Doug Brunk

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Most patients with multiple primary malignancies that are potentially related to human papillomavirus present with cervical cancer, and later develop head and neck squamous cell cancer or anal cancer, results from a long-term, single-center study suggest.

"In head and neck squamous cell cancers, the presence of HPV is correlated with improved patient outcomes," researchers led by Dr. Heath D. Skinner wrote in an abstract presented in a poster session at the annual meeting of the American Society for Radiation Oncology. "However, it is unknown whether the development of one potentially HPV-related cancer affects the development of another and how the disease factors and outcomes are related."

Based on the available literature, this patient population has a two- to fourfold increased risk over the general population for the development of a second potentially HPV-related malignancy, said Dr. Skinner of the University of Texas M.D. Anderson Cancer Center in Houston. He and his associates reviewed the charts of 143 patients with multiple cancers who were treated at the center in 1949-2008. Patients with in situ and non–squamous cell carcinoma malignancies were excluded from the analysis, with the exception of cervical adenocarcinoma.

Of the 301 cancers, the most common was head and neck (115), followed by cancer of the cervix (104), anus (49), vulva (21), vagina (8) and penis (4). The median follow-up from diagnosis of the first and second tumor was 16 years and 3 years, respectively.

The median age of patients at first and second diagnosis was 45 and 60 years, respectively, with a median duration between diagnoses of 11 years. Cervical cancer was the most common initial diagnosis (62%); head and neck squamous cell cancer was the most common second diagnosis (58%).

Dr. Skinner and his associates also found that patients with head and neck squamous cell cancer as the first diagnosis were most likely to develop subsequent cervical cancer.

"There is a significant difference in the timeline of the development of a second potentially HPV-related malignancy based on the primary site," the researchers noted. "Patients with cervix cancer have a much longer latency to a second primary than do patients with head and neck squamous cell cancer, anal [cancer], or other gynecologic malignancies."

Next, the researchers plan to investigate the actual HPV positivity of these tumors and identify whether a single viral genotype is responsible for multiple tumors in an individual patient.

The researchers stated that they have no relevant financial conflicts to disclose.

SAN DIEGO – Patients with stage I and II Hodgkin’s disease who received radiation therapy as part of their treatment plan in 1988-2006 had an 11% improvement in overall survival at 5 years, compared with patients who did not receive radiation, results from large analysis demonstrated.

Use of radiation for this patient population decreased by nearly 20% over the same time period, however, while the percentage of patients who developed second malignancies did not differ between those who had radiation and those who did not, Dr. Matthew Koshy reported at the annual meeting of the American Society for Radiation Oncology.

In the early 1990s, several publications revealed significant long-term complications associated with a combined-modality approach involving full-dose chemotherapy and extended-field radiation therapy in patients with early-stage Hodgkin’s disease, said Dr. Koshy, who led the study during his residency in the department of radiation oncology at the University of Maryland Medical Center, Baltimore.

"As a result, cooperative groups changed the treatment paradigm," said Dr. Koshy, currently of the department of radiation and cellular oncology at the University of Chicago. "The goal of any treatment strategy in Hodgkin’s disease is to maintain the excellent survival rates while reducing the morbidity by minimizing radiotherapy and chemotherapy. As a result, two treatment strategies emerged: One was the use of combined-modality therapy, but with a reduction in the irradiated volume, the radiation dose, the number of chemotherapy cycles, and the number of chemotherapy agents. A second treatment strategy was to use chemotherapy alone with additional cycles and eliminate radiation from the treatment paradigm."

In an effort to study the use of radiation therapy for patients with early-stage Hodgkin’s disease and its impact on overall survival and secondary malignancies, Dr. Koshy and his associates analyzed data from the SEER (Surveillance, Epidemiology, and End Results) database of the National Cancer Institute for patients aged 20 years and older who were diagnosed with stage I or II Hodgkin’s disease in 1988-2006. SEER covers 26% of the U.S. population and collects incidence and survival data from 17 population-based registries.

Of the 12,467 patients studied, Dr. Koshy reported that 51.5% received radiation therapy. The median follow-up was 4.9 years, and 21% of the cohort had more than 10 years of follow-up. Factors associated with a higher likelihood of receiving radiation therapy were having stage II disease, extranodal involvement, B-symptoms (fever greater than 38??C, drenching sweats, weight loss greater than 10% of body weight) and lymphocyte-rich or nodular sclerosis histology.

The 5-year overall survival was 87% for patients who received radiation therapy, compared with 76% for those who did not (P less than .0001).

To control for selection bias, Dr. Koshy and his associates examined patients who survived a minimum of 1 year. The 5-year overall survival for this subset of patients was 90% for patients who received radiation therapy, compared with 85% for those who did not (P less than .001).

In addition, the 5-year, cause-specific survival among all patients in the analysis was 94% for those who received radiation therapy, compared with 88% for those who did not (P less than .0001).

The actuarial rate of developing a second malignancy was statistically similar between the two groups: 14.6% for patients who received radiation therapy, compared with 15% for those who did not. Dr. Koshy acknowledged certain limitations of the study, including the fact that there was no information about whether chemotherapy was administered to these patients or not, or about the mode of radiation delivery.

Some recently published phase III studies have examined the withholding of radiation therapy from patients with early-stage Hodgkin’s disease, Dr. Koshy said, "and all have shown an improvement in freedom from progression in patients who have received radiation therapy. There has never been a phase III study that has validated a chemotherapy-alone strategy."

Despite this fact, he and his associates observed a nearly 20% decrease in the use of radiation therapy for these patients between 1988 and 2006 (from 62.9% to 43.7%). "This large decrease may be a result of patients not receiving centralized care in a multidisciplinary setting," Dr. Koshy said in a later interview. "It is paramount that all cases of early-stage Hodgkin’s lymphoma be considered for combined modality therapy. Treatment planning involving radiation oncologists and medical oncologists should be standard of care."

Dr. Koshy said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients with stage I and II Hodgkin’s disease who received radiation therapy as part of their treatment plan in 1988-2006 had an 11% improvement in overall survival at 5 years, compared with patients who did not receive radiation, results from large analysis demonstrated.

Use of radiation for this patient population decreased by nearly 20% over the same time period, however, while the percentage of patients who developed second malignancies did not differ between those who had radiation and those who did not, Dr. Matthew Koshy reported at the annual meeting of the American Society for Radiation Oncology.

In the early 1990s, several publications revealed significant long-term complications associated with a combined-modality approach involving full-dose chemotherapy and extended-field radiation therapy in patients with early-stage Hodgkin’s disease, said Dr. Koshy, who led the study during his residency in the department of radiation oncology at the University of Maryland Medical Center, Baltimore.

"As a result, cooperative groups changed the treatment paradigm," said Dr. Koshy, currently of the department of radiation and cellular oncology at the University of Chicago. "The goal of any treatment strategy in Hodgkin’s disease is to maintain the excellent survival rates while reducing the morbidity by minimizing radiotherapy and chemotherapy. As a result, two treatment strategies emerged: One was the use of combined-modality therapy, but with a reduction in the irradiated volume, the radiation dose, the number of chemotherapy cycles, and the number of chemotherapy agents. A second treatment strategy was to use chemotherapy alone with additional cycles and eliminate radiation from the treatment paradigm."

In an effort to study the use of radiation therapy for patients with early-stage Hodgkin’s disease and its impact on overall survival and secondary malignancies, Dr. Koshy and his associates analyzed data from the SEER (Surveillance, Epidemiology, and End Results) database of the National Cancer Institute for patients aged 20 years and older who were diagnosed with stage I or II Hodgkin’s disease in 1988-2006. SEER covers 26% of the U.S. population and collects incidence and survival data from 17 population-based registries.

Of the 12,467 patients studied, Dr. Koshy reported that 51.5% received radiation therapy. The median follow-up was 4.9 years, and 21% of the cohort had more than 10 years of follow-up. Factors associated with a higher likelihood of receiving radiation therapy were having stage II disease, extranodal involvement, B-symptoms (fever greater than 38??C, drenching sweats, weight loss greater than 10% of body weight) and lymphocyte-rich or nodular sclerosis histology.

The 5-year overall survival was 87% for patients who received radiation therapy, compared with 76% for those who did not (P less than .0001).

To control for selection bias, Dr. Koshy and his associates examined patients who survived a minimum of 1 year. The 5-year overall survival for this subset of patients was 90% for patients who received radiation therapy, compared with 85% for those who did not (P less than .001).

In addition, the 5-year, cause-specific survival among all patients in the analysis was 94% for those who received radiation therapy, compared with 88% for those who did not (P less than .0001).

The actuarial rate of developing a second malignancy was statistically similar between the two groups: 14.6% for patients who received radiation therapy, compared with 15% for those who did not. Dr. Koshy acknowledged certain limitations of the study, including the fact that there was no information about whether chemotherapy was administered to these patients or not, or about the mode of radiation delivery.

Some recently published phase III studies have examined the withholding of radiation therapy from patients with early-stage Hodgkin’s disease, Dr. Koshy said, "and all have shown an improvement in freedom from progression in patients who have received radiation therapy. There has never been a phase III study that has validated a chemotherapy-alone strategy."

Despite this fact, he and his associates observed a nearly 20% decrease in the use of radiation therapy for these patients between 1988 and 2006 (from 62.9% to 43.7%). "This large decrease may be a result of patients not receiving centralized care in a multidisciplinary setting," Dr. Koshy said in a later interview. "It is paramount that all cases of early-stage Hodgkin’s lymphoma be considered for combined modality therapy. Treatment planning involving radiation oncologists and medical oncologists should be standard of care."

Dr. Koshy said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Patients with stage I and II Hodgkin’s disease who received radiation therapy as part of their treatment plan in 1988-2006 had an 11% improvement in overall survival at 5 years, compared with patients who did not receive radiation, results from large analysis demonstrated.

Use of radiation for this patient population decreased by nearly 20% over the same time period, however, while the percentage of patients who developed second malignancies did not differ between those who had radiation and those who did not, Dr. Matthew Koshy reported at the annual meeting of the American Society for Radiation Oncology.

In the early 1990s, several publications revealed significant long-term complications associated with a combined-modality approach involving full-dose chemotherapy and extended-field radiation therapy in patients with early-stage Hodgkin’s disease, said Dr. Koshy, who led the study during his residency in the department of radiation oncology at the University of Maryland Medical Center, Baltimore.

"As a result, cooperative groups changed the treatment paradigm," said Dr. Koshy, currently of the department of radiation and cellular oncology at the University of Chicago. "The goal of any treatment strategy in Hodgkin’s disease is to maintain the excellent survival rates while reducing the morbidity by minimizing radiotherapy and chemotherapy. As a result, two treatment strategies emerged: One was the use of combined-modality therapy, but with a reduction in the irradiated volume, the radiation dose, the number of chemotherapy cycles, and the number of chemotherapy agents. A second treatment strategy was to use chemotherapy alone with additional cycles and eliminate radiation from the treatment paradigm."

In an effort to study the use of radiation therapy for patients with early-stage Hodgkin’s disease and its impact on overall survival and secondary malignancies, Dr. Koshy and his associates analyzed data from the SEER (Surveillance, Epidemiology, and End Results) database of the National Cancer Institute for patients aged 20 years and older who were diagnosed with stage I or II Hodgkin’s disease in 1988-2006. SEER covers 26% of the U.S. population and collects incidence and survival data from 17 population-based registries.

Of the 12,467 patients studied, Dr. Koshy reported that 51.5% received radiation therapy. The median follow-up was 4.9 years, and 21% of the cohort had more than 10 years of follow-up. Factors associated with a higher likelihood of receiving radiation therapy were having stage II disease, extranodal involvement, B-symptoms (fever greater than 38??C, drenching sweats, weight loss greater than 10% of body weight) and lymphocyte-rich or nodular sclerosis histology.

The 5-year overall survival was 87% for patients who received radiation therapy, compared with 76% for those who did not (P less than .0001).

To control for selection bias, Dr. Koshy and his associates examined patients who survived a minimum of 1 year. The 5-year overall survival for this subset of patients was 90% for patients who received radiation therapy, compared with 85% for those who did not (P less than .001).

In addition, the 5-year, cause-specific survival among all patients in the analysis was 94% for those who received radiation therapy, compared with 88% for those who did not (P less than .0001).

The actuarial rate of developing a second malignancy was statistically similar between the two groups: 14.6% for patients who received radiation therapy, compared with 15% for those who did not. Dr. Koshy acknowledged certain limitations of the study, including the fact that there was no information about whether chemotherapy was administered to these patients or not, or about the mode of radiation delivery.

Some recently published phase III studies have examined the withholding of radiation therapy from patients with early-stage Hodgkin’s disease, Dr. Koshy said, "and all have shown an improvement in freedom from progression in patients who have received radiation therapy. There has never been a phase III study that has validated a chemotherapy-alone strategy."

Despite this fact, he and his associates observed a nearly 20% decrease in the use of radiation therapy for these patients between 1988 and 2006 (from 62.9% to 43.7%). "This large decrease may be a result of patients not receiving centralized care in a multidisciplinary setting," Dr. Koshy said in a later interview. "It is paramount that all cases of early-stage Hodgkin’s lymphoma be considered for combined modality therapy. Treatment planning involving radiation oncologists and medical oncologists should be standard of care."

Dr. Koshy said that he had no relevant financial conflicts to disclose.

SAN DIEGO – Short-interval mammography following breast-conserving therapy is not more effective than annual screening mammography in detecting new ipsilateral invasive breast cancer, results from a large health care system study demonstrated.

The National Comprehensive Cancer Network recommends a mammogram 6-12 months following radiation, whereas the American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis, but no earlier than 6 months after completion of radiotherapy, Dr. William T. Sause said at the annual meeting of the American Society for Radiation Oncology.

For the past 10 years Dr. Sause and his associates at Intermountain Healthcare, an organization of 24 hospitals in Utah, have conducted posttreatment mammograms at 6-month intervals for the first 2 years after patients have completed radiotherapy, followed by annual screening. The researchers use mammography tracking software that has been implemented and standardized at all facilities.

To evaluate the effectiveness of this approach, Dr. Sause and his associates reviewed the records of 1,454 patients who had a lumpectomy and radiation between 2003 and 2007. Of those, 1,386 underwent short-interval mammography. All recurrences were reviewed by a dedicated breast radiologist to verify the recurrence, type, and diagnosis.

Dr. Sause reported that 25 patients (1.8%) experienced a recurrence during the study period. Most recurrences (84%) manifested within 24 months, "which is not surprising, because our study closed in 2007, so the follow-up isn’t much longer than that," he said.

Nearly half of the recurrences (44%) were ductal in situ carcinoma, and 52% occurred in the ipsilateral breast. Of the ipsilateral breast recurrences, 62% were ductal in situ carcinoma.

No ipsilateral or invasive recurrences were identified within 12 months. Five (20%) ipsilateral and invasive recurrences were identified at 12-24 months, for a relative risk of 0.4%. The researchers found that the screening efficacy for patients undergoing short-term mammography is significantly lower compared with that of the general screening population (a yield of 2.9 vs. 4.4 cancers per 1,000 patients, respectively).

"Short-term mammography following modern breast conservation has very low yield for new ipsilateral invasive breast cancer," Dr. Sause concluded. "Eliminating short-term mammography would result in a minimum direct cost savings of approximately $1,160,000 for this patient cohort over the study period."

He said that the analysis "represents a worthwhile demonstration of comparative effectiveness research and has potential to be expanded to other treatment areas."

Electronic data resources, clinical leadership, data and statistical support, and cultural reorganization of priorities are needed for effective comparative effectiveness research, he continued. "All of these are challenging," he acknowledged. "There are misaligned incentives between health care providers and payers. It’s very easy for me to challenge the utilization of mammography. It’s not so easy to challenge the utilization of IMRT [intensity-modulated radiation therapy]."

Dr. Sause said that he had no relevant financial disclosures.

SAN DIEGO – Short-interval mammography following breast-conserving therapy is not more effective than annual screening mammography in detecting new ipsilateral invasive breast cancer, results from a large health care system study demonstrated.

The National Comprehensive Cancer Network recommends a mammogram 6-12 months following radiation, whereas the American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis, but no earlier than 6 months after completion of radiotherapy, Dr. William T. Sause said at the annual meeting of the American Society for Radiation Oncology.

For the past 10 years Dr. Sause and his associates at Intermountain Healthcare, an organization of 24 hospitals in Utah, have conducted posttreatment mammograms at 6-month intervals for the first 2 years after patients have completed radiotherapy, followed by annual screening. The researchers use mammography tracking software that has been implemented and standardized at all facilities.

To evaluate the effectiveness of this approach, Dr. Sause and his associates reviewed the records of 1,454 patients who had a lumpectomy and radiation between 2003 and 2007. Of those, 1,386 underwent short-interval mammography. All recurrences were reviewed by a dedicated breast radiologist to verify the recurrence, type, and diagnosis.

Dr. Sause reported that 25 patients (1.8%) experienced a recurrence during the study period. Most recurrences (84%) manifested within 24 months, "which is not surprising, because our study closed in 2007, so the follow-up isn’t much longer than that," he said.

Nearly half of the recurrences (44%) were ductal in situ carcinoma, and 52% occurred in the ipsilateral breast. Of the ipsilateral breast recurrences, 62% were ductal in situ carcinoma.

No ipsilateral or invasive recurrences were identified within 12 months. Five (20%) ipsilateral and invasive recurrences were identified at 12-24 months, for a relative risk of 0.4%. The researchers found that the screening efficacy for patients undergoing short-term mammography is significantly lower compared with that of the general screening population (a yield of 2.9 vs. 4.4 cancers per 1,000 patients, respectively).

"Short-term mammography following modern breast conservation has very low yield for new ipsilateral invasive breast cancer," Dr. Sause concluded. "Eliminating short-term mammography would result in a minimum direct cost savings of approximately $1,160,000 for this patient cohort over the study period."

He said that the analysis "represents a worthwhile demonstration of comparative effectiveness research and has potential to be expanded to other treatment areas."

Electronic data resources, clinical leadership, data and statistical support, and cultural reorganization of priorities are needed for effective comparative effectiveness research, he continued. "All of these are challenging," he acknowledged. "There are misaligned incentives between health care providers and payers. It’s very easy for me to challenge the utilization of mammography. It’s not so easy to challenge the utilization of IMRT [intensity-modulated radiation therapy]."

Dr. Sause said that he had no relevant financial disclosures.

SAN DIEGO – Short-interval mammography following breast-conserving therapy is not more effective than annual screening mammography in detecting new ipsilateral invasive breast cancer, results from a large health care system study demonstrated.

The National Comprehensive Cancer Network recommends a mammogram 6-12 months following radiation, whereas the American Society of Clinical Oncology recommends the first posttreatment mammogram 1 year after diagnosis, but no earlier than 6 months after completion of radiotherapy, Dr. William T. Sause said at the annual meeting of the American Society for Radiation Oncology.

For the past 10 years Dr. Sause and his associates at Intermountain Healthcare, an organization of 24 hospitals in Utah, have conducted posttreatment mammograms at 6-month intervals for the first 2 years after patients have completed radiotherapy, followed by annual screening. The researchers use mammography tracking software that has been implemented and standardized at all facilities.

To evaluate the effectiveness of this approach, Dr. Sause and his associates reviewed the records of 1,454 patients who had a lumpectomy and radiation between 2003 and 2007. Of those, 1,386 underwent short-interval mammography. All recurrences were reviewed by a dedicated breast radiologist to verify the recurrence, type, and diagnosis.

Dr. Sause reported that 25 patients (1.8%) experienced a recurrence during the study period. Most recurrences (84%) manifested within 24 months, "which is not surprising, because our study closed in 2007, so the follow-up isn’t much longer than that," he said.

Nearly half of the recurrences (44%) were ductal in situ carcinoma, and 52% occurred in the ipsilateral breast. Of the ipsilateral breast recurrences, 62% were ductal in situ carcinoma.

No ipsilateral or invasive recurrences were identified within 12 months. Five (20%) ipsilateral and invasive recurrences were identified at 12-24 months, for a relative risk of 0.4%. The researchers found that the screening efficacy for patients undergoing short-term mammography is significantly lower compared with that of the general screening population (a yield of 2.9 vs. 4.4 cancers per 1,000 patients, respectively).

"Short-term mammography following modern breast conservation has very low yield for new ipsilateral invasive breast cancer," Dr. Sause concluded. "Eliminating short-term mammography would result in a minimum direct cost savings of approximately $1,160,000 for this patient cohort over the study period."

He said that the analysis "represents a worthwhile demonstration of comparative effectiveness research and has potential to be expanded to other treatment areas."

Electronic data resources, clinical leadership, data and statistical support, and cultural reorganization of priorities are needed for effective comparative effectiveness research, he continued. "All of these are challenging," he acknowledged. "There are misaligned incentives between health care providers and payers. It’s very easy for me to challenge the utilization of mammography. It’s not so easy to challenge the utilization of IMRT [intensity-modulated radiation therapy]."

Dr. Sause said that he had no relevant financial disclosures.

SAN DIEGO — Women enrolled in a home environment–focused weight loss program for overweight adults had greater weight loss at 18 months, compared with men, results from a randomized study showed.

“We know that behavioral interventions for obesity produce sizeable and clinically meaningful initial weight losses,” Melissa Crane said at the meeting “But because changes in eating and exercise behaviors are rarely maintained over time, we see a weight regain within the first 3-5 years post intervention. One reason perhaps is that the intervention focuses almost entirely on the individual, largely ignoring the context in which eating and exercise behaviors occur.”

Ms. Crane, a research assistant in the Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, went on to note that most 6-month weight loss programs consist of two educational sessions: one on stimulus control and one on how to increase social support for weight loss. “Otherwise, they're largely expected to implement their new knowledge and skills within their existing environments,” she said. “Failing to modify environmental cues and temptations may make it very difficult to establish new behaviors and make the changes necessary to produce long-term weight loss.”

For the study, known as the Lifestyle Eating and Activity Program (LEAP), 210 overweight and obese adults were randomly assigned to standard behavior treatment alone (standard treatment group) or standard behavior treatment plus direct manipulation of the physical and social home environment (home group). Both groups received 18 months of treatment: 6 months weekly and 12 months biweekly. Treatment goals included a diet of 1,200-1,800 calories per day, with 30% or less of the calories from fat, plus gradually increasing exercise to 200 minutes per week of moderate intensity exercise. All study participants were taught behavioral techniques including self-monitoring, problem solving, goal setting, cognitive restructuring, and relapse prevention.

Goals for the home group included modifying the type and portion sizes of foods consumed in the home, modifying the availability of exercise equipment and sedentary activities in the home, increasing the saliency of the consequences of food choices, and creating a positive model for healthy eating and exercise in the home.

“During the screening program, all participants were required to identify a partner within their home who was also overweight and willing to participate in the program,” Ms. Crane added. “For participants randomized to the home group, those partners were encouraged to attend all group sessions and were required to set a weight loss goal and make similar changes in eating and exercise. In the standard treatment group, the partner attended the weight loss 101 session and assessments only.”

Study outcomes were assessed at baseline, 6 months, and 18 months with a combination of clinic and home visits. Weight loss was the primary outcome. Secondary outcomes included results on home environment measures, including the Home Food Inventory; the Exercise Environment Questionnaire; the presence of aerobic equipment such as a treadmill and whether it was stored in a visible, usable space; the number of televisions in the house; and the Sallis Social Support Questionnaires.

Ms. Crane, who discussed the study on behalf of lead investigator Amy Gorin, Ph.D., of the psychology department at the University of Connecticut, Hartford, reported that the mean age of participants at baseline was 49 years, 78% were women, and 82% were white. Their mean body weight was 99 kg and their mean body mass index was 36 kg/m

At 6 months, the home group lost significantly more weight, compared with the standard treatment group (a mean of 9 vs. 7 kg, respectively). However, by 18 months the difference in weight loss between the two groups was no longer significant (7 vs. 5 kg).

The researchers found that gender was an important moderator of treatment outcome. For example, women in the home group lost significantly more weight than did women in the standard treatment group (a mean of 7 vs. 4 kg, respectively), whereas men in the standard treatment group lost significantly more weight than did men in the home group (a mean of 14 kg vs. 8 kg, respectively).

At 18 months, partners, regardless of sex, lost significantly more weight in the home group than in the standard treatment group (a mean of 7 vs. 2 kg, respectively).

One possible explanation why the home group lost more weight than the standard treatment group at 6 months but not at 18 months is that the modifications to the home environment “may not have been sustained over time,” Ms. Crane said. “For example, when we look at changes in the home food environment, we see that between baseline and 6 months, participants in the home group showed greater increases in low-fat items available, smaller decreases in fruits and vegetables present, and greater decreases in high-fat spreads. But by 18 months the home environments looked remarkably similar between the two groups.”

However, she pointed out that some of the direct modifications made for the home group were still present at 18 months. For example, at the beginning of the study, members of the home group received a full-length mirror, healthy cooking and exercise magazines, and a treadmill or stationary bike. At 18 months, these items were present in the environments of the home group more frequently than in those of the standard treatment group. “Thus it appears that more direct modifications may be needed to produce sustained changes in the home environment,” Ms. Crane said.

Ms. Crane said that she had no relevant financial disclosures to make.

SAN DIEGO — Women enrolled in a home environment–focused weight loss program for overweight adults had greater weight loss at 18 months, compared with men, results from a randomized study showed.

“We know that behavioral interventions for obesity produce sizeable and clinically meaningful initial weight losses,” Melissa Crane said at the meeting “But because changes in eating and exercise behaviors are rarely maintained over time, we see a weight regain within the first 3-5 years post intervention. One reason perhaps is that the intervention focuses almost entirely on the individual, largely ignoring the context in which eating and exercise behaviors occur.”

Ms. Crane, a research assistant in the Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, went on to note that most 6-month weight loss programs consist of two educational sessions: one on stimulus control and one on how to increase social support for weight loss. “Otherwise, they're largely expected to implement their new knowledge and skills within their existing environments,” she said. “Failing to modify environmental cues and temptations may make it very difficult to establish new behaviors and make the changes necessary to produce long-term weight loss.”

For the study, known as the Lifestyle Eating and Activity Program (LEAP), 210 overweight and obese adults were randomly assigned to standard behavior treatment alone (standard treatment group) or standard behavior treatment plus direct manipulation of the physical and social home environment (home group). Both groups received 18 months of treatment: 6 months weekly and 12 months biweekly. Treatment goals included a diet of 1,200-1,800 calories per day, with 30% or less of the calories from fat, plus gradually increasing exercise to 200 minutes per week of moderate intensity exercise. All study participants were taught behavioral techniques including self-monitoring, problem solving, goal setting, cognitive restructuring, and relapse prevention.

Goals for the home group included modifying the type and portion sizes of foods consumed in the home, modifying the availability of exercise equipment and sedentary activities in the home, increasing the saliency of the consequences of food choices, and creating a positive model for healthy eating and exercise in the home.

“During the screening program, all participants were required to identify a partner within their home who was also overweight and willing to participate in the program,” Ms. Crane added. “For participants randomized to the home group, those partners were encouraged to attend all group sessions and were required to set a weight loss goal and make similar changes in eating and exercise. In the standard treatment group, the partner attended the weight loss 101 session and assessments only.”

Study outcomes were assessed at baseline, 6 months, and 18 months with a combination of clinic and home visits. Weight loss was the primary outcome. Secondary outcomes included results on home environment measures, including the Home Food Inventory; the Exercise Environment Questionnaire; the presence of aerobic equipment such as a treadmill and whether it was stored in a visible, usable space; the number of televisions in the house; and the Sallis Social Support Questionnaires.

Ms. Crane, who discussed the study on behalf of lead investigator Amy Gorin, Ph.D., of the psychology department at the University of Connecticut, Hartford, reported that the mean age of participants at baseline was 49 years, 78% were women, and 82% were white. Their mean body weight was 99 kg and their mean body mass index was 36 kg/m

At 6 months, the home group lost significantly more weight, compared with the standard treatment group (a mean of 9 vs. 7 kg, respectively). However, by 18 months the difference in weight loss between the two groups was no longer significant (7 vs. 5 kg).

The researchers found that gender was an important moderator of treatment outcome. For example, women in the home group lost significantly more weight than did women in the standard treatment group (a mean of 7 vs. 4 kg, respectively), whereas men in the standard treatment group lost significantly more weight than did men in the home group (a mean of 14 kg vs. 8 kg, respectively).

At 18 months, partners, regardless of sex, lost significantly more weight in the home group than in the standard treatment group (a mean of 7 vs. 2 kg, respectively).

One possible explanation why the home group lost more weight than the standard treatment group at 6 months but not at 18 months is that the modifications to the home environment “may not have been sustained over time,” Ms. Crane said. “For example, when we look at changes in the home food environment, we see that between baseline and 6 months, participants in the home group showed greater increases in low-fat items available, smaller decreases in fruits and vegetables present, and greater decreases in high-fat spreads. But by 18 months the home environments looked remarkably similar between the two groups.”

However, she pointed out that some of the direct modifications made for the home group were still present at 18 months. For example, at the beginning of the study, members of the home group received a full-length mirror, healthy cooking and exercise magazines, and a treadmill or stationary bike. At 18 months, these items were present in the environments of the home group more frequently than in those of the standard treatment group. “Thus it appears that more direct modifications may be needed to produce sustained changes in the home environment,” Ms. Crane said.

Ms. Crane said that she had no relevant financial disclosures to make.

SAN DIEGO — Women enrolled in a home environment–focused weight loss program for overweight adults had greater weight loss at 18 months, compared with men, results from a randomized study showed.

“We know that behavioral interventions for obesity produce sizeable and clinically meaningful initial weight losses,” Melissa Crane said at the meeting “But because changes in eating and exercise behaviors are rarely maintained over time, we see a weight regain within the first 3-5 years post intervention. One reason perhaps is that the intervention focuses almost entirely on the individual, largely ignoring the context in which eating and exercise behaviors occur.”

Ms. Crane, a research assistant in the Comprehensive Cancer Center at the University of North Carolina, Chapel Hill, went on to note that most 6-month weight loss programs consist of two educational sessions: one on stimulus control and one on how to increase social support for weight loss. “Otherwise, they're largely expected to implement their new knowledge and skills within their existing environments,” she said. “Failing to modify environmental cues and temptations may make it very difficult to establish new behaviors and make the changes necessary to produce long-term weight loss.”

For the study, known as the Lifestyle Eating and Activity Program (LEAP), 210 overweight and obese adults were randomly assigned to standard behavior treatment alone (standard treatment group) or standard behavior treatment plus direct manipulation of the physical and social home environment (home group). Both groups received 18 months of treatment: 6 months weekly and 12 months biweekly. Treatment goals included a diet of 1,200-1,800 calories per day, with 30% or less of the calories from fat, plus gradually increasing exercise to 200 minutes per week of moderate intensity exercise. All study participants were taught behavioral techniques including self-monitoring, problem solving, goal setting, cognitive restructuring, and relapse prevention.

Goals for the home group included modifying the type and portion sizes of foods consumed in the home, modifying the availability of exercise equipment and sedentary activities in the home, increasing the saliency of the consequences of food choices, and creating a positive model for healthy eating and exercise in the home.

“During the screening program, all participants were required to identify a partner within their home who was also overweight and willing to participate in the program,” Ms. Crane added. “For participants randomized to the home group, those partners were encouraged to attend all group sessions and were required to set a weight loss goal and make similar changes in eating and exercise. In the standard treatment group, the partner attended the weight loss 101 session and assessments only.”

Study outcomes were assessed at baseline, 6 months, and 18 months with a combination of clinic and home visits. Weight loss was the primary outcome. Secondary outcomes included results on home environment measures, including the Home Food Inventory; the Exercise Environment Questionnaire; the presence of aerobic equipment such as a treadmill and whether it was stored in a visible, usable space; the number of televisions in the house; and the Sallis Social Support Questionnaires.

Ms. Crane, who discussed the study on behalf of lead investigator Amy Gorin, Ph.D., of the psychology department at the University of Connecticut, Hartford, reported that the mean age of participants at baseline was 49 years, 78% were women, and 82% were white. Their mean body weight was 99 kg and their mean body mass index was 36 kg/m

At 6 months, the home group lost significantly more weight, compared with the standard treatment group (a mean of 9 vs. 7 kg, respectively). However, by 18 months the difference in weight loss between the two groups was no longer significant (7 vs. 5 kg).

The researchers found that gender was an important moderator of treatment outcome. For example, women in the home group lost significantly more weight than did women in the standard treatment group (a mean of 7 vs. 4 kg, respectively), whereas men in the standard treatment group lost significantly more weight than did men in the home group (a mean of 14 kg vs. 8 kg, respectively).

At 18 months, partners, regardless of sex, lost significantly more weight in the home group than in the standard treatment group (a mean of 7 vs. 2 kg, respectively).

One possible explanation why the home group lost more weight than the standard treatment group at 6 months but not at 18 months is that the modifications to the home environment “may not have been sustained over time,” Ms. Crane said. “For example, when we look at changes in the home food environment, we see that between baseline and 6 months, participants in the home group showed greater increases in low-fat items available, smaller decreases in fruits and vegetables present, and greater decreases in high-fat spreads. But by 18 months the home environments looked remarkably similar between the two groups.”

However, she pointed out that some of the direct modifications made for the home group were still present at 18 months. For example, at the beginning of the study, members of the home group received a full-length mirror, healthy cooking and exercise magazines, and a treadmill or stationary bike. At 18 months, these items were present in the environments of the home group more frequently than in those of the standard treatment group. “Thus it appears that more direct modifications may be needed to produce sustained changes in the home environment,” Ms. Crane said.

Ms. Crane said that she had no relevant financial disclosures to make.

SAN DIEGO — More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

The findings come from a sample of 1-day dietary data extracted from “What We Eat in America” (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Donna G. Rhodes, a nutritionist at the U.S. Department of Agriculture's Agricultural Research Service, presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged at least 20 years, who participated in the survey.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Obese adults were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

“Snacking may not contribute to weight gain,” conclused Ms. Rhodes, who said that she had no relevant financial conflicts to disclose.

SAN DIEGO — More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

The findings come from a sample of 1-day dietary data extracted from “What We Eat in America” (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Donna G. Rhodes, a nutritionist at the U.S. Department of Agriculture's Agricultural Research Service, presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged at least 20 years, who participated in the survey.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Obese adults were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

“Snacking may not contribute to weight gain,” conclused Ms. Rhodes, who said that she had no relevant financial conflicts to disclose.

SAN DIEGO — More than half of American men and women report a pattern of consuming breakfast, lunch, and dinner daily, results from a large survey found.

However, obese adults are less likely than normal-weight adults to report a three-meal daily eating pattern. They also are less likely than their normal-weight counterparts to consume four or more snacks per day.

The findings come from a sample of 1-day dietary data extracted from “What We Eat in America” (National Health and Nutrition Examination Survey, 2007-2008), which was released this year. Donna G. Rhodes, a nutritionist at the U.S. Department of Agriculture's Agricultural Research Service, presented findings from a 24-hour dietary recall made by 2,662 men and 2,758 women, aged at least 20 years, who participated in the survey.

In all, 59% of men and 64% of women reported consuming the standard three-meal pattern of breakfast, lunch, and dinner, and about 90% of both sexes reported at least one snack occasion per day, which consisted of at least one food or beverage item that contained calories.

Obese adults were less likely than normal-weight adults to report a three meal per day eating pattern (58% vs. 65%, respectively). However, a smaller proportion of obese adults reported four or more snack occasions per day, compared with normal-weight adults (15% vs. 22%).

“Snacking may not contribute to weight gain,” conclused Ms. Rhodes, who said that she had no relevant financial conflicts to disclose.

SAN DIEGO — Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison.

“We found that's not true, at least in this particular population studied,” he added.

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program.

Mr. Cook said that he had no relevant financial conflicts.

Interventions to prevent holiday weight gain should focus on diet more than exercise, the researchers concluded.

Source ©Olga Lyubkin/Fotolia.com

SAN DIEGO — Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison.

“We found that's not true, at least in this particular population studied,” he added.

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program.

Mr. Cook said that he had no relevant financial conflicts.

Interventions to prevent holiday weight gain should focus on diet more than exercise, the researchers concluded.

Source ©Olga Lyubkin/Fotolia.com

SAN DIEGO — Adults with high total daily energy expenditure are not protected from holiday weight gain, results from a large study demonstrated.

This is one of only a few studies that did not find evidence for the prevention of body weight gain via physical activity across the typical daily physical activity levels observed in the general population, Chad M. Cook said in an interview during a poster session at the meeting.

“We hypothesized that people who habitually burn more daily calories than predicted for their age, height, and body weight may be protected against holiday weight gain,” said Mr. Cook, who is a graduate student in nutritional sciences at the University of Wisconsin–Madison.

“We found that's not true, at least in this particular population studied,” he added.

Mr. Cook and his associates analyzed body weight change during the 1999-2000 winter quarter in 443 men and women aged 40-69 years with doubly labeled water data who participated in the National Cancer Institute–sponsored Observing Protein and Energy Nutrition (OPEN) study. The original purpose of the OPEN study, completed in 2000, was to assess self-reported dietary measurement error by comparing results from self-reported dietary intake questionnaires with objective biomarkers: doubly labeled water and urinary nitrogen.

The researchers used doubly labeled water to measure total energy expenditure, and calculated residual total energy expenditure after adjusting for age, height, and body weight.

Over an average of 107 days, nearly three-quarters of study participants (73%) gained 0.1 kg or more, with 19% gaining 2 kg or more. Men gained more than women (an average of 1.1 kg vs. 0.7 kg).

Men with a baseline body mass index of 30 kg/m

Mr. Cook also reported that there were no correlations seen between increased body weight and total energy expenditure or between increased body weight and total energy expenditure after the researchers adjusted for age and body size. Residual total energy expenditure above or below the average for body size ranged from −877 to 1,813 calories per day, with a median of −36 calories per day.

The findings suggest that interventions targeting the winter holiday quarter to prevent excess body weight gain in older men and women should focus mainly on diet, although increased activity levels should be encouraged for health reasons, the researchers said.

The study was funded by the National Cancer Institute Intramural Research Program.

Mr. Cook said that he had no relevant financial conflicts.

Interventions to prevent holiday weight gain should focus on diet more than exercise, the researchers concluded.

Source ©Olga Lyubkin/Fotolia.com

SANTA BARBARA, CALIF. — Sometimes, changes in skin appearance serve as the first marker of inherited internal disease.

Dr. Bruce H. Thiers highlighted common dermatologic signs associated with several of these syndromes:

▸ Cowden syndrome. This autosomal dominant syndrome is a marker for the eventual development of breast cancer and thyroid tumors. It is characterized by wartlike papules known as trichilemmomas. “They can occur anywhere, especially on the face,” said Dr. Thiers, of the department of dermatology and dermatologic surgery at the Medical University of South Carolina, Charleston.

“You can also see other benign lesions like angiomas and lipomas. I've had a few patients with Cowden syndrome who have a strong history of breast cancer and who have elected to have prophylactic mastectomies.”

Up to 50% of women with Cowden's disease get breast cancer, and 10% are diagnosed with thyroid cancer, he added.

▸ Gardner syndrome. This condition typically presents as deforming epidermoid cysts, though it may also include fibromas, lipomas, leiomyomas, trichoepitheliomas, and neurofibromas. About one-half of patients develop osteomas involving the membranous bones of the face and head. “Many reference sources say that the incidence of colon cancer in Gardner syndrome nears 100%,” said Dr. Thiers. “The standard of care in these patients appears to be frequent colonoscopies with consideration of prophylactic colectomy.”

▸ Muir-Torre syndrome. This condition is most often associated with carcinoma of the lower gastrointestinal tract, “although the tumors tend to be less aggressive than they are with Gardner syndrome,” Dr. Thiers said. The characteristic lesion is a sebaceous neoplasm, usually located on the trunk. “It could be benign, like a sebaceous adenoma, or it could be a sebaceous carcinoma.”

▸ Birt-Hogg-Dubé syndrome. This condition is associated with kidney cancer and is marked by benign fibrofolliculomas and trichodiscomas that most often occur on the head and neck. “These patients have an increased incidence of pneumothorax as well,” he said.

▸ Hereditary leiomyomatosis and renal cell cancer syndrome. This condition is marked by cutaneous leiomyomas and papillary renal cell carcinoma. The skin lesions typically occur before the age of 25.

“These patients not only have an increased risk of kidney cancer, but these tumors tend to occur at a very young age, and they tend to be quite aggressive,” Dr. Thiers noted. “If you see a patient with multiple leiomyomas, realize that this might not be purely a cutaneous phenomenon but part of a significant paraneoplastic syndrome.”

Dr. Thiers said that he had no relevant financial conflicts to disclose.

Multiple fibrofolliculomas inferior to the brow (A), and right pneumothorax, right lower lobe atelectasis, and multiple bilateral thin-wall cysts (B), are characteristic of Birt-Hogg-Dubé syndrome.

Source ©2010 Elsevier

SANTA BARBARA, CALIF. — Sometimes, changes in skin appearance serve as the first marker of inherited internal disease.

Dr. Bruce H. Thiers highlighted common dermatologic signs associated with several of these syndromes:

▸ Cowden syndrome. This autosomal dominant syndrome is a marker for the eventual development of breast cancer and thyroid tumors. It is characterized by wartlike papules known as trichilemmomas. “They can occur anywhere, especially on the face,” said Dr. Thiers, of the department of dermatology and dermatologic surgery at the Medical University of South Carolina, Charleston.

“You can also see other benign lesions like angiomas and lipomas. I've had a few patients with Cowden syndrome who have a strong history of breast cancer and who have elected to have prophylactic mastectomies.”

Up to 50% of women with Cowden's disease get breast cancer, and 10% are diagnosed with thyroid cancer, he added.

▸ Gardner syndrome. This condition typically presents as deforming epidermoid cysts, though it may also include fibromas, lipomas, leiomyomas, trichoepitheliomas, and neurofibromas. About one-half of patients develop osteomas involving the membranous bones of the face and head. “Many reference sources say that the incidence of colon cancer in Gardner syndrome nears 100%,” said Dr. Thiers. “The standard of care in these patients appears to be frequent colonoscopies with consideration of prophylactic colectomy.”

▸ Muir-Torre syndrome. This condition is most often associated with carcinoma of the lower gastrointestinal tract, “although the tumors tend to be less aggressive than they are with Gardner syndrome,” Dr. Thiers said. The characteristic lesion is a sebaceous neoplasm, usually located on the trunk. “It could be benign, like a sebaceous adenoma, or it could be a sebaceous carcinoma.”

▸ Birt-Hogg-Dubé syndrome. This condition is associated with kidney cancer and is marked by benign fibrofolliculomas and trichodiscomas that most often occur on the head and neck. “These patients have an increased incidence of pneumothorax as well,” he said.

▸ Hereditary leiomyomatosis and renal cell cancer syndrome. This condition is marked by cutaneous leiomyomas and papillary renal cell carcinoma. The skin lesions typically occur before the age of 25.

“These patients not only have an increased risk of kidney cancer, but these tumors tend to occur at a very young age, and they tend to be quite aggressive,” Dr. Thiers noted. “If you see a patient with multiple leiomyomas, realize that this might not be purely a cutaneous phenomenon but part of a significant paraneoplastic syndrome.”

Dr. Thiers said that he had no relevant financial conflicts to disclose.

Multiple fibrofolliculomas inferior to the brow (A), and right pneumothorax, right lower lobe atelectasis, and multiple bilateral thin-wall cysts (B), are characteristic of Birt-Hogg-Dubé syndrome.

Source ©2010 Elsevier

SANTA BARBARA, CALIF. — Sometimes, changes in skin appearance serve as the first marker of inherited internal disease.

Dr. Bruce H. Thiers highlighted common dermatologic signs associated with several of these syndromes:

▸ Cowden syndrome. This autosomal dominant syndrome is a marker for the eventual development of breast cancer and thyroid tumors. It is characterized by wartlike papules known as trichilemmomas. “They can occur anywhere, especially on the face,” said Dr. Thiers, of the department of dermatology and dermatologic surgery at the Medical University of South Carolina, Charleston.

“You can also see other benign lesions like angiomas and lipomas. I've had a few patients with Cowden syndrome who have a strong history of breast cancer and who have elected to have prophylactic mastectomies.”

Up to 50% of women with Cowden's disease get breast cancer, and 10% are diagnosed with thyroid cancer, he added.

▸ Gardner syndrome. This condition typically presents as deforming epidermoid cysts, though it may also include fibromas, lipomas, leiomyomas, trichoepitheliomas, and neurofibromas. About one-half of patients develop osteomas involving the membranous bones of the face and head. “Many reference sources say that the incidence of colon cancer in Gardner syndrome nears 100%,” said Dr. Thiers. “The standard of care in these patients appears to be frequent colonoscopies with consideration of prophylactic colectomy.”

▸ Muir-Torre syndrome. This condition is most often associated with carcinoma of the lower gastrointestinal tract, “although the tumors tend to be less aggressive than they are with Gardner syndrome,” Dr. Thiers said. The characteristic lesion is a sebaceous neoplasm, usually located on the trunk. “It could be benign, like a sebaceous adenoma, or it could be a sebaceous carcinoma.”

▸ Birt-Hogg-Dubé syndrome. This condition is associated with kidney cancer and is marked by benign fibrofolliculomas and trichodiscomas that most often occur on the head and neck. “These patients have an increased incidence of pneumothorax as well,” he said.

▸ Hereditary leiomyomatosis and renal cell cancer syndrome. This condition is marked by cutaneous leiomyomas and papillary renal cell carcinoma. The skin lesions typically occur before the age of 25.

“These patients not only have an increased risk of kidney cancer, but these tumors tend to occur at a very young age, and they tend to be quite aggressive,” Dr. Thiers noted. “If you see a patient with multiple leiomyomas, realize that this might not be purely a cutaneous phenomenon but part of a significant paraneoplastic syndrome.”

Dr. Thiers said that he had no relevant financial conflicts to disclose.

Multiple fibrofolliculomas inferior to the brow (A), and right pneumothorax, right lower lobe atelectasis, and multiple bilateral thin-wall cysts (B), are characteristic of Birt-Hogg-Dubé syndrome.

Source ©2010 Elsevier

SAN DIEGO – Slightly more than half of women who underwent breast-conserving surgery rated their cosmetic outcome as "good" and 30% rated it as "fair," results from a large online survey showed.

These percentages are lower than would be predicted, based on currently published studies, Dr. Christine E. Hill-Kayser said at the annual meeting of the American Society for Radiation Oncology.

"In the modern era, more than 50% of breast cancer patients undergo breast-conserving treatment," said Dr. Hill-Kayser of the department of radiation oncology at the University of Pennsylvania, Philadelphia. "Based on available medical literature, more than 90% achieve good or excellent cosmesis based on physician assessment. The rationale for our study was to assess breast cancer survivors’ views on cosmetic outcomes after breast-conserving treatment, and to assess long-term and late effects described by breast cancer survivors after completion of breast-conserving treatment."

She and her associates gathered data from 1,046 breast cancer survivors who voluntarily used an Internet-based tool for creation of survivorship care plans between October 2009 and April 2010. Also available through the OncoLink Web site run by the University of Pennsylvania, the tool allows survivors to enter data anonymously regarding diagnosis, demographics, treatments received, and side effects/late effects experienced, and provides them with customized guidelines for future care.

One component of the tool is a modified version of the Harvard Breast Cosmesis Scale, which poses the following question: How would you rate the cosmetic appearance of the affected breast compared to your other breast? Answer options include "excellent" (almost identical to untreated breast), "good" (minimal difference between breasts), "fair" (obvious difference between breasts but without major distortion), and "poor" (major functional and aesthetic sequelae).

The median age of the 1,046 respondents was 52 years, and 77% identified themselves as residents of the United States. Dr. Hill-Kayser reported that 503 (48%) had undergone lumpectomy followed by radiation therapy (classified as breast-conserving treatment) and 522 (49%) had undergone mastectomy. The remaining 3% did not undergo primary breast surgery.

Of the patients who underwent breast-conserving treatment, 16% rated their cosmetic outcome as excellent, 52% as good, 30% as fair, and 2% as poor. Of the patients who underwent mastectomy with reconstruction, 13% rated their cosmetic outcome as excellent, 48% as good, 30% as fair, and 9% as poor. The responses were statistically similar between both groups (P = .54).

Dr. Hill-Kayser also presented results from a subset of 208 respondents in the breast-conserving testament group who were queried about the incidence of late and/or long-term effects from their treatment. Reported effects included chronic skin and soft-tissue changes (43%), chronic breast or arm pain (21%), loss of shoulder flexibility (21%), and chronic arm swelling (8%).

"Cosmetic outcome is less likely to be classified as excellent or good by survivors after breast-conserving treatment than would be predicted by their health care providers," Dr. Hill-Kayser concluded. "Based on this convenience sample frame, survivor views on cosmesis may be similar after breast-conserving treatment vs. mastectomy and reconstruction. Survivor-reported chronic pain and musculoskeletal concerns are also higher than expected after breast-conserving treatment. Patient-reported outcomes should be considered in decisions regarding treatment paradigms."

She also noted that the limitations of using a convenience sample frame are "somewhat offset by the benefit of anonymity."

Dr. Hill-Kayser said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Slightly more than half of women who underwent breast-conserving surgery rated their cosmetic outcome as "good" and 30% rated it as "fair," results from a large online survey showed.

These percentages are lower than would be predicted, based on currently published studies, Dr. Christine E. Hill-Kayser said at the annual meeting of the American Society for Radiation Oncology.

"In the modern era, more than 50% of breast cancer patients undergo breast-conserving treatment," said Dr. Hill-Kayser of the department of radiation oncology at the University of Pennsylvania, Philadelphia. "Based on available medical literature, more than 90% achieve good or excellent cosmesis based on physician assessment. The rationale for our study was to assess breast cancer survivors’ views on cosmetic outcomes after breast-conserving treatment, and to assess long-term and late effects described by breast cancer survivors after completion of breast-conserving treatment."

She and her associates gathered data from 1,046 breast cancer survivors who voluntarily used an Internet-based tool for creation of survivorship care plans between October 2009 and April 2010. Also available through the OncoLink Web site run by the University of Pennsylvania, the tool allows survivors to enter data anonymously regarding diagnosis, demographics, treatments received, and side effects/late effects experienced, and provides them with customized guidelines for future care.

One component of the tool is a modified version of the Harvard Breast Cosmesis Scale, which poses the following question: How would you rate the cosmetic appearance of the affected breast compared to your other breast? Answer options include "excellent" (almost identical to untreated breast), "good" (minimal difference between breasts), "fair" (obvious difference between breasts but without major distortion), and "poor" (major functional and aesthetic sequelae).

The median age of the 1,046 respondents was 52 years, and 77% identified themselves as residents of the United States. Dr. Hill-Kayser reported that 503 (48%) had undergone lumpectomy followed by radiation therapy (classified as breast-conserving treatment) and 522 (49%) had undergone mastectomy. The remaining 3% did not undergo primary breast surgery.

Of the patients who underwent breast-conserving treatment, 16% rated their cosmetic outcome as excellent, 52% as good, 30% as fair, and 2% as poor. Of the patients who underwent mastectomy with reconstruction, 13% rated their cosmetic outcome as excellent, 48% as good, 30% as fair, and 9% as poor. The responses were statistically similar between both groups (P = .54).

Dr. Hill-Kayser also presented results from a subset of 208 respondents in the breast-conserving testament group who were queried about the incidence of late and/or long-term effects from their treatment. Reported effects included chronic skin and soft-tissue changes (43%), chronic breast or arm pain (21%), loss of shoulder flexibility (21%), and chronic arm swelling (8%).

"Cosmetic outcome is less likely to be classified as excellent or good by survivors after breast-conserving treatment than would be predicted by their health care providers," Dr. Hill-Kayser concluded. "Based on this convenience sample frame, survivor views on cosmesis may be similar after breast-conserving treatment vs. mastectomy and reconstruction. Survivor-reported chronic pain and musculoskeletal concerns are also higher than expected after breast-conserving treatment. Patient-reported outcomes should be considered in decisions regarding treatment paradigms."

She also noted that the limitations of using a convenience sample frame are "somewhat offset by the benefit of anonymity."

Dr. Hill-Kayser said that she had no relevant financial conflicts to disclose.

SAN DIEGO – Slightly more than half of women who underwent breast-conserving surgery rated their cosmetic outcome as "good" and 30% rated it as "fair," results from a large online survey showed.

These percentages are lower than would be predicted, based on currently published studies, Dr. Christine E. Hill-Kayser said at the annual meeting of the American Society for Radiation Oncology.

"In the modern era, more than 50% of breast cancer patients undergo breast-conserving treatment," said Dr. Hill-Kayser of the department of radiation oncology at the University of Pennsylvania, Philadelphia. "Based on available medical literature, more than 90% achieve good or excellent cosmesis based on physician assessment. The rationale for our study was to assess breast cancer survivors’ views on cosmetic outcomes after breast-conserving treatment, and to assess long-term and late effects described by breast cancer survivors after completion of breast-conserving treatment."

She and her associates gathered data from 1,046 breast cancer survivors who voluntarily used an Internet-based tool for creation of survivorship care plans between October 2009 and April 2010. Also available through the OncoLink Web site run by the University of Pennsylvania, the tool allows survivors to enter data anonymously regarding diagnosis, demographics, treatments received, and side effects/late effects experienced, and provides them with customized guidelines for future care.

One component of the tool is a modified version of the Harvard Breast Cosmesis Scale, which poses the following question: How would you rate the cosmetic appearance of the affected breast compared to your other breast? Answer options include "excellent" (almost identical to untreated breast), "good" (minimal difference between breasts), "fair" (obvious difference between breasts but without major distortion), and "poor" (major functional and aesthetic sequelae).

The median age of the 1,046 respondents was 52 years, and 77% identified themselves as residents of the United States. Dr. Hill-Kayser reported that 503 (48%) had undergone lumpectomy followed by radiation therapy (classified as breast-conserving treatment) and 522 (49%) had undergone mastectomy. The remaining 3% did not undergo primary breast surgery.

Of the patients who underwent breast-conserving treatment, 16% rated their cosmetic outcome as excellent, 52% as good, 30% as fair, and 2% as poor. Of the patients who underwent mastectomy with reconstruction, 13% rated their cosmetic outcome as excellent, 48% as good, 30% as fair, and 9% as poor. The responses were statistically similar between both groups (P = .54).

Dr. Hill-Kayser also presented results from a subset of 208 respondents in the breast-conserving testament group who were queried about the incidence of late and/or long-term effects from their treatment. Reported effects included chronic skin and soft-tissue changes (43%), chronic breast or arm pain (21%), loss of shoulder flexibility (21%), and chronic arm swelling (8%).

"Cosmetic outcome is less likely to be classified as excellent or good by survivors after breast-conserving treatment than would be predicted by their health care providers," Dr. Hill-Kayser concluded. "Based on this convenience sample frame, survivor views on cosmesis may be similar after breast-conserving treatment vs. mastectomy and reconstruction. Survivor-reported chronic pain and musculoskeletal concerns are also higher than expected after breast-conserving treatment. Patient-reported outcomes should be considered in decisions regarding treatment paradigms."

She also noted that the limitations of using a convenience sample frame are "somewhat offset by the benefit of anonymity."

Dr. Hill-Kayser said that she had no relevant financial conflicts to disclose.

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

"Mortality patterns of body mass index differ between young and elderly dialysis patients," Dr. Ellen K. Hoogeveen said during a press briefing Nov. 18 at the annual meeting of the American Society of Nephrology, where the findings were presented. "Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight."

At baseline, the researchers classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m2), normal weight (20-25 kg/m2), overweight (25-30 kg/m2), and obese (30 kg/m2 or higher). They used Cox regression analysis to calculate hazard ratios associated with BMI categories, and used normal weight as the reference category

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients was 51 years, while the mean age of elderly patients was 73 years. The mean BMI of both groups was 24 kg/m2, and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

"Mortality patterns of body mass index differ between young and elderly dialysis patients," Dr. Ellen K. Hoogeveen said during a press briefing Nov. 18 at the annual meeting of the American Society of Nephrology, where the findings were presented. "Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight."

At baseline, the researchers classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m2), normal weight (20-25 kg/m2), overweight (25-30 kg/m2), and obese (30 kg/m2 or higher). They used Cox regression analysis to calculate hazard ratios associated with BMI categories, and used normal weight as the reference category

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients was 51 years, while the mean age of elderly patients was 73 years. The mean BMI of both groups was 24 kg/m2, and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.

DENVER – Obese dialysis patients younger than age 65 years were 1.6 times more likely to die within 7 years, compared with their younger, normal-weight dialysis counterparts.

In addition, young and elderly dialysis patients alike who were underweight faced about a twofold increased risk of dying within the same time frame.

The findings come from the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), a prospective analysis of 1,749 dialysis patients at 38 centers who were at least 18 years old at their first dialysis treatment and were followed until death, transplantation, or a maximum of 7 years.

"Mortality patterns of body mass index differ between young and elderly dialysis patients," Dr. Ellen K. Hoogeveen said during a press briefing Nov. 18 at the annual meeting of the American Society of Nephrology, where the findings were presented. "Obesity may be harmful in patients younger than 65 years. For patients younger than 65 years starting with dialysis, it is important to strive for normal weight."

At baseline, the researchers classified patients into one of two age groups: young (younger than age 65) and elderly (age 65 and older). They also classified them into one of four weight groups based on body mass index: underweight (less than 20 kg/m2), normal weight (20-25 kg/m2), overweight (25-30 kg/m2), and obese (30 kg/m2 or higher). They used Cox regression analysis to calculate hazard ratios associated with BMI categories, and used normal weight as the reference category

Dr. Hoogeveen, of the department of nephrology at Jeroen Bosch Hospital, Den Bosch, the Netherlands, reported that the mean age of the younger patients was 51 years, while the mean age of elderly patients was 73 years. The mean BMI of both groups was 24 kg/m2, and more than half were men (62% in each group).

The 7-year mortality rate for all patients was 67%. When the researchers adjusted for age, gender, smoking, cardiovascular disease, and modality of dialysis, they found that younger patients who were obese at baseline were 1.6 times more likely to die within 7 years than were younger, normal-weight patients. Elderly obese patients were 1.1 times more likely to die within 7 years than were younger, normal-weight patients, a statistically significant difference.

In addition, young and elderly dialysis patients alike who were underweight at baseline were at significantly increased risk of dying within 7 years, compared with younger patients who had a normal BMI (hazard ratios of 2.2 and 1.6, respectively).

One of the study authors, Dr. Elisabeth Boeschoten, is a consultant for Amgen and Baxter and receives grants/research support from Abbott, Amgen, Baxter, Genzyme, Roche, and Shire. All of the other authors reported no relevant financial disclosures.