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Health Threats Don’t End for Some Sepsis Survivors

FRIDAY, Aug. 9, 2019 — Sepsis is a life-threatening infection that lands its victims in the hospital, but the dangers don’t end for survivors who have high levels of inflammation long after being discharged, a new study finds.

“Sepsis is the leading cause of death among hospitalized patients. Patients discharged from the hospital aren’t out of the woods yet. Approximately one out of every three sepsis survivors will die in the following year,” said study lead author Dr. Sachin Yende. He is a professor of critical care medicine and clinical and translational science at the University of Pittsburgh’s School of Medicine.

“Our new findings about chronic inflammation post-discharge suggest that addressing this condition may be important to improve patients’ long-term outcomes,” added Yende, vice president of critical care and deputy chief of staff at Veterans Affairs Pittsburgh Healthcare System.

Nearly all sepsis patients have increased inflammation in their bloodstream during the first few days of hospitalization, but how long the inflammation can persist and what effects it might have were unclear.

To find out, the researchers followed 483 people who survived hospitalization with sepsis at 12 U.S. hospitals between 2012 and 2017. They were assessed at three, six and 12 months after hospital discharge.

Up to a year after hospitalization, about one-fourth of the patients had elevated levels of inflammation and half had elevated levels of immunosuppression biomarkers, the findings showed.

These patients had higher rates of hospital readmission (particularly due to heart disease and stroke) and death than patients whose inflammation levels returned to normal after hospitalization.

According to senior study author Dr. Derek Angus, “The participants with increased inflammation had levels that were twice as high as levels in healthy individuals, and that elevated inflammation persisted long after hospital discharge.” Angus is chair of the department of critical care medicine at the University of Pittsburgh.

“Sepsis increases risk of heart disease and stroke, and, for the first time, we’ve linked these adverse outcomes to persistent inflammation,” he said in a university news release. “This opens the door to future studies into why high levels of inflammation persist for at least a year after hospital discharge, and the development of treatments aimed at modifying the inflammation with the hope that will improve health.”

The study was published online Aug. 7 in JAMA Network Open.

Sepsis affects more than 30 million people worldwide every year, according to the World Health Organization.

More information

The U.S. Centers for Disease Control and Prevention has more on sepsis.

© 2019 HealthDay. All rights reserved.

Posted: August 2019

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Cancer Survivors May Have Lower Odds for Dementia

By Amy Norton

HealthDay Reporter

FRIDAY, June 21, 2019 (HealthDay News) — Researchers have found more evidence of a puzzling phenomenon: Older adults who survive cancer seem to be somewhat protected against dementia.

A number of studies in recent years have found that cancer survivors have a relatively lower risk of developing Alzheimer’s.

The new research adds another layer. It shows that even before their diagnosis, older adults who go on to develop cancer have an edge when it comes to memory performance.

Among the older Americans who were tracked for 16 years, those who developed cancer typically had sharper memory skills — both before and after the diagnosis — than those who remained cancer-free.

Researchers said it all supports the theory that some of the biological processes that contribute to cancer may actually protect against dementia.

But the big remaining question is, what are those mechanisms?

“We’re really interested in understanding what [they] could be, because it might point the way to strategies to prevent dementia,” said senior researcher Maria Glymour, a professor at the University of California, San Francisco School of Medicine.

The study findings are based on more than 14,500 U.S. adults born before 1949. Between 1998 and 2014, they underwent periodic tests of memory function. During that time, 2,250 were newly diagnosed with cancer.

On average, the study found, the people with cancer consistently performed better on memory tests. In the decade before the cancer diagnosis, their memory declined at a 10.5% slower rate than their counterparts who remained cancer-free.

After the diagnosis, cancer patients did typically see a sudden worsening in their memory for a short time. But afterward, their rate of memory decline continued at the same pace as before the diagnosis — which meant they maintained an advantage over cancer-free older adults.

There are theories as to why the pattern exists: Some of the mechanisms that allow cancer cells to grow and spread may, in the brain, protect cells from dying.

Glymour’s team points to the example of an enzyme called PIN1: Its activity is enhanced in cancer, but decreased in Alzheimer’s. Among other roles, the enzyme is thought to help prevent the buildup of abnormal proteins in the brain that are the hallmark of Alzheimer’s.

Continued

But there is a lot of work to do before all the pieces can be put together, according to Glymour. One question is whether only certain cancer types are connected to a lower risk of memory decline and dementia.

In past studies, the link has been surprisingly consistent among different cancers, Glymour noted. “But,” she said, “we think that might just be because there were not enough cases of different types of cancer to detect the differences.”

If larger studies do show that only certain cancers are tied to slower memory decline, Glymour noted, that could give clues about the underlying reasons.

Dr. Olivia Okereke is director of geriatric psychiatry at Massachusetts General Hospital in Boston. She said the association between cancer and a lower risk of Alzheimer’s is puzzling and “sounds counterintuitive” — since cancer, and some cancer treatments, can actually take a toll on mental skills such as attention, information-processing and short-term memory.

“But these associations have been noted in studies for years now,” said Okereke, who wrote an editorial accompanying the research. Both were published June 21 online in JAMA Network Open.

She called the new study a “very useful contribution,” because it shows the memory advantage exists before people ever develop cancer, then persists afterward.

That, Okereke said, suggests that “common underlying mechanisms” might contribute to cancer while protecting brain cells.

“But we need more research to elucidate those mechanisms,” she added.

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Sources

SOURCES: Maria Glymour, Sc.D., M.S., professor, epidemiology and biostatistics, University of California, San Francisco School of Medicine; Olivia Okereke, M.D., director, geriatric psychiatry, Massachusetts General Hospital, and associate professor, psychiatry, Harvard Medical School, Boston; June 21, 2019,JAMA Network Open, online

Copyright © 2013-2018 HealthDay. All rights reserved.

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Pagination

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Heart Disease Is Lasting Threat to Breast Cancer Survivors

FRIDAY, June 21, 2019 — Postmenopausal women who survive breast cancer may have a higher risk for developing heart disease, a new study says.

Heart problems can appear more than five years after radiation treatment for breast cancer, and the added risk persists for as much as 30 years, according to Brazilian researchers.

Heart disease is the leading cause of death in older women.

“Heart disease appears more commonly in women treated for breast cancer because of the toxicities of chemotherapy, radiation therapy, and use of aromatase inhibitors, which lower estrogen. Heart-healthy lifestyle modifications will decrease both the risk of recurrent breast cancer and the risk of developing heart disease,” said Dr. JoAnn Pinkerton, executive director of the North American Menopause Society (NAMS).

In this study, researchers led by Dr. Daniel de Araujo Brito Buttros, from Botucatu Medical School at Sao Paulo State University, compared and evaluated heart disease risk factors in 96 postmenopausal breast cancer survivors and 192 women without breast cancer.

The investigators found that cancer survivors were much more likely to have metabolic syndrome, diabetes, atherosclerosis, abdominal obesity and high triglyceride levels in their blood. All are major risk factors for heart disease.

The risk of heart-related death among breast cancer survivors was similar to the risk of death from breast cancer itself.

The study was recently published online in Menopause, the journal of NAMS. The findings suggest that women consider including a cardiologist in their cancer treatment decisions.

“Women should schedule a cardiology consultation when breast cancer is diagnosed and continue with ongoing follow-up after cancer treatments are completed,” Pinkerton advised in a journal news release.

More information

The nonprofit organization Susan G. Komen has more on later effects of breast cancer treatment.

© 2019 HealthDay. All rights reserved.

Posted: June 2019

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Cancer Survivors Predicted to Top 22 Million by 2030

By Steven Reinberg

HealthDay Reporter

TUESDAY, June 11, 2019 (HealthDay News) — More Americans are surviving cancer, and their numbers could top 22 million in another decade, the American Cancer Society says.

Currently, thanks to better screening and treatment, more than 17 million Americans who had cancer remain alive, the society said in a new report.

While this is good news, it comes with a cautionary note. Cancer survivors often have long-term difficulties. Many must also overcome barriers to get the treatments they need, the researchers said.

“People with a history of cancer have unique medical, psychosocial and economic needs that require proactive assessment and management by health care providers,” said report co-author Robin Yabroff. She’s senior scientific director of health services research for the cancer society.

“Although there are growing numbers of tools that can assist patients, caregivers and clinicians in navigating the various phases of cancer survivorship, further evidence-based resources are needed to optimize care,” Yabroff said in a society news release.

The report estimated that 8 million men and nearly 9 million women have a history of cancer. Among the survivors, 68% had their cancer diagnosed five or more years ago and 18% at least 20 years ago.

Also, while nearly two-thirds of survivors are 65 or older, nearly 66,000 survivors are 14 and younger. Close to 48,000 are 15 to 19 years old.

Because of the growing and aging population, survivorship is increasing even though the number of women who develop cancer remains stable and the number of men with cancer declines, the researchers found.

The most common cancers among men are prostate, colon cancer and melanoma. Among women they are breast, uterine and colon cancer.

The report was published June 11 in the journal CA: A Cancer Journal for Clinicians.

WebMD News from HealthDay

Sources

SOURCE: American Cancer Society, news release, June 11, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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AHA News: How Can Therapy for Heart Attack Patients Help Cancer Survivors?

MONDAY, April 8, 2019 (American Heart Association News) — Heart disease and cancer — ruthless conditions that are the nation’s leading causes of death — can sometimes intertwine. Certain cancer treatments can directly damage the heart, while others leave survivors dealing with weight gain or loss of fitness.

One way to potentially counteract these heart-related risks is to adopt a cardiac rehab plan like the one heart attack survivors follow.

That’s the strategy behind cardio-oncology rehabilitation, an emerging health care specialty that could be instrumental in treating the cardiovascular-related problems that arise in cancer survivors, according to a new scientific statement from the American Heart Association published Monday in the journal Circulation.

Thanks to advances in early detection and treatment, there are nearly 17 million cancer survivors in the United States. But many are 1.3 to 3.6 times more likely to die from a cardiovascular-related event compared to someone who has never had cancer. Cancer survivors also are 1.7 to 18.5 times more likely to develop diabetes, high blood pressure, high cholesterol or other heart disease risks.

“There are still cancer patients and health care providers who don’t understand the link between heart disease and cancer, so we’re trying to educate them,” said Dr. Susan Gilchrist, chair of the statement’s writing committee and a cardiologist at the University of Texas MD Anderson Cancer Center in Houston.

The new report explains how certain factors — such as a patient’s age, the type of cancer and whether chemotherapy was involved — can make a difference in a person’s risk for cardiovascular disease, she said.

“We need to do a better job of explaining the issue, and I think this document helps people understand who’s at higher risk and, if they are at higher risk, what can we do about it as both oncologists and cardiologists so we don’t keep separate silos,” Gilchrist said.

Cardiovascular risks go up for cancer survivors for various reasons. Some people already may have cardiovascular risk factors, but not know about them at the time of their cancer diagnosis or during treatment.

Other times, the heart muscle is weakened by the drugs, radiation or other treatments used to eliminate the cancer.

“Many patients, after they receive their cancer therapy, need help getting their heart back to a stronger and healthier functional status,” said Dr. Randal Thomas, a member of the statement’s writing committee.

That’s where cardiac rehabilitation comes into play.

Cardiac rehab is a medically supervised program for people who have had a heart attack or some type of heart surgery. It involves exercise training, education about lifestyle changes and counseling to help reduce stress and anxiety.

“Cardiac rehab is a great way to systematically alter the lifestyles, particularly exercise, and cardiovascular risk factors at play for a cancer patient,” Gilchrist said. “And cardiac rehab already exists — you don’t have to re-invent the wheel. It exists all across the United States, both in community and academic hospitals.”

But because cardio-oncology rehab is an evolving field that has only existed for a handful of years, getting insurance to pay for it has been a problem.

“This scientific statement is a first step to pave the way for reimbursement for patients with cancer within the (cardiac rehab) model,” its authors wrote.

The statement also calls for more research to show cardio-oncology rehabilitation works. Past studies have shown exercise may help people regain some of the cardiorespiratory fitness lost during cancer treatment. Research also suggests programs modeled after cardiac rehab can improve a survivor’s muscular strength and quality of life.

“There’s definitely a need for more studies to look at new populations and methods and when is the best time to initiate therapy,” said Thomas, medical director of the cardiac rehabilitation program at the Mayo Clinic in Rochester, Minnesota, where a cardio-oncology rehab program is currently available for breast cancer survivors.

“But at the same time, it’s a really good time for patients and health care providers to communicate with policymakers, including government leaders, about the importance of covering what we already know can be beneficial to patients recovering from cancer.”

Gilchrist, who heads up one of the nation’s few programs in this area, said there’s an overlap between cardiovascular disease and factors that drive cancer.

“Cardiac rehab is about getting people to exercise more. We know exercise helps people live longer. It keeps people out of the hospital. It lowers the risk of cancer mortality for several types of cancer. It also prevents cardiovascular disease,” she said. “So providing structured exercise to cancer patients, systematically across the U.S., would be a tremendous win for society in general.”

© 2019 HealthDay. All rights reserved.

Posted: April 2019

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AHA News: Post-Stroke Depression Common Among Black, Hispanic Survivors