To advance care for patients with brain metastases: Reject five myths
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A blue-ribbon team of national experts on brain cancer says that professional pessimism and out-of-date “myths,” rather than current science, are guiding - and compromising - the care of patients with cancers that spread to the brain.
In a special article published in the July issue of Neurosurgery, the team, led by an NYU Langone Medical Center neurosurgeon, argues that many past, key clinical trials were designed with out-of-date assumptions and the tendency of some physicians to “lump together” brain metastases of diverse kinds of cancer, often results in less than optimal care for individual patients. Furthermore, payers question the best care when it deviates from these misconceptions, the authors conclude.
“It’s time to abandon this unjustifiable nihilism and think carefully about more individualized care,” says lead author of the article, Douglas S. Kondziolka, M.D., MSc, FRCSC, Vice Chair of Clinical Research and Director of the Gamma Knife Program in the Department of Neurosurgery at NYU Langone. The authors - who also say medical insurers help perpetuate the myths by denying coverage that deviates from them - identify five leading misconceptions that often lead to poorer care:
Poor quality of life may affect teens’ diabetes management
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In the years after being diagnosed with diabetes, adolescents struggling with social and psychological burdens of managing the disease are likely to do a worse job of controlling it, according to a new U.S. study.
Teens who reported a lower quality of life were more likely to have rising levels of hemoglobin A1c, a marker of elevated blood sugar over time and a sign of poor diabetes control.
“We need to intervene from a prevention standpoint,” said Korey Hood, a psychologist at the University of California, San Francisco and lead author of the study. “We need to do systematic screening of these psychosocial issues.”
Teens who are psychologically stressed are less likely to take care of themselves, which could explain the rise in A1c levels, added Michael Scharf, a psychiatrist at the University of Rochester Medical Center who was not involved in the study.
Study Explains How High Blood Pressure in Middle Age Affects Memory in Old Age
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High blood pressure in middle age plays a critical role in whether blood pressure in old age may affect memory and thinking, according to a study published in the online edition of the journal Neurology.
“Our findings bring new insight into the relationship between a history of high blood pressure, blood pressure in old age, the effects of blood pressure on brain structure, and memory and thinking,” said study author Lenore J. Launer, PhD, National Institute on Aging, part of the National Institutes of Health (NIH), Bethesda, Maryland.
For the study, 4,057 older participants free of dementia had their blood pressure measured in middle-age (mean age, 50 years). In late life (mean age, 76 years) their blood pressure was re-measured and participants underwent magnetic resonance imaging (MRI) scans that looked at structure and damage to the small vessels in the brain. They also took tests that measured their memory and thinking ability.
The study found that the association of blood pressure in old age to brain measures depended on a history of blood pressure in middle age. Higher systolic and diastolic blood pressure was associated with increased risk of brain lesions and tiny brain bleeds. This was most noticeable in people without a history of high blood pressure in middle age. For example, people with no history of high blood pressure in middle age who had high diastolic blood pressure in old age were 50% more likely to have severe brain lesions than people with low diastolic blood pressure in old age.
Climate engineering can’t erase climate change
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Tinkering with climate change through climate engineering isn’t going to help us get around what we have to do says a new report authored by researchers at six universities, including Simon Fraser University.
After evaluating a range of possible climate-altering approaches to dissipating greenhouse gases and reducing warming, the interdisciplinary team concluded there’s no way around it. We have to reduce the amount of carbon being released into the atmosphere.
“Some climate engineering strategies look very cheap on paper. But when you consider other criteria, like ecological risk, public perceptions and the abilities of governments to control the technology, some options look very bad,” says Jonn Axsen.
The assistant professor in SFU’s School of Resource and Environmental Management is a co-author on this study, which appears in the latest issue of the peer-reviewed journal Frontiers in Ecology and the Environment. It is the first scholarly attempt to rank a wide range of approaches to minimizing climate change in terms of their feasibility, cost-effectiveness, risk, public acceptance, governability and ethics.
Experts recommend blood, urine testing to diagnose rare adrenal tumors
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The Endocrine Society today issued a Clinical Practice Guideline (CPG) for the diagnosis and treatment of two types of rare adrenal tumors - pheochromocytomas and paragangliomas - that can raise the risk of cardiovascular disease and even death if left untreated.
The CPG, entitled “Pheochromocytoma and Paraganglioma: An Endocrine Society Clinical Practice Guideline,” appeared in the June 2014 issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.
Pheochromocytomas are rare, usually noncancerous tumors that form inside the adrenal glands, while paragangliomas are similar tumors that develop outside the glands. The tumors cause the body to produce excess amounts of the hormones epinephrine - commonly known as adrenaline - and norepinephrine, which is involved in regulating blood pressure. Symptoms of these tumors include high blood pressure, episodic severe headaches, excess sweating, racing heart, feelings of anxiety and trembling.
Experts estimate between 0.1 and 1 percent of patients treated for high blood pressure have pheochromocytomas, according to the National Institutes of Health’s National Cancer Institute.
