Testing a lung cancer patient's blood could help doctors predict the likely success of chemotherapy treatment.
UK scientists identified a molecule made by a more aggressive form of the disease, the journal Clinical Cancer Research reported.
Patients with this in their blood were less likely to respond to drugs, they said.
Cancer Research UK said the discovery could help doctors choose the right kind of treatment for patients.
Lung cancer kills more than 30,000 people in the UK every year, and survival rates have not improved alongside those for breast or bowel cancer in recent years.
There is more than one type of lung cancer, but the variety under investigation by Liverpool-based researchers, small-cell lung cancer, which accounts for between 15% and 20% of cases, is one of the more difficult to treat.
Even small cell lung cancer comes in different forms, with a version called "neuroendocrine" being the least likely to be treated successfully.
The researchers found that a molecule called SCG3 mRNA was more likely to be found in the blood of people with neuroendocrine small cell cancer.
In theory, if larger studies back this up, it could mean that patients arriving at the clinic could be tested to give doctors an idea of the likely success of therapy - or perhaps to predict when a patient was relapsing before other signs emerged.
No tests
It might also make it easier for scientists, when looking at new chemotherapy treatments in trials, to compare their effectiveness in different groups of small cell lung cancer patients.
Dr Judy Coulson, from the University of Liverpool, said: "There are currently no blood-based markers routinely used to monitor patients with this type of lung cancer.
"We found that SCG3 mRNA is an incredibly sensitive marker of these tumours and could be used to detect circulating tumour cells in patients with this disease."
Lesley Walker, from Cancer Research UK, said: "This discovery is an important step to understanding how to treat lung cancer patients more effectively.
"Lung cancer can be very difficult to treat in its later stages, either because it has spread or because there are too many tumours."
Sunday, March 8, 2009
Family Members Of Critically Ill Patients Want To Discuss Loved Ones' Uncertain Prognoses
Critically ill patients frequently have uncertain prognoses, but their families overwhelmingly wish that physicians would address prognostic uncertainty candidly, according to a new study out of the University of San Francisco Medical Center.
"Our interviews revealed that caregivers appear to believe that some uncertainty is unavoidable, and just the nature of life," said lead author Douglas White, M.D., M.A.S., assistant professor in UCSF's Division of Pulmonary and Critical Care Medicine and the UCSF Program in Medical Ethics. "The vast majority of families of critically ill patients want physicians to openly discuss the prognosis, even when physicians can't be certain that their estimates are correct."
But past research showing that physicians are reluctant to discuss uncertain prognoses reveals a schism between families' wishes and physicians' comfort.
The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Between January 2006 and October 2007, researchers at the University of San Francisco Medical Center conducted face-to-face interviews with 179 surrogate decision-makers for patients in four separate intensive care units (ICUs). The interviews explored surrogates' attitudes about whether physicians should discuss prognoses when they cannot be certain their prognostic estimates are correct.
When asked whether they would prefer to hear physicians' prognoses, 87 percent of caregivers indicated that they would want to be told of all prognostic estimates, even if the estimates were tentative. Most also indicated that they appreciated a physician's candor in discussing uncertain outcomes as honest, rather than seeing it as a source of confusion or anxiety.
"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process," Dr. White said. "I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."
Dr. White also noted that while the majority of family members indicated that they did want physicians to discuss all possible outcomes, a not-insignificant portion - 12 percent - said they did not want to discuss uncertain prognoses, indicating that a "one-size-fits-all" approach is insufficient in critical care situations.
"Our findings suggest that physicians need to develop the skills to understand the unique needs of surrogates, and then tailor their approach to discussing prognosis to meet those needs," he said. "This is an area in need of well-designed quantitative and qualitative studies."
Dr. White and his colleagues are currently involved in a follow-up study to help family members navigate the process of surrogate decision making in the ICU setting.
John Heffner, M.D., past president of the ATS, emphasized that the results of this study parallel previous investigations that examined patient and family preferences in discussing do-not-resuscitate orders and end-of-life care. "In almost all studies, patients and families express a desire for clear information to inform their decisions. Although physicians often wish to shelter their patients and patient families from what might seem to be harsh realities, the human spirit is resilient. Patients and families access to information from their doctors."
"Our interviews revealed that caregivers appear to believe that some uncertainty is unavoidable, and just the nature of life," said lead author Douglas White, M.D., M.A.S., assistant professor in UCSF's Division of Pulmonary and Critical Care Medicine and the UCSF Program in Medical Ethics. "The vast majority of families of critically ill patients want physicians to openly discuss the prognosis, even when physicians can't be certain that their estimates are correct."
But past research showing that physicians are reluctant to discuss uncertain prognoses reveals a schism between families' wishes and physicians' comfort.
The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Between January 2006 and October 2007, researchers at the University of San Francisco Medical Center conducted face-to-face interviews with 179 surrogate decision-makers for patients in four separate intensive care units (ICUs). The interviews explored surrogates' attitudes about whether physicians should discuss prognoses when they cannot be certain their prognostic estimates are correct.
When asked whether they would prefer to hear physicians' prognoses, 87 percent of caregivers indicated that they would want to be told of all prognostic estimates, even if the estimates were tentative. Most also indicated that they appreciated a physician's candor in discussing uncertain outcomes as honest, rather than seeing it as a source of confusion or anxiety.
"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process," Dr. White said. "I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."
Dr. White also noted that while the majority of family members indicated that they did want physicians to discuss all possible outcomes, a not-insignificant portion - 12 percent - said they did not want to discuss uncertain prognoses, indicating that a "one-size-fits-all" approach is insufficient in critical care situations.
"Our findings suggest that physicians need to develop the skills to understand the unique needs of surrogates, and then tailor their approach to discussing prognosis to meet those needs," he said. "This is an area in need of well-designed quantitative and qualitative studies."
Dr. White and his colleagues are currently involved in a follow-up study to help family members navigate the process of surrogate decision making in the ICU setting.
John Heffner, M.D., past president of the ATS, emphasized that the results of this study parallel previous investigations that examined patient and family preferences in discussing do-not-resuscitate orders and end-of-life care. "In almost all studies, patients and families express a desire for clear information to inform their decisions. Although physicians often wish to shelter their patients and patient families from what might seem to be harsh realities, the human spirit is resilient. Patients and families access to information from their doctors."
Test could offer lung cancer clue
Testing a lung cancer patient's blood could help doctors predict the likely success of chemotherapy treatment.
UK scientists identified a molecule made by a more aggressive form of the disease, the journal Clinical Cancer Research reported.
Patients with this in their blood were less likely to respond to drugs, they said.
Cancer Research UK said the discovery could help doctors choose the right kind of treatment for patients.
Lung cancer kills more than 30,000 people in the UK every year, and survival rates have not improved alongside those for breast or bowel cancer in recent years.
There is more than one type of lung cancer, but the variety under investigation by Liverpool-based researchers, small-cell lung cancer, which accounts for between 15% and 20% of cases, is one of the more difficult to treat.
Even small cell lung cancer comes in different forms, with a version called "neuroendocrine" being the least likely to be treated successfully.
The researchers found that a molecule called SCG3 mRNA was more likely to be found in the blood of people with neuroendocrine small cell cancer.
In theory, if larger studies back this up, it could mean that patients arriving at the clinic could be tested to give doctors an idea of the likely success of therapy - or perhaps to predict when a patient was relapsing before other signs emerged.
No tests
It might also make it easier for scientists, when looking at new chemotherapy treatments in trials, to compare their effectiveness in different groups of small cell lung cancer patients.
Dr Judy Coulson, from the University of Liverpool, said: "There are currently no blood-based markers routinely used to monitor patients with this type of lung cancer.
"We found that SCG3 mRNA is an incredibly sensitive marker of these tumours and could be used to detect circulating tumour cells in patients with this disease."
Lesley Walker, from Cancer Research UK, said: "This discovery is an important step to understanding how to treat lung cancer patients more effectively.
"Lung cancer can be very difficult to treat in its later stages, either because it has spread or because there are too many tumours."
UK scientists identified a molecule made by a more aggressive form of the disease, the journal Clinical Cancer Research reported.
Patients with this in their blood were less likely to respond to drugs, they said.
Cancer Research UK said the discovery could help doctors choose the right kind of treatment for patients.
Lung cancer kills more than 30,000 people in the UK every year, and survival rates have not improved alongside those for breast or bowel cancer in recent years.
There is more than one type of lung cancer, but the variety under investigation by Liverpool-based researchers, small-cell lung cancer, which accounts for between 15% and 20% of cases, is one of the more difficult to treat.
Even small cell lung cancer comes in different forms, with a version called "neuroendocrine" being the least likely to be treated successfully.
The researchers found that a molecule called SCG3 mRNA was more likely to be found in the blood of people with neuroendocrine small cell cancer.
In theory, if larger studies back this up, it could mean that patients arriving at the clinic could be tested to give doctors an idea of the likely success of therapy - or perhaps to predict when a patient was relapsing before other signs emerged.
No tests
It might also make it easier for scientists, when looking at new chemotherapy treatments in trials, to compare their effectiveness in different groups of small cell lung cancer patients.
Dr Judy Coulson, from the University of Liverpool, said: "There are currently no blood-based markers routinely used to monitor patients with this type of lung cancer.
"We found that SCG3 mRNA is an incredibly sensitive marker of these tumours and could be used to detect circulating tumour cells in patients with this disease."
Lesley Walker, from Cancer Research UK, said: "This discovery is an important step to understanding how to treat lung cancer patients more effectively.
"Lung cancer can be very difficult to treat in its later stages, either because it has spread or because there are too many tumours."
Two Key Cases Challenge Philip Morris on Early-Stage Lung Cancer Detection
A Massachusetts federal judge sent legal questions raised by a lawsuit, which demands that cigarette maker Philip Morris USA Inc. provide early-stage lung cancer detection, to the Supreme Judicial Court of Massachusetts, while a similar New York federal case awaits a decision on class certification.
The purported class action in the U.S. District Court for the District of Massachusetts has two named plaintiffs, but is filed on behalf of Massachusetts residents at least 50 years old who smoked Marlboro cigarettes for at least 20 so-called pack years, which the complaint defines as the number of packs per day multiplied by the number of years the plaintiff smoked. Donovan v. Philip Morris USA Inc., No. 1:06-cv-12234 (D. Mass.).
The complaint further defines the class as current smokers, or those who have quit within the past year, who do not have lung cancer. The lawsuit asks Philip Morris to provide low-dose computed tomography (CT) scanning, which detects lung cancer when it is at an early, curable stage.
The claims include breach of implied warranty, defective design and negligent design and testing based on the allegation that the company knew that cigarettes were not safe for human use. Other claims include violation of the Massachusetts Consumer Protection Act and unfair methods of competition and unfair or deceptive acts and practices under Massachusetts state law.
In an order dated Dec. 31, 2008, and released on Jan. 5, U.S. District Judge Nancy Gertner certified two questions about the case to the state's Supreme Judicial Court. Gertner asked the state's highest court to answer whether the plaintiffs' medical monitoring lawsuit states a claim under state law "based on the subcelluar effects of exposure to cigarette smoke and consequent increased risk of lung cancer." Gertner also asked the court to answer whether the statue of limitations has expired on such claims.
Gertner ordered the parties to submit a joint proposed statement of facts by Jan. 12.
Steven Phillips, a partner at the lead firm on the case, New York's Levy, Phillips & Konigsberg, said he's confident the Massachusetts Supreme Judicial Court will rule in favor of allowing the medical monitoring claims. "We both hope and expect that they see things our way," Phillips said.
A similar case is awaiting a decision on class certification in the Eastern District of New York. Claims in that case include strict liability for defective design, negligent design and testing and breach of implied warranty. Caronia v. Philip Morris USA Inc., No. 1:06-cv-00224 (E.D.N.Y.).
Nobody is opposed to medical monitoring as a public health tool, but the question is whether this is a viable legal theory that can be pursued in a lawsuit, said Jack Marshall, a spokesman for Philip Morris' parent company Altria Group Inc.
"Although the plaintiffs' counsel has come up with a creative and innovative theory in this instance, most states don't recognize medical monitoring as a remedy or a cause of action," said Marshall. "We expect the cases to be dismissed."
The purported class action in the U.S. District Court for the District of Massachusetts has two named plaintiffs, but is filed on behalf of Massachusetts residents at least 50 years old who smoked Marlboro cigarettes for at least 20 so-called pack years, which the complaint defines as the number of packs per day multiplied by the number of years the plaintiff smoked. Donovan v. Philip Morris USA Inc., No. 1:06-cv-12234 (D. Mass.).
The complaint further defines the class as current smokers, or those who have quit within the past year, who do not have lung cancer. The lawsuit asks Philip Morris to provide low-dose computed tomography (CT) scanning, which detects lung cancer when it is at an early, curable stage.
The claims include breach of implied warranty, defective design and negligent design and testing based on the allegation that the company knew that cigarettes were not safe for human use. Other claims include violation of the Massachusetts Consumer Protection Act and unfair methods of competition and unfair or deceptive acts and practices under Massachusetts state law.
In an order dated Dec. 31, 2008, and released on Jan. 5, U.S. District Judge Nancy Gertner certified two questions about the case to the state's Supreme Judicial Court. Gertner asked the state's highest court to answer whether the plaintiffs' medical monitoring lawsuit states a claim under state law "based on the subcelluar effects of exposure to cigarette smoke and consequent increased risk of lung cancer." Gertner also asked the court to answer whether the statue of limitations has expired on such claims.
Gertner ordered the parties to submit a joint proposed statement of facts by Jan. 12.
Steven Phillips, a partner at the lead firm on the case, New York's Levy, Phillips & Konigsberg, said he's confident the Massachusetts Supreme Judicial Court will rule in favor of allowing the medical monitoring claims. "We both hope and expect that they see things our way," Phillips said.
A similar case is awaiting a decision on class certification in the Eastern District of New York. Claims in that case include strict liability for defective design, negligent design and testing and breach of implied warranty. Caronia v. Philip Morris USA Inc., No. 1:06-cv-00224 (E.D.N.Y.).
Nobody is opposed to medical monitoring as a public health tool, but the question is whether this is a viable legal theory that can be pursued in a lawsuit, said Jack Marshall, a spokesman for Philip Morris' parent company Altria Group Inc.
"Although the plaintiffs' counsel has come up with a creative and innovative theory in this instance, most states don't recognize medical monitoring as a remedy or a cause of action," said Marshall. "We expect the cases to be dismissed."
If smoking is so bad for you, who still does it?
It seems that studies on the dangers of smoking come out every week. Just recently, after an article appeared in the journal Pediatrics, we were introduced to the concept of third-hand smoke, the potentially toxic residue that lingers in curtains, clothing, hair, etc. after the smoke itself blows away.
To recap: Smoking exponentially increases your risk of developing lung cancer (and other lung diseases, like emphysema and chronic bronchitis) and puts you at higher risk for cancer of the mouth, throat, larynx, esophagus, bladder, pancreas, kidney, cervix and stomach. Smoking also elevates the risk of cardiovascular disease, stroke and insulin resistance. And, as if all that weren't bad enough, it causes wrinkles.
Yet stand on virtually any streetcorner of any city or town in the United States, and you will see people smoking.
So, who exactly -- in the face of all the mounting scientific evidence, social stigma and legal bans -- still lights up?
According to the CDC, about 43.4 million Americans (19.8 percent of the population) smoke.
Look around you. If you are in Kentucky, the state with the highest smoking rate, more than one out of every four people (28.3 percent) around you smokes. On the other end of the spectrum is Utah, with just over one person in 10 (11.7 percent) a smoker. Find the smoking rate in your state »
Here's the good news: "Smoking prevalence in the entire country has gone under 20 percent for first time in over 50 years," said Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic. "For women, it's 18 percent in most places, and for men it's hovering at about 20 percent. We have gone from one in two men smoking to one in five -- a very dramatic change -- and one in three women to one in five."
Here's the bad news: Smoking rates are unlikely to drop to the national health objective of 12 percent by 2010. Hurt, who is also a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, is a former three-pack-a-day smoker. Unlike most smokers, he picked up the habit during college; according to the CDC, about 90 percent of heavy smokers start in high school. And studies show that the younger you are when you start, the more likely you'll become a heavy smoker as an adult.
According to the American Cancer Society, each day more than 3,500 people younger than 18 try their first cigarette, and 1,100 others become regular daily smokers. About one-third of these kids will eventually die from a smoking-related disease.
Retired radio broadcaster and iReporter Gerald Dimmitt, 65, has smoked since he was 14.
"I've always smoked a pipe," he said. "I have successfully quit about 40 times." But, he says, he always restarted, because "it calms me down." iReport.com: Do you still smoke?
Dimmitt has even more incentive to quit now, since developing lesions and irritation in his mouth. After speaking to his doctor, he received a prescription for Chantix, a pill to aid with smoking cessation. But when he went to pick up his prescription at the pharmacy, he was charged $139 (because it's not generic) for two weeks worth. Outraged, he left the Chantix behind.
"If smoking is so dangerous ... why then do they want to charge $139 to make me stop? There is something very wrong with that. I guess they would rather pay to take care of lung cancer," he said.
Some would-be smokers pick up their first cigarette to fit in.
"I started smoking at 12 years old to be part of the 'in' crowd. It never got me into the 'in' crowd, but with my first cigarette, I was totally hooked," wrote Lori Jerome, 45, a former bartender and now full-time university student from Canada. Said Lisa "Smith," 44, a recently laid-off administrator from Minnesota, "I began smoking in junior high school because I wanted to fit in with a certain crowd. However, that group of friends is looooong gone from my life and I still have the nasty habit." Smith didn't want her last name used.
Hurt says the reason many people start, and continue, is peer influence. But he also blames targeted promotions by tobacco companies (like Virginia Slims targeting women in the 1970s and other brands targeting inner-city minority groups today) and the movies. "There is a lot of research right now that shows that smoking in the movies has made a comeback. ... It clearly affects start-up smoking among young people."
As for things that prevent children from smoking, Hurt cites higher cigarette taxes and smoke-free zones, like offices and restaurants.
"Those two public health policies do three things: reduce smoking among continuing smokers, help people to stop smoking and reduce the chances of our children starting to smoke, because it de-normalizes it. ... The child interprets smoke-free as the social norm," he said. That's why children of smokers are much more likely to become smokers themselves: Smoke-filled surroundings is their norm.
Of course, society's perception of smoking has changed a lot since the days of doctors actually endorsing one brand or another in the first half of last century. Dimmitt recalls "ashtrays in church pews, smoking in the classroom and blowing pipe smoke all over the students!"
"When I was born, my mother was allowed to smoke in the hospital room with me in there," Jerome said. "When I had my adult children, we were allowed to smoke in the day room on the maternity ward floor, although the babies were not allowed in there. When I had my youngest children, ages 5 and 8 now, you couldn't smoke in the hospital. How the times have changed."
Now, smokers in some places face smoking bans in certain public and private spaces, and unspoken -- and sometimes overt -- hostilities.
Smith, a mother of six, wrote, "It's so socially unacceptable where I live, and none of my current friends or relatives smoke. In fact, I don't even smoke out in public anymore -- unless it's dark and I'm in my car. I feel it's such a disgusting and stinky habit."
Dulcie Long, 50, of Denver, Colorado, said, "I won't say I feel actual 'social discrimination,' but it is something I feel a sense of shame about and do my best not to smoke in the presence of friends. None of my friends smoke, and I'm very uncomfortable doing it anywhere near them."
Even Dimmitt switched from a pipe to cigarettes when he was working with youngsters so he wouldn't reek so much.
Not only have attitudes towards smoking changed, the profile of smokers has changed, too. "The demographics have changed so much that now, more often than not, it's the disadvantaged who are still smoking compared to the highly educated, highly trained people," Hurt said. "It is pretty clear that the prevalence of smoking in groups of people is related to education status, which is a surrogate for income status. ... When you go down the income ladder, the smoking prevalence rises. Some groups of severely disadvantaged people have smoking rates of 30 to 40-plus percent."
Hurt says that there is also a much higher prevalence of smoking among people with mental health disorders like depression, alcoholics, drug users and schizophrenics.
But movers and shakers are not immune. President-elect Barack Obama has struggled with, and seems to have conquered, his habit. Former President Clinton was known to sit on the balcony of the White House and enjoy a cigar (his wife, Secretary of State-designate Hilary Clinton, officially made the White House a smoke-free zone). First lady Laura Bush admits to being an ex-smoker.
To recap: Smoking exponentially increases your risk of developing lung cancer (and other lung diseases, like emphysema and chronic bronchitis) and puts you at higher risk for cancer of the mouth, throat, larynx, esophagus, bladder, pancreas, kidney, cervix and stomach. Smoking also elevates the risk of cardiovascular disease, stroke and insulin resistance. And, as if all that weren't bad enough, it causes wrinkles.
Yet stand on virtually any streetcorner of any city or town in the United States, and you will see people smoking.
So, who exactly -- in the face of all the mounting scientific evidence, social stigma and legal bans -- still lights up?
According to the CDC, about 43.4 million Americans (19.8 percent of the population) smoke.
Look around you. If you are in Kentucky, the state with the highest smoking rate, more than one out of every four people (28.3 percent) around you smokes. On the other end of the spectrum is Utah, with just over one person in 10 (11.7 percent) a smoker. Find the smoking rate in your state »
Here's the good news: "Smoking prevalence in the entire country has gone under 20 percent for first time in over 50 years," said Dr. Richard Hurt, director of the Nicotine Dependence Center at the Mayo Clinic. "For women, it's 18 percent in most places, and for men it's hovering at about 20 percent. We have gone from one in two men smoking to one in five -- a very dramatic change -- and one in three women to one in five."
Here's the bad news: Smoking rates are unlikely to drop to the national health objective of 12 percent by 2010. Hurt, who is also a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, is a former three-pack-a-day smoker. Unlike most smokers, he picked up the habit during college; according to the CDC, about 90 percent of heavy smokers start in high school. And studies show that the younger you are when you start, the more likely you'll become a heavy smoker as an adult.
According to the American Cancer Society, each day more than 3,500 people younger than 18 try their first cigarette, and 1,100 others become regular daily smokers. About one-third of these kids will eventually die from a smoking-related disease.
Retired radio broadcaster and iReporter Gerald Dimmitt, 65, has smoked since he was 14.
"I've always smoked a pipe," he said. "I have successfully quit about 40 times." But, he says, he always restarted, because "it calms me down." iReport.com: Do you still smoke?
Dimmitt has even more incentive to quit now, since developing lesions and irritation in his mouth. After speaking to his doctor, he received a prescription for Chantix, a pill to aid with smoking cessation. But when he went to pick up his prescription at the pharmacy, he was charged $139 (because it's not generic) for two weeks worth. Outraged, he left the Chantix behind.
"If smoking is so dangerous ... why then do they want to charge $139 to make me stop? There is something very wrong with that. I guess they would rather pay to take care of lung cancer," he said.
Some would-be smokers pick up their first cigarette to fit in.
"I started smoking at 12 years old to be part of the 'in' crowd. It never got me into the 'in' crowd, but with my first cigarette, I was totally hooked," wrote Lori Jerome, 45, a former bartender and now full-time university student from Canada. Said Lisa "Smith," 44, a recently laid-off administrator from Minnesota, "I began smoking in junior high school because I wanted to fit in with a certain crowd. However, that group of friends is looooong gone from my life and I still have the nasty habit." Smith didn't want her last name used.
Hurt says the reason many people start, and continue, is peer influence. But he also blames targeted promotions by tobacco companies (like Virginia Slims targeting women in the 1970s and other brands targeting inner-city minority groups today) and the movies. "There is a lot of research right now that shows that smoking in the movies has made a comeback. ... It clearly affects start-up smoking among young people."
As for things that prevent children from smoking, Hurt cites higher cigarette taxes and smoke-free zones, like offices and restaurants.
"Those two public health policies do three things: reduce smoking among continuing smokers, help people to stop smoking and reduce the chances of our children starting to smoke, because it de-normalizes it. ... The child interprets smoke-free as the social norm," he said. That's why children of smokers are much more likely to become smokers themselves: Smoke-filled surroundings is their norm.
Of course, society's perception of smoking has changed a lot since the days of doctors actually endorsing one brand or another in the first half of last century. Dimmitt recalls "ashtrays in church pews, smoking in the classroom and blowing pipe smoke all over the students!"
"When I was born, my mother was allowed to smoke in the hospital room with me in there," Jerome said. "When I had my adult children, we were allowed to smoke in the day room on the maternity ward floor, although the babies were not allowed in there. When I had my youngest children, ages 5 and 8 now, you couldn't smoke in the hospital. How the times have changed."
Now, smokers in some places face smoking bans in certain public and private spaces, and unspoken -- and sometimes overt -- hostilities.
Smith, a mother of six, wrote, "It's so socially unacceptable where I live, and none of my current friends or relatives smoke. In fact, I don't even smoke out in public anymore -- unless it's dark and I'm in my car. I feel it's such a disgusting and stinky habit."
Dulcie Long, 50, of Denver, Colorado, said, "I won't say I feel actual 'social discrimination,' but it is something I feel a sense of shame about and do my best not to smoke in the presence of friends. None of my friends smoke, and I'm very uncomfortable doing it anywhere near them."
Even Dimmitt switched from a pipe to cigarettes when he was working with youngsters so he wouldn't reek so much.
Not only have attitudes towards smoking changed, the profile of smokers has changed, too. "The demographics have changed so much that now, more often than not, it's the disadvantaged who are still smoking compared to the highly educated, highly trained people," Hurt said. "It is pretty clear that the prevalence of smoking in groups of people is related to education status, which is a surrogate for income status. ... When you go down the income ladder, the smoking prevalence rises. Some groups of severely disadvantaged people have smoking rates of 30 to 40-plus percent."
Hurt says that there is also a much higher prevalence of smoking among people with mental health disorders like depression, alcoholics, drug users and schizophrenics.
But movers and shakers are not immune. President-elect Barack Obama has struggled with, and seems to have conquered, his habit. Former President Clinton was known to sit on the balcony of the White House and enjoy a cigar (his wife, Secretary of State-designate Hilary Clinton, officially made the White House a smoke-free zone). First lady Laura Bush admits to being an ex-smoker.
Wash. Rep. Bill Grant dies of lung cancer
WALLA WALLA, Wash. —
Rep. Bill Grant has died just one month after he was diagnosed with lung cancer.
Grant, 71, died at a hospital in Walla Walla on Sunday, House Democratic spokeswoman Melinda McCrady said Monday.
Grant, who had served 22 years in the Legislature, was re-elected in November. He represented the 16th District, which covers Walla Walla and Columbia counties, as well as portions of Benton and Franklin Counties.
His seat will be filled by an appointment until a special election can be held in November, McCrady said.
He is survived by his wife, Nancy, four children and 11 grandchildren.
Rep. Bill Grant has died just one month after he was diagnosed with lung cancer.
Grant, 71, died at a hospital in Walla Walla on Sunday, House Democratic spokeswoman Melinda McCrady said Monday.
Grant, who had served 22 years in the Legislature, was re-elected in November. He represented the 16th District, which covers Walla Walla and Columbia counties, as well as portions of Benton and Franklin Counties.
His seat will be filled by an appointment until a special election can be held in November, McCrady said.
He is survived by his wife, Nancy, four children and 11 grandchildren.
Lung cancer cells activate inflammation to induce metastasis
A research team from the University of California, San Diego School of Medicine has identified a protein produced by cancerous lung epithelial cells that enhances metastasis by stimulating the activity of inflammatory cells. Their findings, to be published in the January 1 issue of the journal Nature, explain how advanced cancer cells usurp components of the host innate immune system to generate an inflammatory microenvironment hospitable for the metastatic spread of lung cancer. The discovery could lead to a therapy to limit metastasis of this most common lethal form of cancer. The scientists – headed by Michael Karin, Ph.D., UC San Diego Distinguished Professor of Pharmacology and Pathology, who has been investigating the effects of inflammation on cancer development and progression – used a straightforward biochemical approach to identify proteins produced by metastatic cancer cells that are responsible for generation of an inflammatory microenvironment that supports the growth of metastases. Focusing on macrophages, white blood cells that are key players in the immune response to foreign invaders as well as in cancer growth and progression, they screened for factors produced by metastatic cancer cells in mice that could stimulate the activity of this inflammatory cell type.
Among the mouse cell lines screened, a highly metastatic cell line called Lewis lung carcinoma (LLC) showed particularly potent activation of macrophages. Furthermore, macrophage activation was mediated by a secreted protein. Biochemical purification of proteins secreted by LLC cells resulted in identification of an extracellular matrix protein called versican as the major macrophage activator and metastasis enhancing factor. Versican is also found in very low amounts in normal human lung epithelial cells, but is upregulated in human lung cancer, where a very large amount of this protein is found, especially in aggressive tumors.
The scientists found that versican strongly enhances LLC metastatic growth by activating receptors that lead to production of cytokines – signaling proteins that regulate the immune system. One of these receptors, TLR2, and a cytokine, TNFα, were found to be required for LLC metastasis. However, the normal function of TLR2 and TNF is in host defense-innate immunity to microbial infections. According to Karin, these findings are relevant, not just to the mouse model, but also to human lung cancer – the most common cause of cancer-related deaths worldwide. The major cause of lung cancer is tobacco smoking.
"By usurping these elements of the host immune system, versican helps generate an inflammatory environment that spurs the growth and spread of metastatic cancer," said Karin. "If we can find a way to block the production of versican or its binding to TLR2, therapeutic intervention could be used to limit metastasis of lung cancer."
Among the mouse cell lines screened, a highly metastatic cell line called Lewis lung carcinoma (LLC) showed particularly potent activation of macrophages. Furthermore, macrophage activation was mediated by a secreted protein. Biochemical purification of proteins secreted by LLC cells resulted in identification of an extracellular matrix protein called versican as the major macrophage activator and metastasis enhancing factor. Versican is also found in very low amounts in normal human lung epithelial cells, but is upregulated in human lung cancer, where a very large amount of this protein is found, especially in aggressive tumors.
The scientists found that versican strongly enhances LLC metastatic growth by activating receptors that lead to production of cytokines – signaling proteins that regulate the immune system. One of these receptors, TLR2, and a cytokine, TNFα, were found to be required for LLC metastasis. However, the normal function of TLR2 and TNF is in host defense-innate immunity to microbial infections. According to Karin, these findings are relevant, not just to the mouse model, but also to human lung cancer – the most common cause of cancer-related deaths worldwide. The major cause of lung cancer is tobacco smoking.
"By usurping these elements of the host immune system, versican helps generate an inflammatory environment that spurs the growth and spread of metastatic cancer," said Karin. "If we can find a way to block the production of versican or its binding to TLR2, therapeutic intervention could be used to limit metastasis of lung cancer."
Test could offer lung cancer clue
Testing a lung cancer patient's blood could help doctors predict the likely success of chemotherapy treatment.
UK scientists identified a molecule made by a more aggressive form of the disease, the journal Clinical Cancer Research reported.
Patients with this in their blood were less likely to respond to drugs, they said.
Cancer Research UK said the discovery could help doctors choose the right kind of treatment for patients.
Lung cancer kills more than 30,000 people in the UK every year, and survival rates have not improved alongside those for breast or bowel cancer in recent years. There is more than one type of lung cancer, but the variety under investigation by Liverpool-based researchers, small-cell lung cancer, which accounts for between 15% and 20% of cases, is one of the more difficult to treat.
Even small cell lung cancer comes in different forms, with a version called "neuroendocrine" being the least likely to be treated successfully.
The researchers found that a molecule called SCG3 mRNA was more likely to be found in the blood of people with neuroendocrine small cell cancer.
In theory, if larger studies back this up, it could mean that patients arriving at the clinic could be tested to give doctors an idea of the likely success of therapy - or perhaps to predict when a patient was relapsing before other signs emerged.
No tests
It might also make it easier for scientists, when looking at new chemotherapy treatments in trials, to compare their effectiveness in different groups of small cell lung cancer patients.
Dr Judy Coulson, from the University of Liverpool, said: "There are currently no blood-based markers routinely used to monitor patients with this type of lung cancer.
"We found that SCG3 mRNA is an incredibly sensitive marker of these tumours and could be used to detect circulating tumour cells in patients with this disease."
Lesley Walker, from Cancer Research UK, said: "This discovery is an important step to understanding how to treat lung cancer patients more effectively.
"Lung cancer can be very difficult to treat in its later stages, either because it has spread or because there are too many tumours."
UK scientists identified a molecule made by a more aggressive form of the disease, the journal Clinical Cancer Research reported.
Patients with this in their blood were less likely to respond to drugs, they said.
Cancer Research UK said the discovery could help doctors choose the right kind of treatment for patients.
Lung cancer kills more than 30,000 people in the UK every year, and survival rates have not improved alongside those for breast or bowel cancer in recent years. There is more than one type of lung cancer, but the variety under investigation by Liverpool-based researchers, small-cell lung cancer, which accounts for between 15% and 20% of cases, is one of the more difficult to treat.
Even small cell lung cancer comes in different forms, with a version called "neuroendocrine" being the least likely to be treated successfully.
The researchers found that a molecule called SCG3 mRNA was more likely to be found in the blood of people with neuroendocrine small cell cancer.
In theory, if larger studies back this up, it could mean that patients arriving at the clinic could be tested to give doctors an idea of the likely success of therapy - or perhaps to predict when a patient was relapsing before other signs emerged.
No tests
It might also make it easier for scientists, when looking at new chemotherapy treatments in trials, to compare their effectiveness in different groups of small cell lung cancer patients.
Dr Judy Coulson, from the University of Liverpool, said: "There are currently no blood-based markers routinely used to monitor patients with this type of lung cancer.
"We found that SCG3 mRNA is an incredibly sensitive marker of these tumours and could be used to detect circulating tumour cells in patients with this disease."
Lesley Walker, from Cancer Research UK, said: "This discovery is an important step to understanding how to treat lung cancer patients more effectively.
"Lung cancer can be very difficult to treat in its later stages, either because it has spread or because there are too many tumours."
Family Members Of Critically Ill Patients Want To Discuss Loved Ones' Uncertain Prognoses
Critically ill patients frequently have uncertain prognoses, but their families overwhelmingly wish that physicians would address prognostic uncertainty candidly, according to a new study out of the University of San Francisco Medical Center.
"Our interviews revealed that caregivers appear to believe that some uncertainty is unavoidable, and just the nature of life," said lead author Douglas White, M.D., M.A.S., assistant professor in UCSF's Division of Pulmonary and Critical Care Medicine and the UCSF Program in Medical Ethics. "The vast majority of families of critically ill patients want physicians to openly discuss the prognosis, even when physicians can't be certain that their estimates are correct."
But past research showing that physicians are reluctant to discuss uncertain prognoses reveals a schism between families' wishes and physicians' comfort.
The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Between January 2006 and October 2007, researchers at the University of San Francisco Medical Center conducted face-to-face interviews with 179 surrogate decision-makers for patients in four separate intensive care units (ICUs). The interviews explored surrogates' attitudes about whether physicians should discuss prognoses when they cannot be certain their prognostic estimates are correct.
When asked whether they would prefer to hear physicians' prognoses, 87 percent of caregivers indicated that they would want to be told of all prognostic estimates, even if the estimates were tentative. Most also indicated that they appreciated a physician's candor in discussing uncertain outcomes as honest, rather than seeing it as a source of confusion or anxiety.
"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process," Dr. White said. "I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."
Dr. White also noted that while the majority of family members indicated that they did want physicians to discuss all possible outcomes, a not-insignificant portion - 12 percent - said they did not want to discuss uncertain prognoses, indicating that a "one-size-fits-all" approach is insufficient in critical care situations.
"Our findings suggest that physicians need to develop the skills to understand the unique needs of surrogates, and then tailor their approach to discussing prognosis to meet those needs," he said. "This is an area in need of well-designed quantitative and qualitative studies."
Dr. White and his colleagues are currently involved in a follow-up study to help family members navigate the process of surrogate decision making in the ICU setting.
John Heffner, M.D., past president of the ATS, emphasized that the results of this study parallel previous investigations that examined patient and family preferences in discussing do-not-resuscitate orders and end-of-life care. "In almost all studies, patients and families express a desire for clear information to inform their decisions. Although physicians often wish to shelter their patients and patient families from what might seem to be harsh realities, the human spirit is resilient. Patients and families access to information from their doctors."
"Our interviews revealed that caregivers appear to believe that some uncertainty is unavoidable, and just the nature of life," said lead author Douglas White, M.D., M.A.S., assistant professor in UCSF's Division of Pulmonary and Critical Care Medicine and the UCSF Program in Medical Ethics. "The vast majority of families of critically ill patients want physicians to openly discuss the prognosis, even when physicians can't be certain that their estimates are correct."
But past research showing that physicians are reluctant to discuss uncertain prognoses reveals a schism between families' wishes and physicians' comfort.
The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Between January 2006 and October 2007, researchers at the University of San Francisco Medical Center conducted face-to-face interviews with 179 surrogate decision-makers for patients in four separate intensive care units (ICUs). The interviews explored surrogates' attitudes about whether physicians should discuss prognoses when they cannot be certain their prognostic estimates are correct.
When asked whether they would prefer to hear physicians' prognoses, 87 percent of caregivers indicated that they would want to be told of all prognostic estimates, even if the estimates were tentative. Most also indicated that they appreciated a physician's candor in discussing uncertain outcomes as honest, rather than seeing it as a source of confusion or anxiety.
"We learned that family members wanted prognostic information in order to know whether they needed to begin to prepare for the chance that their loved one might die, and so begin the bereavement process," Dr. White said. "I think one of the strongest messages that comes from this study is that family members want to have this discussion with the physician, and want to have the opportunity to take care of unfinished personal and familial business before their loved one dies. They need that chance to say their goodbyes, in case the patient does die."
Dr. White also noted that while the majority of family members indicated that they did want physicians to discuss all possible outcomes, a not-insignificant portion - 12 percent - said they did not want to discuss uncertain prognoses, indicating that a "one-size-fits-all" approach is insufficient in critical care situations.
"Our findings suggest that physicians need to develop the skills to understand the unique needs of surrogates, and then tailor their approach to discussing prognosis to meet those needs," he said. "This is an area in need of well-designed quantitative and qualitative studies."
Dr. White and his colleagues are currently involved in a follow-up study to help family members navigate the process of surrogate decision making in the ICU setting.
John Heffner, M.D., past president of the ATS, emphasized that the results of this study parallel previous investigations that examined patient and family preferences in discussing do-not-resuscitate orders and end-of-life care. "In almost all studies, patients and families express a desire for clear information to inform their decisions. Although physicians often wish to shelter their patients and patient families from what might seem to be harsh realities, the human spirit is resilient. Patients and families access to information from their doctors."
Saturday, March 7, 2009
Lung cancer to overtake breast cancer
LUNG cancer will soon kill more females than breast cancer as women lag behind men in getting the anti-smoking message, according to the latest snapshot on Australian cancer rates.
Today's report by the Australian Institute of Health and Welfare reveals that women who took up smoking in the 1970s and 1980s are now paying the price, as lung cancer outstrips breast cancer as a cause of death for the first time.
The report, Cancer In Australia: An Overview 2008, predicts that lung cancer rates in women are expected to grow by 0.4 per cent a year until 2010 but will fall by 1.1 per cent for men.
"It's tragic because there is not a lot you can do to prevent breast cancer but there is no reason for having so many people diagnosed with lung cancer when it stems from smoking," the chief executive of the Cancer Council of Australia, Ian Olver, said yesterday.
He called for a price rise on cigarettes and continued graphic advertising campaigns outlining the broad range of smoking's side effects, such as cardiovascular and gum disease.
"One in five people are smokers, so the advertising campaigns are graphic, but they need to remain as intense as they are now to make sure people get the message," he said.
"The Government needs to step up its efforts in reducing smoking-related deaths, and that really means price control and social marketing or advertising campaigns."
More than 100,000 new cases of cancer were diagnosed in 2005, and that number is expected to grow by more than 3000 extra cases each year to 2010, as the population ages.
The most common cancer is still prostate, with 16,349 new cases diagnosed, followed by colorectal (7181), melanoma (6044), lung (5738) and lymphoma (2373).
Testicular cancer had the highest survival rate, with 97 per cent of sufferers still alive five years after diagnosis, followed by thyroid cancer (93 per cent) and skin cancer (92 per cent). Pancreatic cancer had the lowest survival rate, with 4.6 per cent of sufferers alive five years after diagnosis.
Today's report by the Australian Institute of Health and Welfare reveals that women who took up smoking in the 1970s and 1980s are now paying the price, as lung cancer outstrips breast cancer as a cause of death for the first time.
The report, Cancer In Australia: An Overview 2008, predicts that lung cancer rates in women are expected to grow by 0.4 per cent a year until 2010 but will fall by 1.1 per cent for men.
"It's tragic because there is not a lot you can do to prevent breast cancer but there is no reason for having so many people diagnosed with lung cancer when it stems from smoking," the chief executive of the Cancer Council of Australia, Ian Olver, said yesterday.
He called for a price rise on cigarettes and continued graphic advertising campaigns outlining the broad range of smoking's side effects, such as cardiovascular and gum disease.
"One in five people are smokers, so the advertising campaigns are graphic, but they need to remain as intense as they are now to make sure people get the message," he said.
"The Government needs to step up its efforts in reducing smoking-related deaths, and that really means price control and social marketing or advertising campaigns."
More than 100,000 new cases of cancer were diagnosed in 2005, and that number is expected to grow by more than 3000 extra cases each year to 2010, as the population ages.
The most common cancer is still prostate, with 16,349 new cases diagnosed, followed by colorectal (7181), melanoma (6044), lung (5738) and lymphoma (2373).
Testicular cancer had the highest survival rate, with 97 per cent of sufferers still alive five years after diagnosis, followed by thyroid cancer (93 per cent) and skin cancer (92 per cent). Pancreatic cancer had the lowest survival rate, with 4.6 per cent of sufferers alive five years after diagnosis.
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