deal punishing blows to healthy tissues along with cancerous ones. So the hunt has been on for more and more finely targeted therapies that will attack malignant cells yet minimize damage to patients' bodies.

But a new study shows that we might be able to catch cancer cells off guard by using an ancient and body-wide tactic: fasting.

Fasting has long been practiced as part of various cultural traditions and has, more recently, gained favor in alternative and complementary medicine practices. But researchers are still figuring out whether nutritional deprivation can prevent or cure some diseases—and if so, how.

The new study found that in mice with cancer, fasting prior to chemotherapy often led to more tumor shrinkage than chemo alone. And in some cases, the combination apparently eliminated certain kinds of cancer. This fasting–chemo combo, the researchers suggest, “could extend the survival of advanced stage cancer patients by both retarding tumor progression and reducing side effects,” they noted in their study, published online Wednesday in Science Translational Medicine. It might be able to help early-stage patients, too, they say.

One–two punch?
The new work builds on a 2008 mouse study that found fasting helped to protect healthy cells against chemotherapy's toxic effects. That finding raised flags in the cancer field. “The concern was we were also protecting the cancer cells,” says Valter Longo, a professor of biology and gerontology at the University of Southern California Davis School of Gerontology and co-author of the new paper. So he and his colleagues embarked on five years of research to see whether that was the case, testing different fasting and chemotherapy regimens on a variety of cancers—glioma, melanoma, neuroblastoma, breast and ovarian—in mice. “We not only saw that the cancer was not protected but that it was sensitized” to the chemo, he says.

In the new work, fasting mice were allowed to drink water but were not given food for at least two days. When mice with breast cancer, glioma or melanoma were subjected to two rounds of 48-hour fasting before their chemo, their tumors shrunk more than those in mice that received chemotherapy alone.

Mice that had metastasized cancer and were put on the fasting-chemo plan showed a 40 percent greater reduction in their metastases than those that had been fed before receiving chemotherapy. They also seemed to live longer after getting this treatment. With two cycles of fasting and a high dose of chemo, 42 percent of mice with one of two types of metastatic neuroblastoma lived for more than 180 days, whereas all of their well-fed, chemo-treated mice had already died by then. Fasting and chemo together had an even more dramatic effect in a third type of metastatic neuroblastoma: about a quarter of mice lived for more than 300 days, at which point they still seemed to be cancer free.

Fasting appears to protect normal cells from chemotherapy's toxic effects by rerouting energy from growing and reproducing to internal maintenance. But cancer cells do not undergo this switch to self-repair and so continue to be susceptible to drug-induced damage—making for what the researchers call a differential stress resistance. Fasting, then, the authors wrote, should enhance the power of chemotherapies without having to resort to “the more typical strategy of increasing the toxicity of drugs.”

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MMAC seeking cancer survivors

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MMAC seeking cancer survivors

The 2012 Marianas March Against Cancer committee is inviting all cancer survivors and those currently undergoing cancer treatment to register and attend the survivor dinner held in their honor at the annual event.

“Every year we hear of more and more people getting diagnosed with cancer. We also hear of more and more people beating cancer and the annual survivor dinner is our way of celebrating our loved ones who have been directly touched by cancer,” said 2012 overall MMAC chair Catherine Attao-Toves. “There will be a complimentary dinner available for all cancer survivors who register and attend. In addition, each survivor will be given a unique medallion and t-shirt in honor of their fight against this deadly affliction. We encourage survivors to attend as a show of strength and inspiration.”

To register for the survivor dinner or for more information contact survivor committee chair Nora Sablan at 235-0994 or email norasablan@gmail.com.

The 2012 Marianas March Against Cancer will be held from 6pm to 6am on April 27-28 at the Hopwood Junior High School field in Chalan Piao. Call 285-1828 or email attaoc@yahoo.com or visit http://www.ccamarianas.org for more information. (MMAC)

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OSF’s new lung cancer clinic speeds up treatment with coordinated care

Posted: at 2:53 am

Dr. James McGee is not sure why lung cancer rates are so high in Peoria County.

It could be the demographics of an older, historically working class population that came of age when smoking was acceptable.

“There are so many factors,” he says. “Personally, I think environmental factors have a role in cancer rates. It’s just extremely hard to prove.”

But what he knows bothers him.

The debate over expanding a local hazardous waste landfill prompted doctors at OSF Saint Francis Medical Center to look at local cancer rates. “The numbers were very disturbing,” says McGee, medical director of radiation oncology at St. Francis and chairman of the medical center’s cancer committee.  

“Disturbing” is a word McGee uses frequently.

The occurrence of lung cancer in Tazewell and Peoria counties is much higher than the state average, higher even than the national average. The number of deaths related to lung cancer is just as bad — even worse — for African-Americans.

“If you look at the incidence rate for minority males

and the mortality rate, those numbers aren’t very different,” McGee says. “It looks like if you get lung cancer, you’re going to die from lung cancer.”

In comparison, both incidence and mortality rates for lung cancer in Cook County, home of Chicago, are lower than the state average or, in some cases, about the same as the state average, even for African-Americans.  

“Cook County is a bad county, a hot spot for lung cancer. Our rates are considerably higher. For our size, our numbers are really disturbing,” says McGee.  

But lung cancer doesn’t have to be fatal. It can be cured, according to McGee, if it’s diagnosed in the early stages.

He is part of a team undertaking a broad effort to control cancer’s spread while improving cancer’s treatment. The initiative grew out of “Spirit of Hope,” a fundraiser for cancer prevention, and grew into St. Francis’ new Comprehensive Lung Cancer Clinic.  

The clinic is not so much a standing structure as it is a different approach in organizing the care and treatment of lung cancer.

The clinic began in July, the same month Kenneth Jacob’s wife, JoAnn, died of lung cancer.

Jacob, 78, is an easy-going talker who has no qualms showing off the sickle-shaped scar on his right side, the result of his own recent lung cancer surgery. The staff on the ground floor of St. Francis’ Forest Park Building, where the radiation oncology offices are located, still remember him.     

“I just went through cancer with my wife,” Jacob says. “This time it was set up altogether different. They decided they would put all their heads together before they did anything to me.”

Jacob was diagnosed with lung cancer in mid-October. He had surgery on Nov. 29. From all appearances, he’s recovering well since surgeons removed three ribs and the upper two lobes of his right lung. On Christmas Day, he continued the family tradition of walking a mile right after dinner and just before dessert.

He recently started chemotherapy treatments and after that, he’ll undergo radiation treatments, all to assure the cancer doesn’t return.  

His wife’s cancer was more aggressive than his. “Doctors told her up front hers was not fixable,” he says. Though she had been a heavy smoker, Jacob, a retired autobody mechanic, says he never smoked more than a few after-dinner cigars over a lifetime.

Jacob was raised in Deer Creek and now lives in Creve Coeur. His mother and a brother died of lung cancer. They were both heavy smokers, he says. Jacob is optimistic about his recovery.

“They think I’m going to be OK,” he says. “That’s what they keep telling me, and that’s what I’m going on. The surgeon says he’s sure he got it all.”  

The approximate six weeks from his diagnosis to his surgery is one of the successes of the lung cancer clinic.     

The national average from the time of diagnosis to the first treatment, whether surgery, radiation or chemotherapy, is roughly 90 to 120 days. The average for Jacob and some 70 other patients who have gone through the clinic is 15 to 20 days.

Whenever there’s a new patient, a team of cancer specialists, from pulmonologist to surgeon to radiologist and pathologist, meets at 7 a.m. on a Friday at the Forest Park building. While the patient waits outside, the doctors review his tests and decide, as a group, on the best course of action.

“With all their heads together at one time, they probably knew more about exactly how to treat me,” Jacob says.

The difference, explains Jodi Stoner, the nurse navigator assigned to clinic patients, is instead of the patient visiting three or four different specialists before a plan of treatment is determined, the doctors come together and the patients gets a response on the same day.

Coordinated care doesn’t stop there. Stoner, as her title implies, keeps the clinic on course. An advanced practice nurse, she’s the one who makes sure information flows between doctors and from doctor to patient. She makes sure patients keep appointments, and she’s the one patients can reach by telephone easily if they have questions or need help, including transportation, counseling or information about smoking cessation programs.  

“I don’t usually follow them personally,” Stoner says. But, by telephone and computerized records, she knows when and where they have appointments.

Her role, along with the Friday morning meetings among specialists, fits well with healthcare reform’s emphasis on effective, efficient treatment.

“We’ve tried to eliminate a lot of wasted time,” McGee says.

St. Francis also offers affordable CT screenings for lung cancers. It’s part of an effort to catch lung cancer, which increases the chances of a cure and decreases a mortality rate McGee calls “disturbing.”

______

As part of efforts to reduce the incidence of lung cancer in central Illinois, OSF Saint Francis Medical Center now offers low-cost screenings for lung cancer.

The CT Lung Cancer Screening program follows people at risk of developing lung cancer for two years. Participants must undergo a low-dose CT scan each year. The goal is to diagnose lung cancer early, when it is most curable. 

Current or former heavy smokers who smoke, or smoked, a pack of cigarettes a day for 30 years would be an example of those at risk for lung cancer. To participate, they cannot have symptoms such as heavy cough or chest pains.

The cost, $200 for each screening, is not covered by health insurers.

For more information or to schedule a screening, call 624-5864. 

______

Pam Adams can be reached at 686-3245 or padams@pjstar.com.

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Cancer trial participants may have misconceptions

Posted: at 2:53 am

NEW YORK (Reuters Health) – People enrolled in early stage trials for possible cancer treatments may underestimate the risks involved and overestimate the potential benefits, suggests a new study.

The early trials, known as “Phase 1,” are often the first time a new drug is given to humans and the goal of the studies is to test for side effects and acceptable dosage levels. Participation rarely benefits the person's health.

One of the new report's authors says it's well known that people taking part in early trials confuse the research for medical care, but it goes beyond that.

“What we found was that the picture of understanding is much more complicated than once thought,” said Rebecca Pentz, a research ethics professor at Emory University's School of Medicine in Atlanta who led the study.

Pentz told Reuters Health in an email that when participants describe the risks and benefits of participating in the trial, they may use their descriptions to stay hopeful. She added that they also may not understand that participating in research comes with its own risks, including extra biopsies.

For their study, the researchers interviewed and surveyed 95 patients in a Phase 1 cancer trial.

To find out if they were confusing the research for medical care, the researchers asked whether the trial was meant to help research or them as a person, and whether the study or their own physician decides what the treatments will be.

Only 31 people correctly said that the aim of the study was to benefit research and that the study decided the treatment.

Some believe the misconception may stem from early trial participants — who may have tried medications that failed, or have a rare illness for which the study drug is targeted — having few treatment options, but the researchers did not find this to be the case.

As to whether participants overestimated the trial's benefits or underestimated its risks, the researchers found that 59 people said they had a 70 percent or better chance of having some sort of personal benefit. That same number of people estimated their risk to be 30 percent or less.

The researchers said 89 people misestimated the risks and benefits.

A popular theory is that a person's optimism may cloud their judgment when evaluating what risks are involved.

While 89 people ranked their optimism level as “high,” and the authors say that may support the claim, Pentz says she was surprised to find 29 people estimated their personal benefit to be lower or their personal risk to be higher than the rest of the group. They were pessimists.

“We know that many research trial participants are optimistic that they will do better than most people on trial. But we found a significant minority who expected to do worse but still participated in the trial. We don't have an explanation for this,” Pentz told Reuters Health.

Overall, the authors write in the journal Cancer, their results show participants still confuse the research for treatment and don't understand how the two differ, despite advancements made in the last decade.

Mary Faith Marshall, a professor of bioethics at the University of Minnesota in Minneapolis, said despite the study's limitations — which include being from a single center and surveying a predominately white and affluent group — the results are consistent with past research.

“We've known for a long time that this problem exists and that there are ways to improve the informed consent process that would get at some of these problems,” said Marshall, who was not involved with the new study.

Marshall said researchers can make sure participants know the trial's intent and risks by quizzing them and avoiding language that would suggest that there are benefits.

For example, Marshall said sometimes the forms people fill out before a trial use the word “patient,” instead of something like “research participant.”

“When you see the word patient you're going to think 'therapeutic.' Why wouldn't you?” Marshall told Reuters Health.

Christine Grady, acting chief of the Department of Bioethics at the National Institutes of Health Clinical Center said federally funded research and research that will eventually be vetted by the U.S. Food and Drug Administration must meet certain requirements regarding consent.

“The regulations are not specific to Phase 1 studies. They're generic,” Grady told Reuters Health.

She added that regulations include such things as the fact that the trial is voluntary, what the expectations are, the risks and benefits and who to contact for more information.

In fact, the National Cancer Institute, which provided funding for Pentz's study, has a consent form template available on the agency's website.

But Marshall said it's understandable that people can be confused, especially if they're suffering from cancer or in other stressful situations.

“If you have a diagnosis of cancer it's a hugely stressful time. Even when investigators and their staff do the best job, we forget things,” said Marshall.

SOURCE: http://bit.ly/zBXLvn Cancer, online January 31, 2012.

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New Release of NCCN Guidelines for Patients: Colon Cancer; Updated NCCN Guidelines for Patients: Prostate Cancer

Posted: at 2:53 am

FORT WASHINGTON, Pa.–(BUSINESS WIRE)–

In order to provide people with cancer and their caregivers state-of-the-art treatment information in patient-friendly language, the National Comprehensive Cancer Network® (NCCN®) has developed two new publications: a new release of the NCCN Guidelines for Patients™: Colon Cancer and an update to the NCCN Guidelines for Patients™: Prostate Cancer. The guidelines provide a framework to help people with cancer talk with their physician about the best treatment options.

According to the 2012 annual report from the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) (Seigel, Naishadham, & Jemal, 2012), colon cancer is the fourth most common cancer in the United States. The newly released NCCN Guidelines for Patients™: Colon Cancer include a treatment guide covering the different stages of colon cancer from early detection and diagnosis throughout treatment, across the entire continuum of care. The guidelines describe tests and treatment options for colon cancer, along with treatment side effects. A thorough glossary is included to aid patients with medical terminology. These guidelines suggest the best practice for colon cancer care and support enrollment into clinical trials when appropriate.

Prostate cancer is a complex disease; fortunately there is a dearth of sound data to support treatment recommendations. NCCN’s Guidelines for Patients™: Prostate Cancer cover several variables (including life expectancy, disease characteristics, predicted outcomes, and patient preferences) that should be considered by the patient and the physician in tailoring prostate cancer therapy to the individual patient. The guidelines provide information that will help people with prostate cancer and their friends and family understand the cancer, and further to help them talk with their cancer care team about the best treatment options. In particular, the guidelines give treatment recommendations based on the characteristics of the cancer possible side effects of treatments, and a side-by-side comparison of the main benefits and disadvantages of the treatments for prostate cancer.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) are the most widely used guidelines in oncology practice; physicians around the globe use the NCCN Guidelines when determining appropriate cancer treatment for their patients. The NCCN Guidelines for Patients™ present the same information that physicians use when making treatment decisions for people with cancer, and provide it in an easy-to-understand format.

The NCCN Guidelines for Patients™: Colon Cancer and Prostate Cancer are available free of charge on-line at NCCN.com and NCCN.org. The updated NCCN Guidelines for Patients™: Prostate Cancer is also available in print booklet format. To request a hard copy of this resource, e-mail patientguidelines@nccn.org.

Through the support of the NCCN Foundation, NCCN now offers a library of nine NCCN Guidelines for Patients™, including those on breast, colon, ovarian, non-small cell lung and prostate cancers, as well as chronic myelogenous leukemia, malignant pleural mesothelioma, melanoma, and multiple myeloma. All of these Guidelines are available free of charge at NCCN.com, which also features informative articles for patients and caregivers. These guidelines are also featured on NCCN.org.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. 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 primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives.

The NCCN Member Institutions are: 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; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, 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/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas MD Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.

Clinicians, visit NCCN.org. Patients and caregivers, visit NCCN.com.

NCCN aims to provide people with cancer and the general public state-of-the- art cancer treatment information in easy-to-understand language. The NCCN Guidelines for Patients™, translations of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), are meant to help patients with cancer talk with their physician about the best treatment options. These guidelines do not replace the expertise and clinical judgment of the physician.

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New Release of NCCN Guidelines for Patients: Colon Cancer; Updated NCCN Guidelines for Patients: Prostate Cancer

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For pregnant women with cancer, chemo possible

Posted: at 2:53 am

LONDON (AP) — Researchers have encouraging news for women who find themselves in a very frightening situation: having cancer while pregnant. Studies suggest that these women can be treated almost the same as other cancer patients are, with minimal risk to the fetus.

Only about 1 in 1,000 pregnant women face this dilemma, but doctors fear that more will because the risk of cancer rises with age, and more women are delaying having children until they're older.

Doctors have long worried about how to balance treating a pregnant woman with cancer and the need to protect her fetus from the effects of toxic cancer drugs and radiation treatments, and whether it is safe to continue a pregnancy in certain situations. A series of papers in the journals Lancet and Lancet Oncology published Friday make several key contributions:

— A Belgian-led study of 70 children in Europe exposed to chemotherapy while they were in the womb found they developed just as well as other children, according to tests on their hearts, IQ and general health. They were assessed at birth, 18 months, and every few years until age 18.

— Chemotherapy after the first trimester is possible, using extra ultrasounds to ensure the baby is developing properly. Radiation therapy is best done in the first two trimesters, when the baby is small enough to be covered with a lead blanket, according to a review of previous studies, led by Belgian researchers.

— Ending the pregnancy doesn't improve chances for the mother, the same study found.

— The type of cancer seems to matter: An Israeli analysis of past research suggested pregnant women with blood cancers might want to terminate an early pregnancy when chemotherapy can't be delayed.

— Another review of previous studies by French and American researchers concluded doctors should aim to preserve pregnancy in women with cervical or ovarian cancers where possible.

“Many (doctors) aren't keen to give chemotherapy to pregnant women and may even recommend termination,” said Dr. Frederic Amant of the Leuven Cancer Institute in Belgium, an author of two of the papers. “But treating a pregnant woman with cancer doesn't have to be so different from treating a cancer patient who isn't pregnant.”

Amant, who led the study of 70 children, said most of the children with cognitive problems were born premature, and that was probably the primary cause of their delayed development.

“Doctors will often err on the side of caution and deliver a baby early to avoid the effects of chemotherapy,” said Dr. Catherine Nelson-Piercy, an obstetric physician and spokeswoman for Britain's Royal College of Obstetricians and Gynaecologists.

“These data don't say that chemotherapy is completely safe, but the baby is better off being in (the mother) as long as possible,” she said. Nelson-Piercy was not linked to the Lancet series and often works with pregnant women diagnosed with cancer or other illnesses.

Dr. Richard Theriault, a professor of medicine at the MD Anderson Cancer Center in Texas, said he hoped the papers would change how doctors treat pregnant cancer patients.

“Terminating a pregnancy is not always necessary,” said Theriault, who heads a program to treat pregnant women with cancer. He said a minority of pregnant women with cancer still get abortions.

He said the placenta seems to act as a kind of filter for chemotherapy drugs, restricting their effects on the fetus. “There's the phenomenon of the bald mother who gives birth to a baby with a full head of hair,” he said. “It seems to suggest not as much gets to the baby as we thought.”

That was certainly Caroline Swain's experience, who was diagnosed with breast cancer while pregnant with her second son. She had her left breast and many lymph nodes removed and had to wait until her fetus was 12 weeks old before starting chemotherapy.

“I was just so grateful it was possible to have treatment and keep my baby,” said Swain, 45, who lives near London. “I was scared that my child wouldn't remember me if something happened to me.”

Her son Luke, now 9, weighed in at 7.4 pounds (3.35 kilograms) when he was born, only slightly lighter than his older brother Max a year earlier.

“We had celebrations all around when Luke came out absolutely fine,” Swain said of her and her husband Rowland's relief at the birth. “Luke is no different from his brother,” she said. “They both love Legos and X-Box.”

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Smoking May Up Cancer Risk in Barrett's Esophagus Patients

Posted: at 2:53 am

FRIDAY, Feb. 10 (HealthDay News) — People with the condition called Barrett's esophagus who are smokers may have double the risk of developing esophageal cancer, a new study warns.

These people also have twice the risk of developing advanced precancerous cells, according to the study in the February issue of Gastroenterology.

“We found that tobacco smoking emerged as the strongest lifestyle risk factor for cancer progression. Contrary to popular belief, alcohol consumption didn't increase cancer risk in this group of patients with Barrett's esophagus,” lead author Helen Coleman, of Queen's University Belfast in Northern Ireland, said in a news release from the American Gastroenterological Association.

In people with Barrett's esophagus, damage caused by stomach acid causes the lining of the esophagus to become similar to the lining of the stomach, according to the U.S. MedlinePlus Medical Encyclopedia. Most people with Barrett's esophagus do not develop esophageal cancer.

For the study, researchers looked at more than 3,000 Barrett's esophagus patients worldwide and identified 117 cases of dysplasia or cancers of the esophagus or stomach.

Current smoking, regardless of the number of cigarettes smoked per day, was significantly associated with an increased risk of esophageal cancer. Therefore, cutting down on cigarette consumption may not be enough to reduce the risk of esophageal cancer in people with Barrett's esophagus, the researchers suggested.

“Tobacco smoking has been long established as highly carcinogenic,” Coleman said. “Barrett's esophagus patients who smoke should start a cessation program immediately.”

Although the study authors pointed out that more research is needed to confirm the findings, and the association noted in the study did not prove a cause-and-effect relationship between smoking and esophageal cancer in these patients, Coleman's team suggested that smoking should be discouraged.

The investigators also noted that developed countries have seen a rise in the incidence of esophageal cancer.

More information

The U.S. National Cancer Institute has more about esophageal cancer prevention.

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Prostate Size May Be Clue to Severity of Cancer

Posted: at 2:52 am

FRIDAY, Feb. 10 (HealthDay News) — The size of a man's prostate gland may help doctors predict the severity of his prostate cancer, according to a new study.

Researchers from the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., found smaller prostates that produce higher levels of prostate specific antigen (PSA) in the blood are more often linked to serious forms of prostate cancer that require aggressive treatment.

“There's nothing about size that would necessarily predict a bad outcome. What it's really about is the ratio of PSA to size, or PSA density, meaning that a small prostate that is making a lot of PSA is likely to be due to a bad tumor, whereas a large prostate making a lot of PSA is likely to be due to benign enlargement of the prostate (BPH),” said the study's senior author, Dr. Daniel Barocas, an assistant professor of urologic surgery, in a university news release.

The study's authors suggest the findings could help doctors determine the best course of treatment for patients with prostate cancer. For instance, low-risk patients with a small prostate might benefit from aggressive treatment.

In conducting the study, they analyzed about 1,250 cases of prostate cancer among men who had their prostate gland removed but were considered to be low-risk because their cancer was classified as low grade.

Within that group, the researchers zeroed in on patients whose risk was considered so low that they might have qualified for less aggressive treatment, including watching and waiting. The study found that in 31 percent of cases considered low-risk in pre-surgical analysis, the prostate cancer was upgraded to more serious once pathologists examined the tissue removed during surgery. The researchers found men with smaller prostates were more likely to be among this group.

The study was recently published in the Journal of Urology.

The researchers pointed out that the findings are significant since men with prostate cancer who are considered low-risk may receive less aggressive treatment or just be placed under observation.

“Our field suffers from this great confusion because in half of men you can find prostate cancer in microscopic amounts that may not be clinically significant and yet it's the second leading cause of cancer death among men,” Barocas noted. “The more you look for it, the more you find it but that doesn't help us figure out who needs treatment and who doesn't.”

The researchers cautioned that more accurate tests are still needed to determine which cancers are actually threatening to patients.

“The imaging for prostate cancer is relatively weak because the disease tends to be diffuse, rather than growing in what we think of as a tumor — a spherical nodule. Prostate cancer tends to grow along the glands in a sort of flat pattern, so it's a little harder to detect. A better test, which we don't yet have, would reliably image or identify where in the prostate the tumor lies,” Barocas added.

More information

The U.S. National Institutes of Health provides more information on prostate cancer.

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