Daily Dose

Hormone therapy extends life of some prostate cancer patients

July 18, 2011

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Men diagnosed with prostate cancer are routinely given a harsh hormone therapy treatment for four months - it suppresses the production of the male sex hormone testosterone - but little was known about how effective that treatment was at increasing the odds of survival in those with early- and intermediate-stage disease. So researchers decided to test whether giving the drugs along with radiation treatments could prolong a patient’s life.

The answer, according to a study published last week in the New England Journal of Medicine, is no and yes: no, the drugs - such as leuprolide (Lupron, Eligard), and goserelin (Zoladex) - don’t provide much survival benefit for those with small, nonaggressive tumors that haven’t spread, but yes, they can significantly extend life for those who have somewhat larger, more aggressive tumors that fall into the intermediate category.

(Men with late-stage tumors that have spread have already been shown to benefit from hormone therapy.)

“I think it will be a game changer for low-risk patients with early-stage tumors,’’ said Dr. Anthony D’Amico, chief of genitourinary radiation oncology at Dana-Farber Cancer Institute and Brigham and Women’s Hospital, who wrote an editorial that accompanied the study. Oncologists may begin to veer away from giving hormone therapy to shrink enlarged prostates before administering radiation therapy, which is commonplace today for the vast majority of patients diagnosed with early-stage tumors.

The study, conducted by researchers from the University of Pennsylvania, Radiological Associates of Sacramento, and other institutions, provides compelling findings for those with somewhat more advanced cancers. Men with moderate stage 2 cancer who took hormone therapy along with radiation had just a 3 percent risk of dying over 10 years compared with a 10 percent risk for those who had just the radiation therapy.

But the drugs have side effects that can linger for years: hot flashes, erectile dysfunction, loss of sexual desire, brittle bones, weight gain, and an acceleration of heart disease in those who already have it. Men may also experience fatigue, diarrhea, nausea, and excessive itching.

D’Amico wonders, though, whether some doctors now reluctant to prescribe hormones will be leery of changing their prescribing habits due to these side effects.

“A healthier man with no other health problems might be back to his old self within a year after ending the four-month treatment,’’ said D’Amico. But those who have other health problems, such as obesity, heart disease, or diabetes, might take much longer to bounce back and might never fully recover from, say, a progression of their heart disease.

The study, which recruited patients 10 to 15 years ago, also used lower doses of radiation than the higher doses that have become standard for intermediate-stage patients, so oncologists might assume that hormone therapy on top of that won’t provide added benefits.

But D’Amico said other research presented at a recent meeting found that high-dose radiation when combined with hormone therapy led to fewer recurrences of cancer in men with moderate disease.

Still uncertain, though, is how men should navigate the myriad of other dilemmas they face when it comes to screening for and treating prostate cancer, which strikes one in six men. The prostate specific antigen blood test has proven to be a crude screening tool with very limited value for specifically identifying life-threatening cancers. And some men, especially older ones, are being told they can take a “watchful waiting’’ approach if their tumor is small and slow-growing. What’s more, this study addresses only men who opt for radiation treatments. It doesn’t address whether there’s any survival benefit from hormone therapy for those who have their tumors surgically removed.


Hospital visits more deadly in July, study confirms

A review study published last week in the Annals of Internal Medicine indicates that July - when new residents, or doctors in training, start and old residents leave - is the riskiest month, something that was long assumed but never strongly documented.

Patients admitted to teaching hospitals in July are more likely to die, or experience prolonged hospital stays during the year-end changeover - known as the July effect - compared with other months of the year, according to researchers who reviewed data from 39 studies. The best-quality studies reviewed found that patients treated in July had a 4 to 12 percent increase in mortality risk compared with those treated in the spring before the staffing change.

Some of the studies also indicated an increase in medical errors and complications from procedures, but the data were not strong enough to draw firm conclusions.

The study also did not examine whether it was riskier to have outpatient procedures like knee surgeries or biopsies in July.

“It is certainly one factor among many for a patient to consider when scheduling a truly elective procedure,’’ says study author Dr. John Young, a psychiatrist and associate director of the residency training program at the University of California-San Francisco Medical Center. D.K.

HBBob wrote: Maybe it also involves summer activities, stressful family gatherings like weddings or reunions, other holiday celebrations and more accidents?

Placebo relieves asthma symptoms as well as drug

Asthma patients treated with a placebo inhaler or sham acupuncture get as much relief from those “fake’’ therapies as they do from an inhaler containing albuterol. That surprising finding, published last week in the New England Journal of Medicine, underscores the power of the mind to bring relief from pain and other symptoms.

“It gives me a little bit of pause in terms of thinking about how I should approach patients and how I may be able to heal just by being there for them,’’ said Dr. Michael Wechsler, lead author of the study and a pulmonologist at Brigham and Women’s Hospital.

To be clear, Wechsler and his colleagues found that albuterol improved lung function more than the placebos when the medication was randomly assigned to be administered to the 46 patients in the study during four of the 12 scheduled visits. But that difference in lung function did not translate into patients saying they felt greater relief from symptoms.

Patients should still use an inhaler if they are having an asthma attack, Wechsler said. D.K.

urout wrote: The number of deaths from asthma are increasing and along comes this biased publication (who cares if it is in the NEJM) that is dangerous. Everyone knows there is placebo response to nearly every patient-dependent symptom. But this does not mean you use placebo.

ames123 wrote: If there is a placebo effect, we aren’t in control of it well enough to forgo the use of the drug. In philosophical terms, perhaps this implies that asthma in general has a psychological component, that there are forces at work that we don’t understand.

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