Anemia Drugs May Cause Deadly Blood Clots

TUESDAY, Nov. 10 (HealthDay News) — New research on cancer patients adds to the controversy surrounding anemia drugs such as Procrit and Aranesp, concluding that they increase the risk of venous thromboembolism, potentially fatal blood clots.


These drugs, called erythropoiesis-stimulating agents (ESAs), are commonly prescribed to fight anemia associated with chemotherapy and chronic kidney disease. Recent studies have linked them with increased risk of death, stroke and new cancers.

“These drugs hit the market in the mid-1990s, and by 2002, 50 percent of patients on chemotherapy were receiving them,” said lead researcher Dr. Dawn Hershman, co-director of the breast program at the Herbert Irving Comprehensive Cancer Center at New York-Presbyterian Hospital/Columbia University Medical Center in New York City.

Initial testing of these drugs was done on only 12 weeks of use, she noted. “Right from the beginning, there was concern that these drugs would cause some side effects, but the initial studies did not find any risk of thrombosis.”

Her longer study was more informative. “We confirmed that these agents can increase the risk of thrombosis by twofold,” Hershman added.

The report is published in the Nov. 10 online edition of the Journal of the National Cancer Institute in advance of print publication on Dec. 2.

For the study, Hershman’s team collected data on 56,210 cancer patients treated with chemotherapy from 1991 through 2002. Of these patients, 15,346 also received ESAs.

The researchers found that 14.3 percent of patients receiving ESAs developed thromboembolism (deep vein thrombosis or pulmonary embolism) compared with 9.8 percent of those who did not receive an ESA.

ESAs stimulate red blood cell production and are intended to reduce the number of blood transfusions needed during chemotherapy. However, the rate of blood transfusions remained the same for both groups (22 percent). Survival in both groups was also similar, the researchers noted.

“These agents were approved to reduce the risk of blood transfusions by 50 percent,” Hershman said. “There was absolutely no difference in the transfusion rate over the 10-year period from when these drugs hit the market,” she said. “The majority of patients are getting these drugs and receiving transfusions.”

Based on concerns raised by earlier studies, the U.S. Food and Drug Administration in 2007 required a black box warning label on ESAs about the risk for venous thromboembolism, tumor promotion and death. The warning suggested restricting the use of ESAs to specific tumor types, and addressed dosage, duration and targeted hemoglobin levels.

In 2006, U.S. sales of ESAs were $10 billion and accounted for the largest Medicare expenditure for any drug.

Hershman thinks the findings raise questions about the drug’s approval process and whether adequate post-marketing research was undertaken to ensure their long-term safety.

These drugs do have a place, she said. “But we have to figure out what the best indication is and use every agent with caution. We should think about the drugs that we give.”

Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, said that “this study is one more in a list of several that suggests the value of ESAs was less than originally hoped, and the side effects were greater than previously understood.”

Patients and doctors should be aware of all the risks and benefits before using the drugs, he said.

“If you are going to be treated with these drugs, do so with caution, do so with understanding, have a discussion with your physician about the need for these drugs and what the potential difficulties may be,” he said.

More information

For more information on ESAs, visit the U.S. Food and Drug Administration.

By Steven Reinberg
HealthDay Reporter

SOURCES: Dawn Hershman, M.D., co-director, breast cancer program, Herbert Irving Comprehensive Cancer Center at New York-Presbyterian Hospital/Columbia University Medical Center, New York City; J. Leonard Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Nov. 10, 2009, Journal of the National Cancer Institute, online

Last Updated: Nov. 10, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Being ‘Housebound’ Linked to Alzheimer’s in Elderly

By Randy Dotinga
HealthDay Reporter

TUESDAY, April 26 (HealthDay News) — Seniors who are “housebound” seem to have nearly double the risk of developing Alzheimer’s disease, a new study suggests.

The research doesn’t prove that being confined to the house causes dementia, and other factors
could explain the association. Still, the findings raise questions about the possible cost of isolation, said lead investigator Bryan D. James, a postdoctoral fellow at Rush Alzheimer’s Disease Center in Chicago.

“People who don’t leave their home as much aren’t engaging with their environment and meeting new people,” James said. “They may not be using their minds as much.”

But James and his colleagues noted that underlying brain disease may also explain the results — that is, people may not be getting out as much because the insidious workings of Alzheimer’s or another form of dementia may affect the way one moves through the world long before they affect memory or speech.

Alzheimer’s disease afflicts an estimated 5.2 million people in the United States. That number is expected to grow to as many as 7.7 million Americans by 2030 as the Baby Boom generation ages.

The new study, published online April 15 in the American Journal of Geriatric Psychiatry, looks at something known as “life space.”

“[Life space] is actually a measure that has come into vogue with gerontologists lately,” James said. “Mostly it’s been a measurement of mobility, figuring out whether people are getting around their environment, how much they’re seeing that’s different from their couch or bedroom or living room.”

Researchers followed 1,294 seniors from two separate studies of older adults whose health was being tracked over time. At the beginning of this study, none of the elders showed signs of dementia. Over an average of 4.4 years, 180 developed Alzheimer’s disease.

The researchers found that people who reported that they never left their home environment during a given week were about twice as likely to develop Alzheimer’s disease in the five years of follow-up as those who traveled out of town. The research, James said, offers “a new way to see who’s going to be more likely to develop dementia in the future.”

The study also found that those who did not go beyond their driveway or front yard were also more likely to develop mild cognitive disorder, which can be an early manifestation of Alzheimer’s.

There are some caveats to the research. Some of the participants lived in retirement homes and may have led full lives without needing to leave the buildings where they live; however, they were still counted as being housebound.

Still, the researchers found that the connection between isolation and Alzheimer’s disease remained even when they adjusted their statistics so they wouldn’t be thrown off by factors such as depression, social networks, disease and disability, as well as age, sex, education, race or preclinical dementia.

Why does all this matter? “People are interested in figuring out who’s going to develop Alzheimer’s and new ways to target more people likely to develop it,” James said. “Maybe with the limited interventions we do have available, we can target them toward people who aren’t leaving their homes.”

Dr. James R. Burke, director of the Memory Disorders Clinic at Duke University Medical Center, said isolation could offer a clue to possible dementia problems before they become obvious. “This will be particularly important when disease-modifying therapies are available, so that evaluations can be started and interventions considered before there are significant cognitive problems,” Burke said.

“This paper is consistent with, but extends, previous findings that physical activity, intellectual engagement and social stimulation are important to delaying cognitive decline,” Burke added.

More information

For more about Alzheimer’s disease, visit the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Bryan D. James, Ph.D., postdoctoral fellow, Rush Alzheimer’s Disease Center, Chicago; James R. Burke, M.D., Ph.D., director, Memory Disorders Clinic, Duke University Medical Center, Durham, N.C.; April 15, 2011, American Journal of Geriatric Psychiatry, online

Last Updated: April 26, 2011

Copyright © 2011 HealthDay. All rights reserved.

Alzheimer’s Cases Could Double With New Guidelines: Expert

By Amanda Gardner
HealthDay Reporter

TUESDAY, April 19 (HealthDay News) — The first new guidelines in 27 years for the diagnosis of Alzheimer’s disease could double the number of Americans defined as having the brain-robbing illness.


The guidelines, issued Tuesday by the Alzheimer’s Association and the U.S. National Institute of Aging, differ in two important ways from the last recommendations, which have been in use since 1984.

First, Alzheimer’s is now being recognized as a continuum of stages: Alzheimer’s itself with clear symptoms; mild cognitive impairment (MCI) with mild symptoms; and also the “preclinical” stage, when there are no symptoms but when recognizable brain changes may already be occurring.

Second, the new guidelines incorporate the use of so-called “biomarkers” — such as the levels of certain proteins in blood or spinal fluid — to diagnose the disease and assess its progress, but almost exclusively for research purposes only.

Still, the authors of the guidelines emphasized that these revisions are unlikely to change what happens in doctors’ offices when diagnosing Alzheimer’s or its precursors.

“It will not change practice,” said Dr. Guy M. McKhann, one of the guideline authors, at a Monday press conference.

MCI will, however, become a new diagnosis. And that could mean that the number of people considered to be on the new Alzheimer’s continuum could double, said Marilyn Albert, another author, director of the division of cognitive neuroscience at Johns Hopkins. But how MCI is determined won’t change.

The new U.S. National Institute on Aging/Alzheimer’s Association Diagnostic Guidelines for Alzheimer’s Disease now recognize three clear stages of Alzheimer’s disease.

The first and most severe is Alzheimer’s dementia, when patients are clearly cognitively and functionally impaired. This is to be characterized now not just by memory loss but also visual, spatial and judgment problems.

The new guidelines also make a clearer distinction between Alzheimer’s dementia and vascular dementia (such as that caused by stroke), McKhann said. The diagnosis will still be made by a doctor, with help from someone who knows the patient and perhaps the patient him- or herself, but biomarkers may be called in “to augment our certainty about the diagnosis,” said McKhann, a professor of neurology and neuroscience at Johns Hopkins University School of Medicine in Baltimore.

Another stage, MCI, can represent an earlier phase of dementia and consists of modest impairments, primarily in memory, which can be a harbinger of full-blown Alzheimer’s years down the road. In the research arena, investigators will be working towards standardizing biomarkers which indicate, for example, the presence of amyloid protein or nerve damage in the brain.

But for now, how diagnoses are made “will be extremely similar to what’s been used in the last 10 years,” said Albert, who added that “a very large number” of individuals with MCI do go on to develop Alzheimer’s.

“Older adults with MCI progress to dementia at a higher rate than those with no impairment, but progression is not inevitable,” according to the Alzheimer’s Association’s online overview of mild cognitive impairment.

“Not everyone diagnosed with MCI goes on to develop Alzheimer’s,” the association noted.

The preclinical category was formulated for research purposes only, namely to study biomarkers that may be present in the blood or cerebrospinal fluid or evident on different imaging tests that would indicate the build-up of amyloid plaque or damage to nerve cells.

“The main conceptual point was to define Alzheimer’s on the basis of the underlying brain changes rather than just requiring clinical symptoms,” said Dr. Reisa A. Sperling, a neurologist at Brigham and Women’s Hospital and associate professor of neurology at Harvard Medical School in Boston. “We thought our best chance for disease-modifying therapy was to detect evidence of the disease and intervene much earlier.”

As in cancer and diabetes, McKhann pointed out, if you’re trying therapies “only in people who have advanced dementia, the chances of them working is not very great.”

“We’re worried that there could be drugs around now that could be beneficial but that we could be using them too late in the disease course,” added Albert.

The new guidelines, summarized William Thies, chief medical and scientific officer of the Alzheimer’s Association, “will result in little change in current clinical practice of medicine as applied to Alzheimer’s disease. . . . [However] the new criteria are really extending the range of our ability to investigate this disease and eventually to find treatments that will be so necessary to avoid the epidemic of Alzheimer’s that we see facing us.”

The new guidelines appear in four papers in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

More information

The Alzheimer’s Association has more about mild cognitive impairment (MCI).

SOURCES: April 18, 2011 teleconference with William Thies, Ph.D., chief medical and scientific officer, Alzheimer’s Association; Guy M. McKhann, M.D., professor of neurology and neuroscience, Johns Hopkins University School of Medicine; Marilyn Albert, Ph.D., director, division of cognitive neuroscience, department of neurology, Johns Hopkins University School of Medicine and Reisa A. Sperling, M.D., neurologist, Brigham and Women’s Hospital and associate professor of neurology, Harvard Medical School

Last Updated: April 19, 2011

Copyright © 2011 HealthDay. All rights reserved.

Dermatitis May Be More Cause Than Effect of Food Allergies

THURSDAY, Feb. 10 (HealthDay News) — One of the most common forms of eczema, the chronic inflammatory skin disease, may actually precede the onset of food allergies, rather than be the product of existing allergies, new research suggests.

This means that parents of children with the specific skin condition, known as atopic dermatitis, should be on the lookout for signs of food allergies in their children.


“Considering that 6 to 10 percent of children have atopic dermatitis and that up to one-third of those individuals may have documented food allergy, the number of these children affected by food allergies may be significant,” Dr. Jon M. Hanifin, a dermatologist and professor at Oregon Health & Science University, said in a news release from the American Academy of Dermatology.

Hanifin presented his team’s findings Feb. 4 in New Orleans at the annual meeting of the American Academy of Dermatology.

Their conclusions stem from a five-year study that focused on children aged 3 months to 18 months old who had atopic dermatitis, which is characterized by red, cracked and itchy skin.

The researchers found that about 15 percent of the children had food allergies, including those with the mildest form of the disease. Children with more severe disease had a greater risk for developing allergies, they said.

Experts note that research presented at meetings has not been subjected to the same type of rigorous scrutiny given to research published in peer-reviewed medical journals.

Hanifin added that people with atopic dermatitis produce relatively large amounts of an antibody known as IgE, which normally is generated when foreign proteins enter the bloodstream, which is key to the onset of an allergic reaction.

However, the researchers cautioned that the true determination of a food allergy requires careful testing with controlled exposures to particular foods followed by a rigorous analysis of ensuing reactions.

“In most cases,” Hanifin said, “patients experience atopic dermatitis before food allergies, so it is important for parents of infants and small children affected by this skin condition to be aware of the risk of food allergies.”

More information

The American Academy of Dermatology has more on eczema.

– Alan Mozes

SOURCE: American Academy of Dermatology, news release, Feb. 4, 2011

Last Updated: Feb. 10, 2011

Copyright © 2011 HealthDay. All rights reserved.

Allergies Linked to Lower Brain Cancer Rate in Study

By Randy Dotinga
HealthDay Reporter

MONDAY, Feb. 7 (HealthDay News) — If you suffer from allergies, take heart: Researchers say you may be less likely to develop a tough-to-treat brain cancer, possibly because your immune system is on high alert.


It’s not clear how this knowledge might improve prevention or treatment of brain cancer, but the study’s lead author said the findings pave the way for further research.

“We need to do more studies to really get at that underlying mechanism. Then we might be able to do things that would influence people who might have a higher risk or may have a family history,” said Bridget J. McCarthy, a research associate professor of epidemiology at the University of Illinois at Chicago.

The lesions studied are known as gliomas, the most common type of adult brain tumor. They account for more than half of the 18,000-plus malignant brain tumors diagnosed in the United States every year, according to the U.S. National Cancer Institute.

Gliomas — which led to the death of Sen. Edward Kennedy — often cause death within months, despite surgery or treatment with chemotherapy or radiation.

Researchers have published conflicting studies about whether people with allergies and autoimmune disorders (which cause the immune system to attack the body) have a lower risk of developing the tumors, McCarthy said. “We wanted to look at the spectrum and see if we found the association with any type of allergy,” McCarthy explained.

In the study, published Feb. 7 in the journal Cancer Epidemiology, Biomarkers & Prevention, McCarthy and colleagues examined surveys filled out by 419 patients with gliomas and 612 cancer-free patients from North Carolina and Illinois. All of the patients were asked if they had doctor-diagnosed allergies — seasonal, medication, food, pet or any other — and whether they took antihistamines.

The researchers found that patients with both high- and low-grade tumors were more likely to report no allergies than the other patients. And the more allergies someone had, the lower their odds of having gliomas. Antihistamine use didn’t affect the results, the authors said.

However, the study didn’t specify exactly how much more likely it is that an allergy-free person will develop a glioma compared to someone who has allergies.

What might allergies — or the lack of them — have to do with brain tumors? McCarthy said overactive immune systems may cause allergies and also allow people to fight off cancer. Figuring out what to do about this is the tough question.

“Obviously, it’s not like allergies are a modifiable risk factor,” she said. “You can’t tell people to go out and develop allergies. That’s not going to happen. And you can’t tell people with allergies that, ‘You’re doing a good thing, and don’t try to get rid of them.’”

The study doesn’t prove a cause and effect — that allergies directly lower the risk of brain tumor. It only shows a possible connection, one that doesn’t sway Dr. Eugene S. Flamm, chairman of the department of neurosurgery at Montefiore Medical Center in New York City.

Flamm said the study is small and draws conclusions “far beyond the observational data.”

“As the authors point out, there are several conflicting reports in the literature, and this paper does not resolve the issue in any way,” Flamm said.

One reason for the conflicting reports, the authors said, was that “allergy” was defined differently in various studies — sometimes broadly and sometimes narrowly, as in seasonal allergies alone. Further studies are essential, they said.

More information

For more about brain cancer, visit the U.S. National Library of Medicine.

SOURCES: Bridget J. McCarthy, Ph.D., research associate professor of epidemiology, University of Illinois at Chicago; Eugene S. Flamm, M.D., Jeffrey P. Bergstein Professor and chairman, department of neurological surgery, Montefiore Medical Center, New York City; February 2011, Cancer Epidemiology, Biomarkers & Prevention

Last Updated: Feb. 07, 2011

Copyright © 2011 HealthDay. All rights reserved.

Heavy Beer Drinking, Genetics May Raise Risk of Stomach Cancer

By Kathleen Doheny
HealthDay Reporter

MONDAY, April 4 (HealthDay News) — Heavy beer drinkers who carry a gene mutation involved in the metabolism of alcohol may face a higher risk than others of developing stomach cancer, new European research suggests.

Having a certain genetic variant and drinking roughly three 12-ounce cans or more of beer a day appears to markedly increase the risk of “non-cardia gastric cancer,” a study found.

“This is the first time we’ve seen this genetic variant associated with gastric cancer risk, so we need to emphasize that this result needs to be replicated in other populations,” cautioned study lead author Eric Duell, a senior epidemiologist at the Catalan Institute of Oncology in Barcelona, Spain.

“For now, if people want to know whether they should go out and get tested for this variant or whether they should stop drinking if they’re heavy beer drinkers, I would basically say that we’re not there yet,” added Duell.

“All we can currently say is that the genetic variant is associated with increased risk, heavy drinking is associated with increased risk, and when the two are together, the risk is even worse,” he noted.

The study focused on the “rs1230025 variant” located among a group of three genes already linked to alcohol digestion.

And although the results focus on the coupling of the mutation with heavy drinking, the authors also found that either factor on its own also raised stomach cancer risk, although less dramatically. Namely, cancer risk was elevated among non-drinkers bearing the mutation and among heavy drinkers without the mutation.

Duell and his colleagues are slated to present their findings Monday in Orlando, Fla., at the annual meeting of the American Association for Cancer Research. Findings presented at meetings are considered preliminary until published in a peer-reviewed journal.

Globally, stomach cancer is the second-greatest cause of cancer death, the authors say, but it is less prevalent in the United States than in some other countries.

Such differences have led researchers to suspect that potentially modifiable factors, such as drinking patterns, might influence risk.

Duell and his team analyzed information from a large cancer and nutrition study involving more than 521,000 residents of 10 European countries between 1992 and 1998. They looked at consumption patterns of beer, wine and liquor, cancer incidence and genetic screening information for the study participants, who were 35 to 70 years old.

The team linked a 75 percent bump in gastric cancer risk to consumption of 30 grams or more of pure ethanol/alcohol a day in the form of beer. A standard 12-ounce can of beer contains 13 grams of pure ethanol/alcohol, they noted. Wine and hard liquor did not appear to increase cancer risk.

Europeans who drank heavily and also carried the gene mutation in question demonstrated an even higher stomach cancer risk, the researchers found.

The mutations analyzed are common, said Duell. “I don’t know what it would be in the U.S., but among our European population about 20 percent carried this variant. So it’s not rare,” he explained.

“But gastric cancer is multi-factorial,” he added. “There are many, many causes. So it’s important to note that someone who’s a heavy drinker may never get gastric cancer, and that clearly there are other health problems associated with gastric cancer that play a role.”

Dr. George Kim, assistant professor of oncology at the Mayo Clinic College of Medicine in Jacksonville, Fla., said the observations should be considered in context.

“If you’re a young American in a bar in New York,” he said, “the question is, does this even apply to you? And I have some concerns that it does not. This genetic issue seems to be more applicable to certain northern Europeans and perhaps Asian populations,” Kim said.

“Also, if you’re drinking three beers a day, that’s a lot,” Kim noted. “That may raise the risk for a lot of other issues, such as liver disease. So I would say that drinking in moderation is always desirable. But at this point this particular finding should not raise undue concern.”

However, Dr. Janice Dutcher, an attending oncologist at St. Luke’s-Roosevelt Hospital Center/Continuum Cancer Centers in New York City, said the findings “make logical sense.”

“It’s certainly interesting enough that it needs to be looked at further,” she said. “And it’s enough to give people pause, if one comes from a family, for example, that has a history of gastric cancer, because we’ve long thought that alcohol is related to certain types of cancer. It’s just been very hard to prove.

Following this line of reasoning could eventually explain some degree of risk and lead to testing for those who might be most susceptible to alcohol-induced damage, she added.

More information

For more on alcohol and cancer, visit the American Cancer Society.

SOURCES: Eric Duell, Ph.D., senior epidemiologist, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain; George Kim, M.D, consultant and assistant professor, director of gastro-intestinal cancers, Mayo Clinic, Jacksonville, Fla., and assistant professor, oncology, Mayo Clinic College of Medicine; Janice Dutcher, M.D., attending oncologist, St. Luke’s-Roosevelt Hospital Center/Continuum Cancer Centers, New York City; American Association for Cancer Research, news release, April 4, 2011

Last Updated: April 04, 2011

Copyright © 2011 HealthDay. All rights reserved.

Alcohol May Play Dual Role in Some Cases of Elder Abuse

FRIDAY, March 25 (HealthDay News) — Seniors who suffer elder abuse are more likely to be women, to have a neurological or mental disorder and to abuse drugs or alcohol, new research indicates.

In the study, researchers examined medical record data from two Chicago-area trauma units and compared 41 cases of elder abuse with a random set of patients over age 60 (control group) who were treated between 1999 and 2006.


The analysis revealed that 29 percent of abuse victims tested positive for alcohol, compared to 13 percent of the control group. “Past studies have shown that alcohol abuse by the perpetrator plays a substantial role and is strongly associated with physical abuse,” lead study author Lee Friedman, assistant professor of environmental and occupational health sciences at the University of Illinois at Chicago, said in a university news release. “Our findings indicate that alcohol abuse among the victims may be an important contributing factor as well.”

In addition, the abuse victims were also more likely to have pre-existing medical conditions such as dementia and Alzheimer’s disease, mental illness, alcohol abuse and heart disease, the investigators found.

Compared to patients in the control group, abuse victims had more severe injuries, higher in-hospital death rates, longer stays in the hospital, and were more likely to be admitted to intensive care units.

After treatment, 20 of the abuse victims returned to the setting where the abuse occurred. In most cases, the perpetrator of the abuse had been arrested, but 17 percent of the victims said they wanted to return to that person and not to press charges. Family members or intimate partners were the perpetrators in 85 percent of the cases, according to the report published in the March issue of the Journal of the American Geriatrics Society.

The researchers also found that most abuse cases weren’t identified until after the patient had been admitted or had spent several days in hospital. This failure of medical staff to recognize cases of abuse and to contact adult protective services in the majority of cases shows that health professionals need to improve their understanding of elder abuse, Friedman pointed out.

More information

The U.S. Administration on Aging has more about elder abuse.

— Robert Preidt

SOURCE: University of Illinois at Chicago, news release, March 22, 2011

Last Updated: March 25, 2011

Copyright © 2011 HealthDay. All rights reserved.