Patient knowledge of health information influences cancer treatment

24 feb 2009--A new analysis finds that when colorectal cancer patients seek out health information from the internet and news media, they are more likely to be aware of and receive the latest treatments for their disease. Published in the April 1, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study indicates that patients can influence their own treatment, in some cases in inappropriate ways.
In their review, authors led by Stacy Gray, M.D. of the Dana-Farber Cancer Institute in Boston note that in the last several decades, patients have become more involved in their health care as patient autonomy has become increasingly important. That change has been accompanied by unprecedented growth in the amount of health information available to patients. Studies show nearly four out of ten of cancer patients seek cancer information on the internet. But the authors say it is unclear how these phenomena influence a cancer patient's treatment.
Dr. Gray and colleagues from the NCI Center of Excellence in Cancer Communication Research at the University of Pennsylvania Annenberg School designed a study to examine the relationship between information-seeking among 633 colorectal cancer patients chosen at random from the Pennsylvania Cancer Registry and the use of novel new agents for the disease. The investigators focused on the use of the targeted therapies bevacizumab (Avastin) and cetuximab (Erbitux) because of these drugs' clinical importance, significant media coverage, and recent approval by the U.S. Food and Drug Administration.
Dr. Gray and her team hypothesized that there would be a relationship between information seeking and awareness of these targeted therapies among colorectal cancer patients. They also hypothesized that patients who seek information may ask their physicians about these targeted therapies and may be more likely to receive them than patients who do not seek information.
The researchers found that high levels of information seeking were strongly associated with both awareness of and receiving treatment using targeted therapies. Patients who sought information about treatments for colorectal cancer were 2.83 times more likely to have heard about targeted therapies and 3.22 times more likely to have received targeted therapies than people who did not seek information. These associations were present for patients with advanced disease where use of targeted therapies is FDA approved as well as for patients with early stages of the disease where their use is not FDA approved.
"These findings emphasize the importance of exploring patient influence on physician prescribing patterns and understanding the impact of information seeking on cancer outcomes," the authors write.
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Article: "Colon cancer patient information seeking and the adoption of targeted therapy for on-label and off-label indications." Stacy W. Gray, Katrina Armstrong, Angela DeMichele, J. Sanford Schwartz, and Robert C. Hornik. CANCER; Published Online: February 23, 2009 (DOI: 10.1002/cncr.24186); Print Issue Date: April 1, 2009.

Antidepressant may help head/neck cancer patients

By Karla Gale
24 may 2008--The results of a pilot study suggest that antidepressant therapy with Celexa during treatment for head and neck cancer reduces the risk of depression and diminishes the impact of cancer treatment on quality of life.
Depression has been reported in up to 40 percent of patients with head and neck cancer "typically within the first 3 months of diagnosis," Dr. William M. Lydiatt and colleagues write in the journal, Archives of Otolaryngology -- Head and Neck Surgery.
The elevated suicide rates associated with cancer are particularly high among patients with head and neck cancer, Lydiatt told Reuters Health. "The relative intensity of treatment, and the fact that treatments tend to affect the most basic aspects of living, including speech, swallowing, and breathing" contribute to the increased rates of depression and suicide in head and neck cancer patients, he explained.
Because most of the treatment for head and neck cancer -- surgery and radiation -- is completed in 12 weeks, Lydiatt's team conducted their pilot study during 12 weeks of treatment, with a final 16-week follow-up visit.
The research team, based at the University of Nebraska Medical Center in Omaha, randomly assigned 36 patients to Celexa (also called citalopram) or to matching placebo. Thirteen patients in the Celexa group and 10 in the placebo group completed the trial.
"All measures of psychiatric well-being favored the group taking citalopram," Lydiatt and his colleagues report.
Fifteen percent of patients taking Celexa had symptoms of depression that were at least "mild" at week 16, whereas 60 percent in the placebo group were rated "mildly ill" or worse.
Similarly, the percentage diagnosed with major depression was 17 percent in the Celexa group compared with 50 percent at weeks 12 and 16 in the placebo group.
In the placebo group two patients experienced suicidal thoughts and one patient was hospitalized for depression, compared with none in the Celexa group.
Quality of life declined in both groups, but less so in the antidepressant group, and while quality of life continued to worsen between 12 and 16 weeks in the placebo group, it actually improved in the Celexa group.
"These findings are hopeful, but this study was too small for us to make a definitive recommendation to treat all head and neck cancer patients with antidepressants," Lydiatt noted.
"We have started a similar trial in a larger group of patients, with funding by the National Institutes of Mental Health, to study this issue more completely using the antidepressant escitalopram, also known as Lexapro."
SOURCE: Archives of Otolaryngology Head and Neck Surgery, May 2008.

Disparities: With Cancer Treatment, an Edge for Rural Patients

By ERIC NAGOURNEY
It seems only natural to assume that when cancer strikes people who live in rural areas, more time will pass before it is discovered than for people in cities.
In fact, a study reports, the opposite seems to be true. Urban residents are more likely to see a doctor later than those in the country are, a lapse that can make the cancers harder to treat.
Writing in the November issue of The Journal of the American College of Surgeons, researchers said the findings confounded the assumptions of many in the medical community — including doctors who work in rural areas.
“Rural surgeons are often uneasy when their outcomes are compared with those of urban surgeons,” the study says, “largely because they perceive that rural patients typically present with worse disease.”
The researchers, Dr. Ian Paquette and Dr. Samuel R. G. Finlayson of the Dartmouth-Hitchcock Medical Center, based their findings on a review of information about almost 300,000 cancer patients gathered by the National Cancer Institute.
The study looked at more than 125,000 people with colorectal cancer and more than 160,000 people with lung cancer over a three-year period. For both kinds of cancers, the researchers found, urban patients were more likely to seek treatment for the first time when they were in advanced stages of the disease.
This was true even though those cancer patients who lived in the country tended to be considerably poorer — and, in the case of the colorectal cancer patients, older — than those in the city. And people who live in cities are more likely to be near a broader range of medical services.

Treatment may fuel cancer's spread, study finds

Thu Apr 5, 2007 10:15PM EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - Treating cancer with surgery, chemotherapy or radiation may sometimes cause tumors to spread and U.S. researchers said on Thursday they may have nailed down one of the causes -- a compound called TGF-beta.
Tests in mice show that using the chemotherapy drug doxorubicin or radiation both raised levels of TGF-beta, which in turn helped breast cancer tumors spread to the lung.
But using an antibody to block TGF-beta stopped the process, Dr. Carlos Arteaga and colleagues at Vanderbilt University in Tennessee reported.
Developing drugs that block TGF-beta might help prevent cancer from recurring, Arteaga's team reports in the May issue of the Journal of Clinical Investigation.
"The repopulation and progression of tumors after anti-cancer therapy is a well-recognized phenomenon," the researchers wrote. "It has been shown to occur following radiotherapy, chemotherapy, and surgery."
Cancer experts have wondered if the so-called primary tumor -- the first and biggest tumor -- might somehow suppress the growth of other tumors, and that removing or destroying the first tumor might allow other, undetectable, tumors to then grow.
TGF-beta, which is involved in both the growth and suppression of tumors, may hold part of the answer, Arteaga's team said.