Women in the U.K. May Lose Access to Important Breast Cancer Drugs

SALT LAKE CITY (Reuters) - Elizabeth Smart, who was kidnapped at age 14 from her Utah home and held for what she described as "nine months of hell," exchanged vows on Saturday with her boyfriend of the past year at a private wedding in Hawaii, her uncle told Reuters. Smart, 24, and Matthew Gilmour, whom she met while she …

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Most women with cancer want a role in decisions

NEW YORK (Reuters Health) - About two-thirds of women diagnosed with early stage breast cancer want to take part in making decisions about their treatment, according to a new survey of patients from five different countries.

Some of these women want complete control over making treatment choices while others want to share the decision with their doctor -- yet only a minority of them actually get the level of involvement they are hoping for.

"Physicians should be trying to elicit patient preferences," said Richard Brown, the lead author of the study and an assistant professor at Virginia Commonwealth University.

Brown's team asked 683 women who were recently diagnosed with breast cancer what kind of role they would like to have in making decisions about their treatment: would they like to have total control, a shared role with their doctor, or have the doctor make the choices.

After the women met with their physicians, the researchers followed up to ask how their visit went and whether their preferences for how involved they would like to be in the future had changed.

Only 28 out of every 100 women initially wanted to delegate the decision to their doctor, but 46 out of every 100 reported that their doctor ended up making the decision.

"I think it's not so surprising that the actual decision making tended to be more doctor-directed than the patients wanted," said Dr. Michael Barry, president of the Foundation for Informed Medical Decision Making, who was not involved in this study.

"I think sometimes clinicians think most patients don't want to participate in decisions, particularly around serious things like cancer, and that's not the finding here or in previous studies," he told Reuters Health.

Among the 282 women who changed their preference after the consultation with their doctor, a little more than half of them shifted toward a greater involvement.

A third of them originally wanted their doctor to make the decision and later preferred to either share it or take control themselves, and one in five who originally wanted to share the decision later preferred to make the choice on their own.

When women had more involvement than they originally intended, they "were less conflicted over the decision, more satisfied with their ultimate decision, more satisfied with the consultation communication" than women who had less involvement, the authors write in the Journal of Clinical Oncology.

Barry said the findings make sense for women with early-stage breast cancer, because there are often multiple, effective options for treatment.

For instance, the risk of death might be the same if a woman has her breast removed compared to having her breast preserved, but one woman might prioritize keeping her breast and be more willing to go through the extra surgeries and radiation.

"When patients then understand there are multiple reasonable options for treatment of early stage breast cancer...usually you'll see more desire for participatory decision making," Barry said.

After they had the consultation with their doctor, about a third of the women in the study continued to want their physicians to have control over the decision.

"The preference to leave the decision to the physician is a perfectly reasonable decision to make," Brown told Reuters Health.

He and his colleagues note in the new report that they intend to pursue future studies of patients with other cancers, especially those with limited treatment options.

SOURCE: http://bit.ly/xp9uLX Journal of Clinical Oncology, online February 6, 2012.

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For pregnant women with cancer, chemo possible

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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For pregnant women with cancer, chemo possible

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

View the original article here

Most women with cancer want a role in decisions

NEW YORK (Reuters Health) - About two-thirds of women diagnosed with early stage breast cancer want to take part in making decisions about their treatment, according to a new survey of patients from five different countries.

Some of these women want complete control over making treatment choices while others want to share the decision with their doctor -- yet only a minority of them actually get the level of involvement they are hoping for.

"Physicians should be trying to elicit patient preferences," said Richard Brown, the lead author of the study and an assistant professor at Virginia Commonwealth University.

Brown's team asked 683 women who were recently diagnosed with breast cancer what kind of role they would like to have in making decisions about their treatment: would they like to have total control, a shared role with their doctor, or have the doctor make the choices.

After the women met with their physicians, the researchers followed up to ask how their visit went and whether their preferences for how involved they would like to be in the future had changed.

Only 28 out of every 100 women initially wanted to delegate the decision to their doctor, but 46 out of every 100 reported that their doctor ended up making the decision.

"I think it's not so surprising that the actual decision making tended to be more doctor-directed than the patients wanted," said Dr. Michael Barry, president of the Foundation for Informed Medical Decision Making, who was not involved in this study.

"I think sometimes clinicians think most patients don't want to participate in decisions, particularly around serious things like cancer, and that's not the finding here or in previous studies," he told Reuters Health.

Among the 282 women who changed their preference after the consultation with their doctor, a little more than half of them shifted toward a greater involvement.

A third of them originally wanted their doctor to make the decision and later preferred to either share it or take control themselves, and one in five who originally wanted to share the decision later preferred to make the choice on their own.

When women had more involvement than they originally intended, they "were less conflicted over the decision, more satisfied with their ultimate decision, more satisfied with the consultation communication" than women who had less involvement, the authors write in the Journal of Clinical Oncology.

Barry said the findings make sense for women with early-stage breast cancer, because there are often multiple, effective options for treatment.

For instance, the risk of death might be the same if a woman has her breast removed compared to having her breast preserved, but one woman might prioritize keeping her breast and be more willing to go through the extra surgeries and radiation.

"When patients then understand there are multiple reasonable options for treatment of early stage breast cancer...usually you'll see more desire for participatory decision making," Barry said.

After they had the consultation with their doctor, about a third of the women in the study continued to want their physicians to have control over the decision.

"The preference to leave the decision to the physician is a perfectly reasonable decision to make," Brown told Reuters Health.

He and his colleagues note in the new report that they intend to pursue future studies of patients with other cancers, especially those with limited treatment options.

SOURCE: http://bit.ly/xp9uLX Journal of Clinical Oncology, online February 6, 2012.

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Anti-cancer drug for women weakens bone density

A drug tipped for widespread use to prevent breast cancer in post-menopausal women also accelerates loss of bone density, thus potentially boosting the risk of fractures, a study published on Tuesday said.

Exemestane -- brand name Aromasin -- is part of a drug class called aromatase inhibitors, which lower levels of the oestrogen that some breast cancers need in order to grow.

Canadian bone specialists took a look at a group of patients who had taken part in a study into the effectiveness of exemestane among 4,500 healthy women with a worrying family history of breast cancer.

Overall, the big study showed that the drug was highly effective, reducing the risk of breast cancer by almost two-thirds.

The bone sub-study looked at 351 women who had been taking either exemestane or a dummy lookalike pill and whose bone density was measured with hi-tech scanners.

After two years, women taking exemestane had a high loss of bone density at a common fracture point in the wrist called the distal radius, and also at the lower end of the tibia, compared with their counterparts on placebo.

The exemestane users also had an eight-percent decline in the thickness of cortical bone, which comprises the protective outer shell of the bones.

That finding in particular is worrying because nearly four out of every five fractures in old age occur in cortical bone. These accidents are a huge source of disability.

"Women considering exemestane for the primary prevention of breast cancer should weigh their individual risks and benefits," says the study, headed by Angela Cheung of the University Health Network in Toronto.

"For women taking exemestane, regular bone monitoring plus adequate calcium and vitamin D supplementation are important."

The paper is published online by the journal The Lancet Oncology.

View the original article here

Anti-cancer drug for women weakens bone density

A drug tipped for widespread use to prevent breast cancer in post-menopausal women also accelerates loss of bone density, thus potentially boosting the risk of fractures, a study published on Tuesday said.

Exemestane -- brand name Aromasin -- is part of a drug class called aromatase inhibitors, which lower levels of the oestrogen that some breast cancers need in order to grow.

Canadian bone specialists took a look at a group of patients who had taken part in a study into the effectiveness of exemestane among 4,500 healthy women with a worrying family history of breast cancer.

Overall, the big study showed that the drug was highly effective, reducing the risk of breast cancer by almost two-thirds.

The bone sub-study looked at 351 women who had been taking either exemestane or a dummy lookalike pill and whose bone density was measured with hi-tech scanners.

After two years, women taking exemestane had a high loss of bone density at a common fracture point in the wrist called the distal radius, and also at the lower end of the tibia, compared with their counterparts on placebo.

The exemestane users also had an eight-percent decline in the thickness of cortical bone, which comprises the protective outer shell of the bones.

That finding in particular is worrying because nearly four out of every five fractures in old age occur in cortical bone. These accidents are a huge source of disability.

"Women considering exemestane for the primary prevention of breast cancer should weigh their individual risks and benefits," says the study, headed by Angela Cheung of the University Health Network in Toronto.

"For women taking exemestane, regular bone monitoring plus adequate calcium and vitamin D supplementation are important."

The paper is published online by the journal The Lancet Oncology.

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Breast cancer kills older women more often

NEW YORK (Reuters Health) - Breast cancer is often considered more deadly among younger women, but a new study shows older women are actually more likely to die of the disease.

Researchers found that among women who had been diagnosed with a certain type of breast cancer, those over 75 years old were 63 percent more likely to die of the cancer than women younger than 65.

"I suspect it's undertreatment," said Dr. Stephen Jones, one of the authors of the study and the medical director at US Oncology Research in Texas. "We did show the rates of chemotherapy and radiation therapy are less in the older group."

Jones and his colleagues tracked nearly 10,000 women who had already gone through menopause and who had been diagnosed with hormone receptor-positive breast cancer.

That is the most common type of the disease, and it is considered less dangerous than the hormone receptor-negative types because it is often slower growing and might respond to hormone treatments.

Younger women are more likely than older women to have the receptor-negative cancer and they also tend to get diagnosed at a later stage, leading to the idea that breast cancer is more deadly for them.

In this study, the researchers found that five out of every 100 women who were diagnosed under age 65 and six out of every 100 women diagnosed between 65 and 74 years old died from breast cancer within five years.

Among women over age 75 at the time of their diagnosis, eight out of every 100 died from the cancer.

The team isn't sure how to account for the gap, but Dr. Hyman Muss of the University of North Carolina School of Medicine, agreed with Jones.

"What's different in older women is they tend to get lesser and poorer treatment," said Muss, who was not involved in the new study.

About one in eight American women will get breast cancer at some point in their life, but less than a fourth of them will die from it.

Breast cancer can be treated with a combination of surgery, radiation, chemotherapy and hormonal medications.

Nearly all the women in the study went through surgery, but just half of the women over age 75 had radiation, and just five percent had chemotherapy.

In comparison, 75 percent of women under age 65 received radiation and 51 percent had chemotherapy.

"There are beliefs that older women do not benefit from chemotherapy as much as younger women, and that the side effects are worse," said Dr. Gerrit-Jan Liefers, a researcher at Leiden University Medical Centre in The Netherlands who also worked on the study.

He added that the patients themselves may also be more hesitant to treat their cancer aggressively.

A recent study found that, while the rates of breast cancer deaths have been slowing, older women have had smaller gains than younger women (see Reuters Health report of November 11, 2011).

Those authors also attribute the differences in part to less aggressive treatment in older women.

"You don't want to treat older women so aggressively that you actually cause more problems from the treatment than from the disease," Dr. Benjamin Smith from the University of Texas MD Anderson Cancer Center in Houston, who worked on that study, told Reuters Health in November.

Muss said it's possible to overtreat elderly patients, but otherwise healthy women in their 70s would likely benefit from chemotherapy.

"We need to teach doctors not to think of a person's chronologic age, but think of their functional age," Muss said.

Liefers said clinicians badly need a tool that can help them better calculate the optimal treatment for older women.

His findings, published in the Journal of the American Medical Association, also showed that as women got older, the chances of dying from something other than their breast cancer increased dramatically.

The encouraging finding for women of all age groups is that the vast majority will survive their cancer, Jones pointed out.

"The overall death rates are pretty low," he told Reuters Health. "I think that's a good message."

SOURCE: http://bit.ly/4HWZ7 Journal of the American Medical Association, February 8, 2012.

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