Health Update

THURSDAY, Jan. 26 (HealthDay News) — More than 40 percent of rheumatoid arthritis patients live a sedentary life, a new study finds.

It used to be thought that medication and rest was the best treatment, but now experts believe physical activity is important to keep joints flexible, improve balance and strength and reduce pain, the researchers noted.

“Our results suggest that public health initiatives need to address the lack of motivation to exercise and to promote the benefits of physical activity to reduce the prevalence of inactivity in those with rheumatoid arthritis,” said lead researcher Jungwha Lee, an assistant professor in the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.

Physical inactivity among these patients is a public health concern, Lee said.

“Enhancing strong motivation for physical activity and strong beliefs in the benefits of physical activity may help rheumatoid arthritis patients to be more physically active,” she said.

The report was published in the Jan. 26 online edition of Arthritis Care & Research.

For the study, Lee’s team collected data on 176 patients with rheumatoid arthritis aged 18 and older who took part in a trial assessing the effectiveness of physical activity.

In addition, they looked at the relationship between inactivity and risk factors such as obesity and pain, and also the motivation for physical activity.

They found that 42 percent of the patients were inactive. These people didn’t participate in the moderate-to-vigorous physical activity program in the trial, which consisted of periods of activity at least 10 minutes during the week.

Moderate physical activity is equivalent to brisk walking, Lee said.

Moreover, 53 percent of the patients weren’t motivated to do physical activity and 49 percent didn’t think exercise would benefit them, Lee’s group found.

These reasons accounted for 65 percent of the inactivity, they noted.

Dr. Jon Giles, an assistant professor of medicine in the division of rheumatology at Columbia University’s College of Physicians and Surgeons in New York City, said that “the most striking aspect to me about the paper is that although we generally consider joint pain and damage as the reason that rheumatoid arthritis patients may not exercise, this does not appear to be the primary driver of lack of exercise in the group studied.

“Low activity motivation and lack of belief in the benefits of exercise are actually the primary reasons for physical inactivity in the general population, so it is interesting that rheumatoid arthritis patients are actually not very different from their non-rheumatoid arthritis counterparts,” he added.

Another expert, Dr. Waseem Mir, a rheumatologist at Lenox Hill Hospital in New York City, said that part of the problem is that many patients don’t really have their arthritis under control.

“Their physical activity is lacking because they have stiffness, pain and fatigue, so there are a lot of factors involved,” he said.

Many of these patients just don’t feel well, he said. “They feel really beat up,” he said. “These patients feel wiped out day in and day out.”

Mir noted that exercise for these patients is important not only to maintain flexibility and strength, but because they are already at an increased risk for heart disease. “Their inactivity only adds to that risk,” he said.

In the United States, almost 1.3 million people suffer from rheumatoid arthritis, according to the American College of Rheumatology.

The condition is characterized by inflammation of the joints, which leads to stiffness, pain and loss of function.

More information

For more on rheumatoid arthritis, visit the Arthritis Foundation .

NEW YORK (Reuters Health) – People with mild depression may benefit from taking antidepressants, suggests a new analysis of past studies that compared symptoms in people on the drugs to those given drug-free placebo pills.

Some earlier reports had suggested that antidepressants generally only improve mood in people with severe depression.

But that might be because those studies weren’t precise enough to pick up on smaller changes in symptoms that can still make a difference for people with milder forms of the disease, researchers said.

“I think there’s a valid concern… that if someone has not-that-severe depression that hasn’t lasted that long, maybe it will get better itself or with therapy,” said Dr. David Hellerstein, from the New York State Psychiatric Institute and Columbia University, who worked on the study.

Still, he said the question of whether or not to prescribe medication shouldn’t necessarily come down to how severe the depression is, but how long symptoms have lasted.

People with “transient depression” that will improve with diet or exercise or after a few weeks of therapy “shouldn’t be taking the risk of being on meds,” he told Reuters Health.

“But people who have more persistent depression should be evaluated for treatment and medicine should be one of the options,” even when the depression is more modest.

Hellerstein and his colleagues collected data from six studies done at the state’s psychiatric institute between 1985 and 2000. Those included 825 people with non-severe, long-lasting depression enrolled in trials that compared symptoms with antidepressant treatment versus a placebo.

In three of the six studies, patients taking an antidepressant improved more on a widely-used scale of depression symptoms and severity than those taking a placebo, and in four studies, a higher percentage of patients taking antidepressants went into remission, meaning they were no longer considered to have clinically-significant depression.

Depending on the particular drug and study, the researchers calculated that between three and eight people with non-severe depression would have to be treated with an antidepressant for one to benefit substantially from it.

That, they wrote in the Journal of Clinical Psychiatry, is “a range considered by researchers as sufficiently robust to recommend treatment.”

The drugs tested in those studies included Prozac, as well as older and now less-popular medications known as monoamine oxidase inhibitors and tricyclic and tetracyclic antidepressants. It’s hard to know how well the findings would apply for newer antidepressants, the researchers said.

The results don’t mean that everyone with mild depression should be on an antidepressant, a psychiatrist not involved in the study pointed out.

“People with these milder depressions also respond well to counseling and psychotherapy and can respond well to exercise,” said Dr. Michael Thase, from the University of Pennsylvania School of Medicine in Philadelphia.

“This is basically saying, these antidepressants aren’t that good, and you should also consider other treatment options and don’t just focus on the thing that’s the easiest,” he told Reuters Health.

The researchers said that some combination of antidepressants and talk therapy is considered most effective in depression treatment — but getting therapy is often more expensive and time-consuming than medication.

Talk therapy can run $100 or more per session, while generic brands of antidepressants usually cost about $20 per month. Drugs may come with side effects, including insomnia and stomach aches, but they’re usually minor, according to Hellerstein.

Still, people on antidepressants should be followed closely by a doctor to see how they’re responding to treatment, he said.

Several of the authors of the current study reported having received funding for other research projects from drug companies that make antidepressants.

One recent study found that some depressed people on the antidepressant Cymbalta did worse than the comparison placebo group — but the majority got some benefit (see Reuters Health story of December 9, 2011).

“I believe the basic finding that drugs are more effective than placebo,” Thase said.

But, “The benefits of antidepressants may not be that dramatic in patients with milder depressions for whom many other (non-drug) strategies can also be considered.”

SOURCE: http://bit.ly/yVBEdk Journal of Clinical Psychiatry, online December 27, 2011.

ZURICH (Reuters) – Patients with advanced colorectal cancer who received Roche’s Avastin live longer when they also receive the drug as part of their second round of treatment, the Swiss drugmaker said on Thursday, citing a late-stage study.

Patients with metastatic colorectal cancer first treated with Avastin and standard chemotherapy before being given Avastin with a different chemotherapy after their disease had progressed lived significantly longer than those given only chemotherapy in the second-line setting, Roche said.

The news is likely to boost sentiment around the drug, which recently suffered a major setback when U.S. authorities decided to revoke their backing of its use in breast cancer.

Roche will submit the results of the ML 18147 study at an upcoming medical meeting.

In Europe, Avastin is currently approved in colorectal, lung, renal, breast cancer and it has just won approval in ovarian cancer.

(Reporting by Katie Reid; Editing by Hans-Juergen Peters)

WEDNESDAY, Jan. 25 (HealthDay News) — The addition of the cancer-fighting medication Avastin to chemotherapy prior to breast cancer surgery increases the chance that all of the cancer will be removed, according to new research.

However, when looking at which patients might benefit the most from this therapy, two recent studies found conflicting results, and neither study was yet able to address whether or not the addition of Avastin (bevacizumab) early in the treatment process would improve survival rates.

Information on survival will be especially important for defining Avastin’s role in early breast cancer treatment. That’s because in November 2011, the U.S. Food and Drug Administration (FDA) revoked Avastin’s approval for the treatment of breast cancer that has spread to other parts of the body. With metastatic breast cancers, the agency felt the survival benefits were lacking, and the drug carries significant risks. Avastin is, however, still FDA-approved as a treatment for some metastatic colon, brain, kidney and lung cancers.

“The bevacizumab story is not done. The addition of Avastin to neoadjuvant chemotherapy in women with operable breast cancer increased the rate of women having the disappearance of their breast cancer at the time of surgery,” said Dr. Harry Bear, lead author of one of the new studies.

“With more follow-up of these trials and several others, we may find that bevacizumab actually does increase the cure rate. But, it may not be for all breast cancers; it may just be for some,” said Bear, a professor and chairman of the division of surgical oncology at Virginia Commonwealth University’s Massey Cancer Center in Richmond.

Results of the studies are published in the Jan. 26 edition of the New England Journal of Medicine.

Bear’s study included more than 1,200 women who had been diagnosed with breast cancer. None of the women had yet had surgery to remove their tumors. All of the women had tumors that were at least 2 centimeters (about 0.8 inches) in diameter, and none had metastatic cancer.

The women received chemotherapy before surgery (neoadjuvant therapy). They were randomly assigned to treatment groups that included the chemotherapy drugs docetaxel, capecitabine and gemcitabine in various doses and combinations. They were also randomly assigned to receive Avastin or not during their first six cycles of chemotherapy.

The study found that adding capecitabine or gemcitabine to docetaxel therapy didn’t improve response rates. But the addition of Avastin increased the rate of “pathological complete response” — meaning the tumor disappeared before surgery — from 28.2 percent to 34.5 percent, according to the study.

However, the addition of Avastin also increased the risk of serious side effects, such as high blood pressure and heart problems.

The second study, conducted in Germany, included almost 2,000 women with an average tumor size of 4 centimeters (about 1.6 inches). As in Bear’s study, the women were randomly assigned to several neoadjuvant chemotherapy groups. In this study, however, treatment was with docetaxel, epirubicin and cyclophosphamide. They were also randomly assigned to receive Avastin or not.

Overall, the odds of pathological complete response were increased by 29 percent with the addition of Avastin. However, when the researchers looked at tumors by hormone receptor status, they found that it was primarily women with triple-negative cancers who showed a significant response to Avastin. Having a triple-negative breast cancer means that a cancer’s growth isn’t influenced by hormones such as estrogen or progesterone. If a tumor is called hormone receptor-positive, it means that hormones, such as estrogen, can help fuel that cancer’s growth.

In Bear’s study, the investigators found Avastin had an effect on both hormone receptor-positive and hormone receptor-negative cancers, but there appeared to be slightly more benefit for the hormone receptor-positive women.

Bear said a number of factors could explain these seemingly conflicting findings. The differences may have something to do with the women involved in each study, he said. Some of the women in the German study had more advanced cancers. And, the chemotherapy regimens weren’t the same, he explained.

Commenting on the findings, Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, said that “these studies suggest that for certain patients, there may be a benefit to using Avastin prior to surgery for breast cancer.”

However, Lichtenfeld added, “what we don’t know from these studies is which women would benefit the most, and we don’t have the long-term follow-up on these women to see if the survival or the course of the disease is improved.”

Both Lichtenfeld and Bear acknowledged that because Avastin isn’t FDA-approved for the treatment of breast cancers, insurance companies may be reluctant to pay for these treatments outside of a clinical trial setting.

“There still remain significant questions about the benefits of using Avastin in breast cancer,” Lichtenfeld pointed out. “There is an increased risk of side effects, and there’s a cost to adding this treatment. Based on these two studies, it’s difficult to say whether any particular women should consider this treatment. As with many similar research findings, it’s important to talk to your own doctor to get a better understanding of your potential risks and benefits,” he added.

More information

To learn more about Avastin, visit the U.S. National Library of Medicine.

WEDNESDAY, Jan. 25 (HealthDay News) — Women need to get recommended Pap tests, while girls and young women should be vaccinated against human papillomavirus (HPV) to protect them from cervical cancer, the American College of Obstetricians and Gynecologists advises during Cervical Health Awareness Month.

Cervical cancer kills more than 4,000 women in the United States each year. Many of them could have been saved by routine Pap tests, which look for abnormal cells in the cervix that can turn into cancer. When caught early, those abnormal cells are highly treatable, according to the college.

More than 12,000 new cases of cervical cancer will be diagnosed in the United States this year, according to the American Cancer Society.

The good news is that the rate of cervical cancer in the United States has fallen more than 50 percent in the past three decades due to the widespread use of the Pap test, the college says.

Cervical cancer is caused by certain strains of HPV, a common sexually transmitted disease. HPV can also cause genital and anal warts and cancer of the mouth, head and neck, penis and anus.

Women can help protect themselves against cervical cancer by being monogamous, practicing safe sex and getting periodic Pap tests. In addition, girls and young women aged 9 to 26 should receive the HPV vaccine, the college recommends.

A young women should get her first Pap test when she turns 21 and continue having a Pap test every two years until age 30. Women age 30 and beyond who have three consecutive negative Pap test results can be screened once every three years, the college says.

More information

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

SUNDAY, Jan. 22 (HealthDay News) — Researchers have identified three new genomic regions they believe are linked with breast cancer that may help explain why some women develop the disease.

All three newly identified areas “contain interesting genes that open up new avenues for biological and clinical research,” said researcher Douglas Easton, a professor of genetic epidemiology at the University of Cambridge in England.

Breast cancer is the most common cancer among women, with about 1 million new cases annually worldwide and more than 400,000 deaths a year.

Scientists conducting genome-wide association studies — research that looks at the association between genetic factors and disease to pinpoint possible causes — had already identified 22 breast cancer susceptibility loci. Locus is the physical location of a gene or DNA sequence on a chromosome.

“The three [newly identified] loci take the number of common susceptibility loci from 22 to 25,” said Easton.

However, the three new susceptibility loci might explain only about 0.7 percent of the familial risks of breast cancer, bringing the total contribution to about 9 percent, the researchers said.

Michael Melner, scientific program director for the American Cancer Society, said this current research adds some important new clues to existing evidence, but he agreed that the number of cases likely associated with these three variants is probably low.

“So the total impact in terms of patients would be fairly small,” Melner said.

The study is published online Jan. 22 in Nature Genetics.

To find the new clues, Easton’s team worked with genetic information on about 57,000 breast cancer patients and 58,000 healthy women obtained from two genome-wide association studies.

The investigators zeroed in on 72 different single nucleotide polymorphisms (SNPs). A SNP — pronounced “snip” — is a change in which a single base in the DNA differs from the usual base. The human genome has millions of SNPs, some linked with disease, while others are normal variations.

The researchers focused on three SNPs — on chromosomes 12p11, 12q24 and 21q21.

Easton’s team found that the variant on the 12p11 chromosome is linked with both estrogen receptor-positive breast cancer (which needs estrogen to grow) and estrogen receptor-negative breast cancer. The other two variants are only linked with ER-positive cancers, they said.

One of the newly identified variants is in an area with a gene that has a role in the development of mammary glands and bones. Easton said it was already known that mammary gland development in puberty is an important period in terms of determining later cancer risk. “But these are the first susceptibility genes to be shown to be involved in this process,” he said.

One of the other SNPs is in an area that can affect estrogen receptor signaling, the researchers found.

Melner, noting some of the research is “fine tuning” of other work, said in his view the new understanding of the signaling pathways and their genetic links is the most important finding.

“When you delineate a pathway, you bring up new potential targets for therapy,” he said. “The more targets you have, you open up the potential for having multiple drugs and attacking a cancer more easily, without it becoming more resistant.”

Overall, Melner added, the results underscore the complexity of the different mechanisms involved in breast cancer development.

More information

For more about the genetics of breast cancer, visit the American Cancer Society.