Tachycardia in cancer patients may signal increased mortality risk

by American College of Cardiology

Cancer patients who experienced tachycardia within one year of cancer diagnosis had higher mortality rates up to 10 years after diagnosis of tachycardia, according to research presented at the American College of Cardiology's Advancing the Cardiovascular Care of the Oncology Patient conference. The course convenes in Washington on Jan. 25-27, 2019, bringing together top experts in both cardiology and oncology to review new and relevant science in this rapidly evolving field.

26 jan2019--Sinus tachycardia is when the heart beats faster than normal while at rest and may cause palpitations and discomfort. In addition to cancer treatment, it can also occur as a result of other conditions such as blood clots that cause heart attack or stroke, heart failure, fainting or sudden death. In the study, researchers defined sinus tachycardia as a heart rate over 100 beats per minute (bpm) diagnosed via electrocardiogram.

"Tachycardia is a secondary process to an underlying disease and reflective of significant multi-system organ stress and disease in cancer patients," said Mohamad Hemu, MD, a resident at Rush University Medical Center in Chicago and one of the study authors. "As a result, the most important initial step is to figure out what is causing the tachycardia. Reversible causes like dehydration and infections should be ruled out. Additionally, cardiopulmonary processes such as pulmonary embolism and other arrhythmias must be taken into consideration. Once these and all other causes of tachycardia are ruled out, then it is more likely that sinus tachycardia is a marker of poorer prognosis in these patients."

Researchers analyzed 622 cancer patients, including lung cancer, leukemia, lymphoma or multiple myeloma, from Rush University Medical Center from 2008 to 2016. The patients were 60.5 percent women, 76.4 percent white and an average age of 70 years; 69.4 percent of the cohort was classified with stage 4 cancer and 43 percent had lung cancer. The study included 50 patients with tachycardia and 572 control patients without tachycardia. Patients included in the study had tachycardia at more than three different clinic visits within one year of diagnosis, excluding history of pulmonary embolism, thyroid dysfunction, ejection fraction less than 50 percent, atrial fibrillation and a heart rate over 180 bpm.

Researchers assessed mortality for patients adjusting for age and other characteristics that were significantly different between a heart rate of more than 100 bpm and less than 100 bpm, characteristics included race, albumin, hemoglobin, beta blockers, kidney disease, use of blood thinners, and type of cancer. They also examined mortality adjusting for age and other clinically relevant characteristics, such as race, coronary artery disease, stroke, diabetes, smoking and radiation. Tachycardia was a significant predictor of overall mortality in both models. Of the patients who experienced tachycardia, 62 percent died within 10 years of diagnosis compared to 22.9 percent of the control group.

"We are continuously learning about the unique heart disease risks that face cancer patients, and our study shows that tachycardia is a strong prognosticator regardless of cancer type. That's why it is critically important to be co-managing both cancer and heart conditions to ensure patients receive the most effective treatment possible," said senior author Tochi M. Okwuosa, DO, director of the cardio-oncology program at Rush University Medical Center. "However, we need to do more studies to determine whether management of tachycardia in cancer patients will have any effect on survival."

Provided by American College of Cardiology

Scams and Shams That Prey on Cancer Patients

By Amanda Gardner
30 sept 2008-- Cancer patients often turn to the Internet as a source of information and hope. But all too often, those hopes are betrayed by purveyors of so-called cancer "cures" that are anything but, experts say.
Earlier this month, five companies were charged with making false and misleading claims for cancer cures, and settlements were reached with six other companies, the U.S. Federal Trade Commission announced. Products marketed by the companies included essiac teas and other herbal mixtures, laetrile, black salve (a corrosive ointment), and mushroom extracts.
"There is no credible scientific evidence that any of the products marketed by these companies can prevent, cure, or treat cancer of any kind," said Lydia Parnes, director of the FTC's bureau of consumer protection, the Associated Press reported.
In June, the U.S. Food and Drug Administration issued warning letters to two dozen companies peddling everything from cure-all teas to tablets and tonics. And earlier this year, more than 100 manufacturers of such products were issued similar letters.
According to the American Institute for Cancer Research, black salves are one of the most dangerous of these fake cures. The products, which supposedly "draw out" the disease from under the skin, can actually burn the skin and cause scarring.
Which is not to say that none of these compounds has potential as cancer fighters. But consumers need to be careful.
"Many of these compounds touted as having beneficial effects have lots of lab research, but it's more selling hope in a jar based on preliminary lab research," said Sarah Wally, a nutritionist with the American Institute for Cancer Research in Washington, D.C. "That's not fair to the consumer, particularly consumers with cancer who have a really strong motivation to try anything that might offer hope."
Many of these so-called cures or preventive treatments won't actually cause harm (except to your wallet), but some can interact with regular, supervised medical treatment, Wally said.
"Antioxidants can actually interfere with chemotherapy and radiation treatment," she said. "Some people think, 'I'm just drinking juice.' But they might be drinking two gallons of juice a day of super-antioxidant juice compound, not thinking to discuss it with their doctor."
And, some consumers may actually forego lifesaving conventional treatments in favor of shams.
Here's some advice from the experts: "If it sounds too good to be true, it probably is," said Dr. Ted Gansler, director of medical content for the American Cancer Society. Beware of claims that one treatment will cure all types of cancer or more than one type of disease. Also be leery of language such as "scientific breakthrough," "miraculous cure," "secret ingredient" and "ancient remedy," as well as claims that a product is "natural" and therefore safe. And take note of claims that the product has limited availability and that the company needs advance payment. Find out if the product has ever been tested in humans. Laboratory and animal research is fine, but only as a starting point, not as a basis for recommending the therapy in humans, Wally said. "Be careful about the credentials of the people promoting the treatment," Gansler said. "The possibility that someone with no medical or scientific treatment is going to come up with a cure for cancer or other diseases is not very likely." Reliable sources of information include the American Cancer Society, Memorial Sloan-Kettering Cancer Center in New York City, and the University of Texas M.D. Anderson Cancer Center. (All have Web sites.) "Watch out for evidence that is only testimonial," Gansler said. "In some of the most notorious alternative clinics, people will be diagnosed with cancer who don't even have cancer and, later on, they're 'cured.' " The "patient" may actually believe he or she was cured. Be on the lookout for obvious factual errors. If someone says their "Stage 7" cancer has been cured, be leery. There is no "Stage 7" cancer. Wally advised: "Before you wholeheartedly jump into these things, you need to really sit down and have a discussion with your physician." This is especially true in an age when alternative and complementary medicines are gaining acceptance. It can be tricky distinguishing between something bogus and something that may have a benefit, Wally added.
More information
The FDA has more on fake cancer cures to be avoided.

Rural Cancer Patients Get to the Doctor Earlier than City Dwellers


LEBANON, N.H., Nov. 21 -- Patients who live in urban areas were significantly more likely to present with late-stage colorectal or lung cancer than those who live in rural areas (P0.001), researchers here found.
Action Points
Explain to interested patients that people from rural areas do not actually take a longer time to visit the doctor than their urban counterparts as had been previously believed.
Explain to interested patients that people who live in cities are actually more likely than their rural counterparts to present with late-stage colon or lung cancer.
Explain to interested patients that it is important to discuss personal cancer risks and screening guidelines with their doctor.
"Rural residence should not be assumed to be a proxy for advanced patient disease associated with poor outcomes," said Samuel R.G. Finlayson, M.D. M.P.H., of Dartmouth, reporting on his study in the November issue of the Journal of the American College of Surgeons.
Dr. Finlayson and co-author Ian Paquette, M.D., of Dartmouth-Hitchcock Medical Center, looked at more than 125,000 people with colorectal cancer and more than 160,000 people with lung cancer who were drawn from the 2000 to 2003 National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. They used the rural-urban continuum codes from the U.S. Department of Agriculture to determine rural versus urban designations.
Using an ordinal logistic regression model, the research duo then compared stages at presentation between rural and urban colorectal and lung cancer patients while controlling for other factors associated with late-stage presentation, including age, race, gender, marital status, income level, and level of education.
When compared with urbanites, rural patients were slightly more likely to present with a stage I or stage II colon cancer, and slightly less likely to present with stage III or IV colon cancer.
Those odds were even a bit better when it came to lung cancer. Compared with urban patients, country dwellers were more likely to present with stage I disease (22.81% versus 21.59%) and less likely to present with stage IV disease (41.18% versus 42.90%).
Other factors, including race, socioeconomic status, age, and divorce do tend to predict when a patient will present with colorectal or lung cancer, the study showed. For example, low income status, African-American race, age less than 65, divorce, male gender, and being from a language-isolated community are associated with presenting with stage IV colon cancer, the researchers said. Being African-American, divorced, male and hailing from a language-isolated community are associated with having stage IV lung cancer at the time of diagnosis.
The researchers found some other differences between cancer patients based on where they live: rural patients with colorectal cancer tended to be older and poorer than their urban counterparts. By contrast, city-dwelling colorectal patients were more likely to come from language-isolated communities, be African-American, and be divorced.
Rural lung cancer patients were more likely to be younger, male, and substantially poorer than their urban counterparts. By contrast, urban lung cancer patients were more likely to be African-American, divorced, and come from a language-isolated community, the study showed.
They did note limitations to the study. Among them was the fact that there has been no uniform way to define rurality in different studies and databases. They also noted a limitation based on the number of unstaged cancer patients. However, they said that although the absolute numbers of urban patients with unstaged cancer were substantially higher, a higher percentage of rural patients had unstaged disease.
The researchers said their study calls into question the effectiveness of current screening recommendations and practices.
The numbers of patients presenting with advanced stage cancers is "alarming," the study authors concluded. "This observation raises questions about how well screening is implemented in urban versus rural areas, and the overall effectiveness of cancer screening to prevent late-stage presentation, [and] highlights the need for better screening efforts for colorectal cancer and the need to develop an effective screening program for people at high risk for lung cancer."
Neither of the study authors reported any conflicts of interest.Primary source: Journal of the American College of SurgeonsSource reference: Paquette I, Finlayson S, "Rural versus urban colorectal and lung cancer patients: differences in stage at presentation"J Am Coll Surg 2007; DOI: 10.1016/j.jamcollsurg.2007.04.043.

Opioids Give Safe Pain Relief for Cancer Patients

CLEVELAND, March 22 -- Concerns that morphine or other opioids will cause respiratory depression when given to cancer patients for pain are unfounded, researchers here asserted.
During titration of parenteral opioids for relief of severe pain in various forms of cancer, there was no evidence of significant respiratory depression, as measured by end-tidal CO2, found Bassam Estfan, M.D., of the Cleveland Clinic, and colleagues.
"Although 80% to 90% of cancer pain can be controlled with opioids, suboptimal pain control is common because under-prescribing remains a major barrier," the authors wrote in the March issue of Palliative Medicine.
Many clinicians are reluctant to use adequate doses of the drugs to alleviate pain, out of concern that aggressive use of opioids could hasten death or lead to other problems such as substance abuse, diversion of drugs to others, hemodynamic instability, CNS toxicity, and respiratory depression, the investigators wrote. http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb1/5305