Too much time in front of electronic screens can increase the risk of headaches and migraine in young adults, according to research published online ahead of print December 2, 2015, in Cephalalgia.

Previous studies have observed associations between screen time exposure and headaches in children between ages 10 and 12 and adolescents. Data also have found an association between screen time exposure and low-back and shoulder pain in adolescents. “This [information] had led to speculation that the high amount of screen time exposure among students of higher education institutions may be correlated with the high prevalence of headache and migraine observed in this population,” said Ilaria Montagni, PhD, a research fellow at the University of Bordeaux in Talence, France.

Dr. Montagni and her coinvestigators studied 4,927 individuals in France, all of whom were age 18 or older and part of the Internet-based Students Health Research Enterprise (i-Share) project cohort, which is an ongoing, prospective, population-based study of students at French-speaking universities and institutions of higher education. The mean age of the students was 20.8, and 75.5% were female.

Subjects completed self-reported surveys on the average amount of time they spend in front of screens during the following five activities: computer or tablet work, playing video games on a computer or tablet, Internet surfing on a computer or tablet, watching videos on a computer or tablet, and using a smartphone. All questions were scored using a five-point scale. A score of 0 indicated never, 1 indicated less than 30 minutes, 2 indicated 30 minutes to two hours, 3 indicated four to eight hours, and 5 indicated eight hours or more. Scores from the surveys were divided into quartiles of very low, low, high, and very high screen-time exposure.

Surveys also asked if participants had experienced any headaches that had lasted several hours in the previous 12 months. Participants who answered negatively were classified as “no headache,” while those who answered positively were asked a series of follow-up questions related to symptom type and severity, sensitivity to light or sound, nausea, vomiting, and disruption of daily routines. To establish a classification of migraine, the investigators used the “probable migraine” category of the International Classification of Headache Disorders, third edition. With these data, the investigators used multinomial logistic regression models to calculate odds ratios of any relationship between screen time exposure and the presence and severity of headaches.

Of the 4,927 participants, 2,773 (56.3%) reported no headaches. In all, 710 (14.4%) participants reported a nonmigraine headache, 791 (16.1%) reported migraine without aura, and 653 (13.3%) reported migraine with aura. In comparisons against very low screen time exposure, very high exposure increased the likelihood of having migraine by 37%, which resulted in a statistically significant 50% greater odds for migraine without aura, but not for migraine with aura.

“Students reporting very high screen time exposure were more likely to be male, to be older, to have higher BMI, and to consume cannabis [and] were also more likely to report nonmigraine headache or migraine,” the authors noted. Furthermore, higher exposure to screens was a significant indicator of recurrent headaches in adolescent males, and the same indicator was seen in adolescent females who spent more time on the computer and in front of the TV.

—Deepak Chitnis

Too much time in front of electronic screens can increase the risk of headaches and migraine in young adults, according to research published online ahead of print December 2, 2015, in Cephalalgia.

Previous studies have observed associations between screen time exposure and headaches in children between ages 10 and 12 and adolescents. Data also have found an association between screen time exposure and low-back and shoulder pain in adolescents. “This [information] had led to speculation that the high amount of screen time exposure among students of higher education institutions may be correlated with the high prevalence of headache and migraine observed in this population,” said Ilaria Montagni, PhD, a research fellow at the University of Bordeaux in Talence, France.

Dr. Montagni and her coinvestigators studied 4,927 individuals in France, all of whom were age 18 or older and part of the Internet-based Students Health Research Enterprise (i-Share) project cohort, which is an ongoing, prospective, population-based study of students at French-speaking universities and institutions of higher education. The mean age of the students was 20.8, and 75.5% were female.

Subjects completed self-reported surveys on the average amount of time they spend in front of screens during the following five activities: computer or tablet work, playing video games on a computer or tablet, Internet surfing on a computer or tablet, watching videos on a computer or tablet, and using a smartphone. All questions were scored using a five-point scale. A score of 0 indicated never, 1 indicated less than 30 minutes, 2 indicated 30 minutes to two hours, 3 indicated four to eight hours, and 5 indicated eight hours or more. Scores from the surveys were divided into quartiles of very low, low, high, and very high screen-time exposure.

Surveys also asked if participants had experienced any headaches that had lasted several hours in the previous 12 months. Participants who answered negatively were classified as “no headache,” while those who answered positively were asked a series of follow-up questions related to symptom type and severity, sensitivity to light or sound, nausea, vomiting, and disruption of daily routines. To establish a classification of migraine, the investigators used the “probable migraine” category of the International Classification of Headache Disorders, third edition. With these data, the investigators used multinomial logistic regression models to calculate odds ratios of any relationship between screen time exposure and the presence and severity of headaches.

Of the 4,927 participants, 2,773 (56.3%) reported no headaches. In all, 710 (14.4%) participants reported a nonmigraine headache, 791 (16.1%) reported migraine without aura, and 653 (13.3%) reported migraine with aura. In comparisons against very low screen time exposure, very high exposure increased the likelihood of having migraine by 37%, which resulted in a statistically significant 50% greater odds for migraine without aura, but not for migraine with aura.

“Students reporting very high screen time exposure were more likely to be male, to be older, to have higher BMI, and to consume cannabis [and] were also more likely to report nonmigraine headache or migraine,” the authors noted. Furthermore, higher exposure to screens was a significant indicator of recurrent headaches in adolescent males, and the same indicator was seen in adolescent females who spent more time on the computer and in front of the TV.

—Deepak Chitnis

Too much time in front of electronic screens can increase the risk of headaches and migraine in young adults, according to research published online ahead of print December 2, 2015, in Cephalalgia.

Previous studies have observed associations between screen time exposure and headaches in children between ages 10 and 12 and adolescents. Data also have found an association between screen time exposure and low-back and shoulder pain in adolescents. “This [information] had led to speculation that the high amount of screen time exposure among students of higher education institutions may be correlated with the high prevalence of headache and migraine observed in this population,” said Ilaria Montagni, PhD, a research fellow at the University of Bordeaux in Talence, France.

Dr. Montagni and her coinvestigators studied 4,927 individuals in France, all of whom were age 18 or older and part of the Internet-based Students Health Research Enterprise (i-Share) project cohort, which is an ongoing, prospective, population-based study of students at French-speaking universities and institutions of higher education. The mean age of the students was 20.8, and 75.5% were female.

Subjects completed self-reported surveys on the average amount of time they spend in front of screens during the following five activities: computer or tablet work, playing video games on a computer or tablet, Internet surfing on a computer or tablet, watching videos on a computer or tablet, and using a smartphone. All questions were scored using a five-point scale. A score of 0 indicated never, 1 indicated less than 30 minutes, 2 indicated 30 minutes to two hours, 3 indicated four to eight hours, and 5 indicated eight hours or more. Scores from the surveys were divided into quartiles of very low, low, high, and very high screen-time exposure.

Surveys also asked if participants had experienced any headaches that had lasted several hours in the previous 12 months. Participants who answered negatively were classified as “no headache,” while those who answered positively were asked a series of follow-up questions related to symptom type and severity, sensitivity to light or sound, nausea, vomiting, and disruption of daily routines. To establish a classification of migraine, the investigators used the “probable migraine” category of the International Classification of Headache Disorders, third edition. With these data, the investigators used multinomial logistic regression models to calculate odds ratios of any relationship between screen time exposure and the presence and severity of headaches.

Of the 4,927 participants, 2,773 (56.3%) reported no headaches. In all, 710 (14.4%) participants reported a nonmigraine headache, 791 (16.1%) reported migraine without aura, and 653 (13.3%) reported migraine with aura. In comparisons against very low screen time exposure, very high exposure increased the likelihood of having migraine by 37%, which resulted in a statistically significant 50% greater odds for migraine without aura, but not for migraine with aura.

“Students reporting very high screen time exposure were more likely to be male, to be older, to have higher BMI, and to consume cannabis [and] were also more likely to report nonmigraine headache or migraine,” the authors noted. Furthermore, higher exposure to screens was a significant indicator of recurrent headaches in adolescent males, and the same indicator was seen in adolescent females who spent more time on the computer and in front of the TV.

—Deepak Chitnis

Risk-based payment models are becoming increasingly common in healthcare. Programs and initiatives such as Medicare Advantage, accountable care organizations (ACOs), and bundled payments are tasking hospitals, physicians, post-acute, and other providers with better managing patient care to improve outcomes and lower costs.

According to the Kaiser Family Foundation, Medicare Advantage—through which providers accept full risk to treat patients for a fixed annual rate—grew by more than 1 million beneficiaries between March 2014 and March 2015. Today, 31%, or almost one in three Medicare beneficiaries, are enrolled in a Medicare Advantage plan.

The much newer ACO and bundled payment models are also growing quickly. And by the end of 2018, the Department of Health & Human Services would like to move more than 50% of Medicare payments into such models.

According to healthcare intelligence firm Leavitt Partners, in early 2015 there were 744 active ACOs in the U.S., up from just 64 at the same time in 2011. Those organizations, through which providers collaborate to manage the cost and quality of care for a patient population, grew by about 4.5 million covered lives between the beginning of 2014 and 2015, reaching 23.5 million participants.

The somewhat similar Bundled Payment for Care Improvement (BPCI) initiative had more than 2,100 participating providers as of August 2015, including acute-care hospitals, skilled nursing facilities (SNFs), physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies working together to assume financial risk for certain episodes of care based upon specific diagnosis-related groups (DRGs).

As this growth continues, hospitalists are uniquely positioned to drive success in risk-based payment models if they can become more “longitudinally” involved in patient care rather than focused solely on inpatient services. That means partnering with providers outside the hospital, extending their own practice beyond the hospital, and leveraging technology.

Partnering outside the Hospital

In a recent series of “On the Horizon” articles in The Hospitalist, Win Whitcomb, MD, MHM, argues that hospitalists hoping to capitalize on savings from the BPCI program must think “beyond the four walls” of the hospital to how they can impact the cost and quality of care in the post-acute setting as well as readmission rates. I couldn’t agree more.

The “buying power” hospitalists wield with their referral patterns puts them in a unique position to influence the quality of care at post-acute facilities, thereby benefiting hospitals and their patients.

Traditionally, a hospitalist discharging a patient to a SNF would not ordinarily recommend a particular facility. They likely would leave the mandated “patient choice” presentation to the case manager. And that presentation normally would consist of a list of facilities in the market, with little to no quality or cost information associated with any of the facilities. This process essentially becomes a roll of the dice as to whether the best facility is chosen for particular patients and their conditions.

Under risk-based payment models, hospitalists should consider working with SNFs to help them develop clinical protocols that reduce costly lengths of stay and hospital readmission rates. In return for improving their efficiency and care, the hospitalists can help increase referrals to those SNFs by designing a process (in partnership with the discharge-planning staff) that will provide information on cost and quality of post-discharge options for patients and families. Given the information, patients and families are much more likely to choose a facility that benefits them and, in turn, benefits the system.

Broaden Your Practice

In addition, hospitalists should consider hiring or designating personnel to help manage patients in a post-discharge environment.

In particular, HM groups are increasingly partnering with or hiring “SNFists” to manage the patients they discharge from hospitals. As the name suggests, SNFists are dedicated to treating patients in the SNF environment, just as hospitalists treat patients in the hospital. Nurse practitioners and physician assistants are playing an increasingly important role in this space.

By partnering with SNFists (internal or external to the hospital medicine practice), hospitalists can ensure better continuity of care after discharge and a higher level of care than patients typically receive in a post-acute setting. Often, SNFists are able to detect declines in a patient’s condition early enough to intervene and prevent a hospital readmission. Similarly, their supervision and communication with the hospitalist helps ensure the patient is following the discharge plan and more likely to achieve a prompt recovery.

Leveraging Technology

Though providers across healthcare settings are embracing technology systems such as electronic medical records, most continue to struggle with the lack of system interoperability for adequately sharing patient information.

On a local level, hospitalists can work with post-acute and other partnering providers to help identify what, if any, existing medical record technologies can be made to interface with one another—or if there are any adequate workarounds to facilitate the transfer of patient information and support the continuity of care post-discharge.

Other technology tools, such as telemedicine programs or remote patient monitoring, may also be options hospitalists may want to champion as a way to help manage episodes of care that extend beyond the acute-care hospital stay.

Looking Ahead

There’s no doubt risk-based payment models will continue to gain prevalence in the healthcare market. By thinking beyond the hospital, hospitalists can take a more active role in achieving success in these new models. TH

Risk-based payment models are becoming increasingly common in healthcare. Programs and initiatives such as Medicare Advantage, accountable care organizations (ACOs), and bundled payments are tasking hospitals, physicians, post-acute, and other providers with better managing patient care to improve outcomes and lower costs.

According to the Kaiser Family Foundation, Medicare Advantage—through which providers accept full risk to treat patients for a fixed annual rate—grew by more than 1 million beneficiaries between March 2014 and March 2015. Today, 31%, or almost one in three Medicare beneficiaries, are enrolled in a Medicare Advantage plan.

The much newer ACO and bundled payment models are also growing quickly. And by the end of 2018, the Department of Health & Human Services would like to move more than 50% of Medicare payments into such models.

According to healthcare intelligence firm Leavitt Partners, in early 2015 there were 744 active ACOs in the U.S., up from just 64 at the same time in 2011. Those organizations, through which providers collaborate to manage the cost and quality of care for a patient population, grew by about 4.5 million covered lives between the beginning of 2014 and 2015, reaching 23.5 million participants.

The somewhat similar Bundled Payment for Care Improvement (BPCI) initiative had more than 2,100 participating providers as of August 2015, including acute-care hospitals, skilled nursing facilities (SNFs), physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies working together to assume financial risk for certain episodes of care based upon specific diagnosis-related groups (DRGs).

As this growth continues, hospitalists are uniquely positioned to drive success in risk-based payment models if they can become more “longitudinally” involved in patient care rather than focused solely on inpatient services. That means partnering with providers outside the hospital, extending their own practice beyond the hospital, and leveraging technology.

Partnering outside the Hospital

In a recent series of “On the Horizon” articles in The Hospitalist, Win Whitcomb, MD, MHM, argues that hospitalists hoping to capitalize on savings from the BPCI program must think “beyond the four walls” of the hospital to how they can impact the cost and quality of care in the post-acute setting as well as readmission rates. I couldn’t agree more.

The “buying power” hospitalists wield with their referral patterns puts them in a unique position to influence the quality of care at post-acute facilities, thereby benefiting hospitals and their patients.

Traditionally, a hospitalist discharging a patient to a SNF would not ordinarily recommend a particular facility. They likely would leave the mandated “patient choice” presentation to the case manager. And that presentation normally would consist of a list of facilities in the market, with little to no quality or cost information associated with any of the facilities. This process essentially becomes a roll of the dice as to whether the best facility is chosen for particular patients and their conditions.

Under risk-based payment models, hospitalists should consider working with SNFs to help them develop clinical protocols that reduce costly lengths of stay and hospital readmission rates. In return for improving their efficiency and care, the hospitalists can help increase referrals to those SNFs by designing a process (in partnership with the discharge-planning staff) that will provide information on cost and quality of post-discharge options for patients and families. Given the information, patients and families are much more likely to choose a facility that benefits them and, in turn, benefits the system.

Broaden Your Practice

In addition, hospitalists should consider hiring or designating personnel to help manage patients in a post-discharge environment.

In particular, HM groups are increasingly partnering with or hiring “SNFists” to manage the patients they discharge from hospitals. As the name suggests, SNFists are dedicated to treating patients in the SNF environment, just as hospitalists treat patients in the hospital. Nurse practitioners and physician assistants are playing an increasingly important role in this space.

By partnering with SNFists (internal or external to the hospital medicine practice), hospitalists can ensure better continuity of care after discharge and a higher level of care than patients typically receive in a post-acute setting. Often, SNFists are able to detect declines in a patient’s condition early enough to intervene and prevent a hospital readmission. Similarly, their supervision and communication with the hospitalist helps ensure the patient is following the discharge plan and more likely to achieve a prompt recovery.

Leveraging Technology

Though providers across healthcare settings are embracing technology systems such as electronic medical records, most continue to struggle with the lack of system interoperability for adequately sharing patient information.

On a local level, hospitalists can work with post-acute and other partnering providers to help identify what, if any, existing medical record technologies can be made to interface with one another—or if there are any adequate workarounds to facilitate the transfer of patient information and support the continuity of care post-discharge.

Other technology tools, such as telemedicine programs or remote patient monitoring, may also be options hospitalists may want to champion as a way to help manage episodes of care that extend beyond the acute-care hospital stay.

Looking Ahead

There’s no doubt risk-based payment models will continue to gain prevalence in the healthcare market. By thinking beyond the hospital, hospitalists can take a more active role in achieving success in these new models. TH

Risk-based payment models are becoming increasingly common in healthcare. Programs and initiatives such as Medicare Advantage, accountable care organizations (ACOs), and bundled payments are tasking hospitals, physicians, post-acute, and other providers with better managing patient care to improve outcomes and lower costs.

According to the Kaiser Family Foundation, Medicare Advantage—through which providers accept full risk to treat patients for a fixed annual rate—grew by more than 1 million beneficiaries between March 2014 and March 2015. Today, 31%, or almost one in three Medicare beneficiaries, are enrolled in a Medicare Advantage plan.

The much newer ACO and bundled payment models are also growing quickly. And by the end of 2018, the Department of Health & Human Services would like to move more than 50% of Medicare payments into such models.

According to healthcare intelligence firm Leavitt Partners, in early 2015 there were 744 active ACOs in the U.S., up from just 64 at the same time in 2011. Those organizations, through which providers collaborate to manage the cost and quality of care for a patient population, grew by about 4.5 million covered lives between the beginning of 2014 and 2015, reaching 23.5 million participants.

The somewhat similar Bundled Payment for Care Improvement (BPCI) initiative had more than 2,100 participating providers as of August 2015, including acute-care hospitals, skilled nursing facilities (SNFs), physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies working together to assume financial risk for certain episodes of care based upon specific diagnosis-related groups (DRGs).

As this growth continues, hospitalists are uniquely positioned to drive success in risk-based payment models if they can become more “longitudinally” involved in patient care rather than focused solely on inpatient services. That means partnering with providers outside the hospital, extending their own practice beyond the hospital, and leveraging technology.

Partnering outside the Hospital

In a recent series of “On the Horizon” articles in The Hospitalist, Win Whitcomb, MD, MHM, argues that hospitalists hoping to capitalize on savings from the BPCI program must think “beyond the four walls” of the hospital to how they can impact the cost and quality of care in the post-acute setting as well as readmission rates. I couldn’t agree more.

The “buying power” hospitalists wield with their referral patterns puts them in a unique position to influence the quality of care at post-acute facilities, thereby benefiting hospitals and their patients.

Traditionally, a hospitalist discharging a patient to a SNF would not ordinarily recommend a particular facility. They likely would leave the mandated “patient choice” presentation to the case manager. And that presentation normally would consist of a list of facilities in the market, with little to no quality or cost information associated with any of the facilities. This process essentially becomes a roll of the dice as to whether the best facility is chosen for particular patients and their conditions.

Under risk-based payment models, hospitalists should consider working with SNFs to help them develop clinical protocols that reduce costly lengths of stay and hospital readmission rates. In return for improving their efficiency and care, the hospitalists can help increase referrals to those SNFs by designing a process (in partnership with the discharge-planning staff) that will provide information on cost and quality of post-discharge options for patients and families. Given the information, patients and families are much more likely to choose a facility that benefits them and, in turn, benefits the system.

Broaden Your Practice

In addition, hospitalists should consider hiring or designating personnel to help manage patients in a post-discharge environment.

In particular, HM groups are increasingly partnering with or hiring “SNFists” to manage the patients they discharge from hospitals. As the name suggests, SNFists are dedicated to treating patients in the SNF environment, just as hospitalists treat patients in the hospital. Nurse practitioners and physician assistants are playing an increasingly important role in this space.

By partnering with SNFists (internal or external to the hospital medicine practice), hospitalists can ensure better continuity of care after discharge and a higher level of care than patients typically receive in a post-acute setting. Often, SNFists are able to detect declines in a patient’s condition early enough to intervene and prevent a hospital readmission. Similarly, their supervision and communication with the hospitalist helps ensure the patient is following the discharge plan and more likely to achieve a prompt recovery.

Leveraging Technology

Though providers across healthcare settings are embracing technology systems such as electronic medical records, most continue to struggle with the lack of system interoperability for adequately sharing patient information.

On a local level, hospitalists can work with post-acute and other partnering providers to help identify what, if any, existing medical record technologies can be made to interface with one another—or if there are any adequate workarounds to facilitate the transfer of patient information and support the continuity of care post-discharge.

Other technology tools, such as telemedicine programs or remote patient monitoring, may also be options hospitalists may want to champion as a way to help manage episodes of care that extend beyond the acute-care hospital stay.

Looking Ahead

There’s no doubt risk-based payment models will continue to gain prevalence in the healthcare market. By thinking beyond the hospital, hospitalists can take a more active role in achieving success in these new models. TH

Yuankai Shi, MD, PhD

Photo by Larry Young

SAN FRANCISCO—The oral histone deacetylase inhibitor chidamide can elicit responses in patients with relapsed or refractory cutaneous T-cell Lymphoma (CTCL), a new study suggests.

Chidamide has already demonstrated efficacy against relapsed or refractory peripheral T-cell lymphoma and has been approved for this indication in China.

Now, results of a phase 2 trial suggest chidamide might be a feasible treatment option for relapsed or refractory CTCL as well.

Yuankai Shi, MD, PhD, of the Chinese Academy of Medical Science & Peking Union Medical College in Beijing, China, discussed this trial at the 8th Annual T-cell Lymphoma Forum. The trial is sponsored by Chipscreen Biosciences Ltd.

He presented results observed in 50 patients with relapsed/refractory CTCL. They had a median age of 47 (range, 26-75), and half were male. Most patients had stage II disease (44%), 20% percent had stage III, and 18% each had stage I and IV. The median time from diagnosis was 2 years.

Patients were randomized to receive chidamide at 30 mg twice a week for 2 weeks out of a 3-week cycle (n=12), 4 weeks out of a 6-week cycle (n=13), or 30 mg twice a week without a drug-free holiday (n=25).

The objective response rate was 32% for the entire cohort, 33% for the 3-week cycle arm, 23% for the 6-week cycle arm, and 36% for the successive dosing arm.

There was 1 complete response, and it occurred in the successive dosing arm. There were 15 partial responses—4 in the 3-week arm, 3 in the 6-week arm, and 9 in the successive dosing arm.

The median duration of response was 92 days overall (range, 78-106), 50 days in the 3-week arm (range, 26-130), 92 days in the 6-week arm (range, 84-99), and 169 days in the successive dosing arm (range, 58-279).

The median progression-free survival was 85 days overall (range, 78-92), 84 days in the 3-week arm (range, 43-126), 81 days in the 6-week arm (range, 39-222), and 88 days in the successive dosing arm (range, 58-261).

Dr Shi noted that the major toxicities associated with chidamide were hematologic and gastrointestinal in nature, and they were controllable.

The incidence of adverse events (AEs) was 83% overall, 92% in the 3-week arm, 85% in the 6-week arm, and 77% in the successive dosing arm. The incidence of grade 3 or higher AEs was 23%, 23%, 38%, and 15%, respectively.

The most common AEs were thrombocytopenia (33%, 39%, 23%, and 35%, respectively), leucopenia (29%, 54%, 31%, and 15%, respectively), fatigue (17%, 23%, 23%, and 12%, respectively), nausea (13%, 23%, 8%, and 12%, respectively), diarrhea (10%, 8%, 8%, and 12%, respectively), fever (8%, 0%, 15%, and 8%, respectively), and anemia (8%, 8%, 15%, and 4%, respectively).

There were 2 serious AEs. One patient in the 3-week arm was hospitalized for fever and lung infection, and 1 patient in the successive dosing arm was hospitalized for hyperglycemia.

Dr Shi said these results suggest chidamide is effective and tolerable for patients with relapsed/refractory CTCL. And, based on the overall profiles of the 3 dosing regimens, successive dosing of chidamide at 30 mg twice a week is recommended.

Yuankai Shi, MD, PhD

Photo by Larry Young

SAN FRANCISCO—The oral histone deacetylase inhibitor chidamide can elicit responses in patients with relapsed or refractory cutaneous T-cell Lymphoma (CTCL), a new study suggests.

Chidamide has already demonstrated efficacy against relapsed or refractory peripheral T-cell lymphoma and has been approved for this indication in China.

Now, results of a phase 2 trial suggest chidamide might be a feasible treatment option for relapsed or refractory CTCL as well.

Yuankai Shi, MD, PhD, of the Chinese Academy of Medical Science & Peking Union Medical College in Beijing, China, discussed this trial at the 8th Annual T-cell Lymphoma Forum. The trial is sponsored by Chipscreen Biosciences Ltd.

He presented results observed in 50 patients with relapsed/refractory CTCL. They had a median age of 47 (range, 26-75), and half were male. Most patients had stage II disease (44%), 20% percent had stage III, and 18% each had stage I and IV. The median time from diagnosis was 2 years.

Patients were randomized to receive chidamide at 30 mg twice a week for 2 weeks out of a 3-week cycle (n=12), 4 weeks out of a 6-week cycle (n=13), or 30 mg twice a week without a drug-free holiday (n=25).

The objective response rate was 32% for the entire cohort, 33% for the 3-week cycle arm, 23% for the 6-week cycle arm, and 36% for the successive dosing arm.

There was 1 complete response, and it occurred in the successive dosing arm. There were 15 partial responses—4 in the 3-week arm, 3 in the 6-week arm, and 9 in the successive dosing arm.

The median duration of response was 92 days overall (range, 78-106), 50 days in the 3-week arm (range, 26-130), 92 days in the 6-week arm (range, 84-99), and 169 days in the successive dosing arm (range, 58-279).

The median progression-free survival was 85 days overall (range, 78-92), 84 days in the 3-week arm (range, 43-126), 81 days in the 6-week arm (range, 39-222), and 88 days in the successive dosing arm (range, 58-261).

Dr Shi noted that the major toxicities associated with chidamide were hematologic and gastrointestinal in nature, and they were controllable.

The incidence of adverse events (AEs) was 83% overall, 92% in the 3-week arm, 85% in the 6-week arm, and 77% in the successive dosing arm. The incidence of grade 3 or higher AEs was 23%, 23%, 38%, and 15%, respectively.

The most common AEs were thrombocytopenia (33%, 39%, 23%, and 35%, respectively), leucopenia (29%, 54%, 31%, and 15%, respectively), fatigue (17%, 23%, 23%, and 12%, respectively), nausea (13%, 23%, 8%, and 12%, respectively), diarrhea (10%, 8%, 8%, and 12%, respectively), fever (8%, 0%, 15%, and 8%, respectively), and anemia (8%, 8%, 15%, and 4%, respectively).

There were 2 serious AEs. One patient in the 3-week arm was hospitalized for fever and lung infection, and 1 patient in the successive dosing arm was hospitalized for hyperglycemia.

Dr Shi said these results suggest chidamide is effective and tolerable for patients with relapsed/refractory CTCL. And, based on the overall profiles of the 3 dosing regimens, successive dosing of chidamide at 30 mg twice a week is recommended.

Yuankai Shi, MD, PhD

Photo by Larry Young

SAN FRANCISCO—The oral histone deacetylase inhibitor chidamide can elicit responses in patients with relapsed or refractory cutaneous T-cell Lymphoma (CTCL), a new study suggests.

Chidamide has already demonstrated efficacy against relapsed or refractory peripheral T-cell lymphoma and has been approved for this indication in China.

Now, results of a phase 2 trial suggest chidamide might be a feasible treatment option for relapsed or refractory CTCL as well.

Yuankai Shi, MD, PhD, of the Chinese Academy of Medical Science & Peking Union Medical College in Beijing, China, discussed this trial at the 8th Annual T-cell Lymphoma Forum. The trial is sponsored by Chipscreen Biosciences Ltd.

He presented results observed in 50 patients with relapsed/refractory CTCL. They had a median age of 47 (range, 26-75), and half were male. Most patients had stage II disease (44%), 20% percent had stage III, and 18% each had stage I and IV. The median time from diagnosis was 2 years.

Patients were randomized to receive chidamide at 30 mg twice a week for 2 weeks out of a 3-week cycle (n=12), 4 weeks out of a 6-week cycle (n=13), or 30 mg twice a week without a drug-free holiday (n=25).

The objective response rate was 32% for the entire cohort, 33% for the 3-week cycle arm, 23% for the 6-week cycle arm, and 36% for the successive dosing arm.

There was 1 complete response, and it occurred in the successive dosing arm. There were 15 partial responses—4 in the 3-week arm, 3 in the 6-week arm, and 9 in the successive dosing arm.

The median duration of response was 92 days overall (range, 78-106), 50 days in the 3-week arm (range, 26-130), 92 days in the 6-week arm (range, 84-99), and 169 days in the successive dosing arm (range, 58-279).

The median progression-free survival was 85 days overall (range, 78-92), 84 days in the 3-week arm (range, 43-126), 81 days in the 6-week arm (range, 39-222), and 88 days in the successive dosing arm (range, 58-261).

Dr Shi noted that the major toxicities associated with chidamide were hematologic and gastrointestinal in nature, and they were controllable.

The incidence of adverse events (AEs) was 83% overall, 92% in the 3-week arm, 85% in the 6-week arm, and 77% in the successive dosing arm. The incidence of grade 3 or higher AEs was 23%, 23%, 38%, and 15%, respectively.

The most common AEs were thrombocytopenia (33%, 39%, 23%, and 35%, respectively), leucopenia (29%, 54%, 31%, and 15%, respectively), fatigue (17%, 23%, 23%, and 12%, respectively), nausea (13%, 23%, 8%, and 12%, respectively), diarrhea (10%, 8%, 8%, and 12%, respectively), fever (8%, 0%, 15%, and 8%, respectively), and anemia (8%, 8%, 15%, and 4%, respectively).

There were 2 serious AEs. One patient in the 3-week arm was hospitalized for fever and lung infection, and 1 patient in the successive dosing arm was hospitalized for hyperglycemia.

Dr Shi said these results suggest chidamide is effective and tolerable for patients with relapsed/refractory CTCL. And, based on the overall profiles of the 3 dosing regimens, successive dosing of chidamide at 30 mg twice a week is recommended.

Cancer patient receiving

chemotherapy

Photo by Rhoda Baer

Loved ones of cancer patients often turn to the Internet for further information about the disease, but they are less inclined to seek emotional support from social media forums, according to a study published in Computers, Informatics, Nursing.

It is fairly common for loved ones of cancer patients to develop depression or anxiety disorders as a result of the diagnosis, but there aren’t many studies focusing specifically on cancer patients’ caregivers and family members, said study author Carolyn Lauckner, PhD, of the University of Georgia in Athens.

“I think, sometimes, the loved ones and caregivers get forgotten about,” she said. “And that’s why I wanted to research this population to see if there are ways that we can better support these individuals.”

Dr Lauckner surveyed 191 people whose loved ones were diagnosed with cancer in the past year or who were currently acting as caregivers to someone with cancer. The motivation behind the research was personal for Dr Lauckner.

“I went through a period of time where I had 3 loved ones diagnosed within a short amount of time,” she said. “I had these experiences where I heard about the diagnosis and I would go online to look it up, and then I would immediately become terrified and freak out about all the stuff I read online.”

Like Dr Lauckner, more than 75% of the subjects she surveyed searched online for information on a loved one’s disease. Most looked for treatment options, prevention strategies and risk factors, and prognosis information.

“I was pleasantly surprised by the amount of people who said that they were looking for prevention information online and detection information,” Dr Lauckner said. “[T]hat shows that not only are they concerned for their loved one but they’re also concerned about how they themselves can avoid cancer, which, from a public health perspective, is great.”

Respondents were less inclined to view blogs or go online to hear about others’ cancer experiences. These kinds of sites were linked to negative emotions for participants, such as fear, sadness, and anger.

“A lot of people, especially in the cancer realm, they will use blogs or discussion posts to vent and to talk about the harsh realities of living with an illness,” Dr Lauckner said.

“And while I think that that is beneficial for both the person who is writing it and potentially for some people who want an idea of what to expect, when someone is dealing with the prospect of their loved one having to go through that experience, it can be extremely distressing.”

The most commonly visited websites were those of charitable organizations like the American Cancer Society, which were associated with positive emotions. Dr Lauckner said she found this information encouraging because it shows that participants were consulting reliable sources of information and not being swayed by personal accounts as much.

Dr Lauckner ultimately wants to build on the information gleaned in this study to determine the most effective use of social media and technology to distribute cancer prevention and risk reduction messages to the public.

Cancer patient receiving

chemotherapy

Photo by Rhoda Baer

Loved ones of cancer patients often turn to the Internet for further information about the disease, but they are less inclined to seek emotional support from social media forums, according to a study published in Computers, Informatics, Nursing.

It is fairly common for loved ones of cancer patients to develop depression or anxiety disorders as a result of the diagnosis, but there aren’t many studies focusing specifically on cancer patients’ caregivers and family members, said study author Carolyn Lauckner, PhD, of the University of Georgia in Athens.

“I think, sometimes, the loved ones and caregivers get forgotten about,” she said. “And that’s why I wanted to research this population to see if there are ways that we can better support these individuals.”

Dr Lauckner surveyed 191 people whose loved ones were diagnosed with cancer in the past year or who were currently acting as caregivers to someone with cancer. The motivation behind the research was personal for Dr Lauckner.

“I went through a period of time where I had 3 loved ones diagnosed within a short amount of time,” she said. “I had these experiences where I heard about the diagnosis and I would go online to look it up, and then I would immediately become terrified and freak out about all the stuff I read online.”

Like Dr Lauckner, more than 75% of the subjects she surveyed searched online for information on a loved one’s disease. Most looked for treatment options, prevention strategies and risk factors, and prognosis information.

“I was pleasantly surprised by the amount of people who said that they were looking for prevention information online and detection information,” Dr Lauckner said. “[T]hat shows that not only are they concerned for their loved one but they’re also concerned about how they themselves can avoid cancer, which, from a public health perspective, is great.”

Respondents were less inclined to view blogs or go online to hear about others’ cancer experiences. These kinds of sites were linked to negative emotions for participants, such as fear, sadness, and anger.

“A lot of people, especially in the cancer realm, they will use blogs or discussion posts to vent and to talk about the harsh realities of living with an illness,” Dr Lauckner said.

“And while I think that that is beneficial for both the person who is writing it and potentially for some people who want an idea of what to expect, when someone is dealing with the prospect of their loved one having to go through that experience, it can be extremely distressing.”

The most commonly visited websites were those of charitable organizations like the American Cancer Society, which were associated with positive emotions. Dr Lauckner said she found this information encouraging because it shows that participants were consulting reliable sources of information and not being swayed by personal accounts as much.

Dr Lauckner ultimately wants to build on the information gleaned in this study to determine the most effective use of social media and technology to distribute cancer prevention and risk reduction messages to the public.

Cancer patient receiving

chemotherapy

Photo by Rhoda Baer

Loved ones of cancer patients often turn to the Internet for further information about the disease, but they are less inclined to seek emotional support from social media forums, according to a study published in Computers, Informatics, Nursing.

It is fairly common for loved ones of cancer patients to develop depression or anxiety disorders as a result of the diagnosis, but there aren’t many studies focusing specifically on cancer patients’ caregivers and family members, said study author Carolyn Lauckner, PhD, of the University of Georgia in Athens.

“I think, sometimes, the loved ones and caregivers get forgotten about,” she said. “And that’s why I wanted to research this population to see if there are ways that we can better support these individuals.”

Dr Lauckner surveyed 191 people whose loved ones were diagnosed with cancer in the past year or who were currently acting as caregivers to someone with cancer. The motivation behind the research was personal for Dr Lauckner.

“I went through a period of time where I had 3 loved ones diagnosed within a short amount of time,” she said. “I had these experiences where I heard about the diagnosis and I would go online to look it up, and then I would immediately become terrified and freak out about all the stuff I read online.”

Like Dr Lauckner, more than 75% of the subjects she surveyed searched online for information on a loved one’s disease. Most looked for treatment options, prevention strategies and risk factors, and prognosis information.

“I was pleasantly surprised by the amount of people who said that they were looking for prevention information online and detection information,” Dr Lauckner said. “[T]hat shows that not only are they concerned for their loved one but they’re also concerned about how they themselves can avoid cancer, which, from a public health perspective, is great.”

Respondents were less inclined to view blogs or go online to hear about others’ cancer experiences. These kinds of sites were linked to negative emotions for participants, such as fear, sadness, and anger.

“A lot of people, especially in the cancer realm, they will use blogs or discussion posts to vent and to talk about the harsh realities of living with an illness,” Dr Lauckner said.

“And while I think that that is beneficial for both the person who is writing it and potentially for some people who want an idea of what to expect, when someone is dealing with the prospect of their loved one having to go through that experience, it can be extremely distressing.”

The most commonly visited websites were those of charitable organizations like the American Cancer Society, which were associated with positive emotions. Dr Lauckner said she found this information encouraging because it shows that participants were consulting reliable sources of information and not being swayed by personal accounts as much.

Dr Lauckner ultimately wants to build on the information gleaned in this study to determine the most effective use of social media and technology to distribute cancer prevention and risk reduction messages to the public.

Kenichi Miharada, PhD

Photo by Åsa Hansdotter

Experiments in pregnant mice indicate that bile acid supports the production of hematopoietic stem cells (HSCs) in fetuses.

The work revealed large amounts of bile acids inside mouse fetuses and suggested these acids are transferred from the mothers via the placenta to help the fetuses produce HSCs.

“Fetuses produce small amounts of bile acids on their own, but here we are talking about much larger quantities,” said study author Kenichi Miharada, PhD, of Lund University in Sweden.

“The bile acid appears to be produced by the mother and then transferred to the fetus via the placenta.”

Dr Miharada and his colleagues detailed this discovery in Cell Stem Cell.

The investigators already knew that bile acid is produced in the fetal liver, but they did not know why.

With this study, they discovered that bile acid supports the production of HSCs in the fetal liver and enables them to develop normally. The additional contribution from the mother is important for the fetus to develop normally.

And although a large part of bile acid is toxic for cells, it undergoes a purification process when transferred through the placenta, letting only harmless bile acid through to the fetus.

“Our hypothesis is that the consequence of a damaged placenta, which, for various reasons, is unable to transfer bile acids to the fetus, can lead to leukemia or other blood diseases later in life, and we will continue our research to see if this hypothesis holds up,” Dr Miharada said.

He and his colleagues also said this work has implications for producing HSCs that could treat these blood diseases.

The problem with making HSCs proliferate outside the body is that the artificial growth gives rise to an accumulation of abnormal proteins in the endoplasmic reticulum (ER). This ER stress, if severe and chronic, causes cell death.

Dr Miharada and his colleagues previously showed it is possible to reduce ER stress chemically by adding bile acids to the cell culture. Bile acids, which are produced naturally in the liver and stored in the gallbladder, support protein production during the cell division process.

“Compared to other ways of trying to develop stem cells to treat blood diseases, this method is safer and quicker because it does not involve using any artificial substances or any genetic modifications, merely a substance that already exists inside the body,” Dr Miharada explained.

Kenichi Miharada, PhD

Photo by Åsa Hansdotter

Experiments in pregnant mice indicate that bile acid supports the production of hematopoietic stem cells (HSCs) in fetuses.

The work revealed large amounts of bile acids inside mouse fetuses and suggested these acids are transferred from the mothers via the placenta to help the fetuses produce HSCs.

“Fetuses produce small amounts of bile acids on their own, but here we are talking about much larger quantities,” said study author Kenichi Miharada, PhD, of Lund University in Sweden.

“The bile acid appears to be produced by the mother and then transferred to the fetus via the placenta.”

Dr Miharada and his colleagues detailed this discovery in Cell Stem Cell.

The investigators already knew that bile acid is produced in the fetal liver, but they did not know why.

With this study, they discovered that bile acid supports the production of HSCs in the fetal liver and enables them to develop normally. The additional contribution from the mother is important for the fetus to develop normally.

And although a large part of bile acid is toxic for cells, it undergoes a purification process when transferred through the placenta, letting only harmless bile acid through to the fetus.

“Our hypothesis is that the consequence of a damaged placenta, which, for various reasons, is unable to transfer bile acids to the fetus, can lead to leukemia or other blood diseases later in life, and we will continue our research to see if this hypothesis holds up,” Dr Miharada said.

He and his colleagues also said this work has implications for producing HSCs that could treat these blood diseases.

The problem with making HSCs proliferate outside the body is that the artificial growth gives rise to an accumulation of abnormal proteins in the endoplasmic reticulum (ER). This ER stress, if severe and chronic, causes cell death.

Dr Miharada and his colleagues previously showed it is possible to reduce ER stress chemically by adding bile acids to the cell culture. Bile acids, which are produced naturally in the liver and stored in the gallbladder, support protein production during the cell division process.

“Compared to other ways of trying to develop stem cells to treat blood diseases, this method is safer and quicker because it does not involve using any artificial substances or any genetic modifications, merely a substance that already exists inside the body,” Dr Miharada explained.

Kenichi Miharada, PhD

Photo by Åsa Hansdotter

Experiments in pregnant mice indicate that bile acid supports the production of hematopoietic stem cells (HSCs) in fetuses.

The work revealed large amounts of bile acids inside mouse fetuses and suggested these acids are transferred from the mothers via the placenta to help the fetuses produce HSCs.

“Fetuses produce small amounts of bile acids on their own, but here we are talking about much larger quantities,” said study author Kenichi Miharada, PhD, of Lund University in Sweden.

“The bile acid appears to be produced by the mother and then transferred to the fetus via the placenta.”

Dr Miharada and his colleagues detailed this discovery in Cell Stem Cell.

The investigators already knew that bile acid is produced in the fetal liver, but they did not know why.

With this study, they discovered that bile acid supports the production of HSCs in the fetal liver and enables them to develop normally. The additional contribution from the mother is important for the fetus to develop normally.

And although a large part of bile acid is toxic for cells, it undergoes a purification process when transferred through the placenta, letting only harmless bile acid through to the fetus.

“Our hypothesis is that the consequence of a damaged placenta, which, for various reasons, is unable to transfer bile acids to the fetus, can lead to leukemia or other blood diseases later in life, and we will continue our research to see if this hypothesis holds up,” Dr Miharada said.

He and his colleagues also said this work has implications for producing HSCs that could treat these blood diseases.

The problem with making HSCs proliferate outside the body is that the artificial growth gives rise to an accumulation of abnormal proteins in the endoplasmic reticulum (ER). This ER stress, if severe and chronic, causes cell death.

Dr Miharada and his colleagues previously showed it is possible to reduce ER stress chemically by adding bile acids to the cell culture. Bile acids, which are produced naturally in the liver and stored in the gallbladder, support protein production during the cell division process.

“Compared to other ways of trying to develop stem cells to treat blood diseases, this method is safer and quicker because it does not involve using any artificial substances or any genetic modifications, merely a substance that already exists inside the body,” Dr Miharada explained.

Osteoclast culture

New research has revealed single-nucleotide polymorphisms (SNPs) that may increase the risk of bone disease in patients with multiple myeloma (MM).

One of these SNPs affects a gene encoding osteoprotegerin (OPG), a signaling protein that helps regulate the density of bones.

In patients with MM bone disease (MBD), bones are broken down faster than they can be repaired, resulting in fractures and lesions.

OPG is known to keep the numbers of osteoclasts in check, so it follows that mutations adversely affecting the gene may contribute to excessive bone breakdown.

Richard Houlston, MD, PhD, of The Institute of Cancer Research in London, UK, and his colleagues reported these findings in Leukemia.

The researchers analyzed the DNA of 3774 MM patients and used imaging techniques to detect which of these patients had MBD and which did not. The team used statistical analysis to compare sequencing data from the group of patients who developed MBD with those who did not.

The analysis revealed 9 SNPs that showed an association with MBD and reached genome-wide significance. They were all located in the same region at 8q24.12 and were in strong linkage disequilibrium (LD).

The strongest association at 8q24.12 was observed with the SNP rs4407910, which localizes 19Kb 3’ to the gene encoding TNFRSF11B, also known as OPG (odds ratio=1.38, P=4.02×10⁻⁹).

The researchers also found a “promising association” for MBD with the SNP rs74676832 at 19q13.43, which is located within a 29 kb region of LD intergenic to ZNF444 and GALP (odds ratio=1.97, P=9.33×10^–7).

The team said these findings demonstrate that germline variation influences MBD, and they highlight the importance of the RANK/RANKL/OPG pathway in MBD development.

Furthermore, the work could enable scientists to develop new strategies to prevent MBD development and identify which patients might benefit from treatment with existing bone therapies such as bisphosphonates.

“It is really important to understand why some patients with myeloma are severely affected by bone disease,” Dr Houlston said. “This study tells us that at least part of the answer is in the patient’s DNA, greatly improving our understanding of the disease.”

“We want to be able to identify which patients are most at risk and which treatments are most likely to help them. This study gives us clues that can begin to help us do this. In the longer term, understanding the factors that contributed to bone breakdown could help us find new treatments for the disease.”

Osteoclast culture

New research has revealed single-nucleotide polymorphisms (SNPs) that may increase the risk of bone disease in patients with multiple myeloma (MM).

One of these SNPs affects a gene encoding osteoprotegerin (OPG), a signaling protein that helps regulate the density of bones.

In patients with MM bone disease (MBD), bones are broken down faster than they can be repaired, resulting in fractures and lesions.

OPG is known to keep the numbers of osteoclasts in check, so it follows that mutations adversely affecting the gene may contribute to excessive bone breakdown.

Richard Houlston, MD, PhD, of The Institute of Cancer Research in London, UK, and his colleagues reported these findings in Leukemia.

The researchers analyzed the DNA of 3774 MM patients and used imaging techniques to detect which of these patients had MBD and which did not. The team used statistical analysis to compare sequencing data from the group of patients who developed MBD with those who did not.

The analysis revealed 9 SNPs that showed an association with MBD and reached genome-wide significance. They were all located in the same region at 8q24.12 and were in strong linkage disequilibrium (LD).

The strongest association at 8q24.12 was observed with the SNP rs4407910, which localizes 19Kb 3’ to the gene encoding TNFRSF11B, also known as OPG (odds ratio=1.38, P=4.02×10⁻⁹).

The researchers also found a “promising association” for MBD with the SNP rs74676832 at 19q13.43, which is located within a 29 kb region of LD intergenic to ZNF444 and GALP (odds ratio=1.97, P=9.33×10^–7).

The team said these findings demonstrate that germline variation influences MBD, and they highlight the importance of the RANK/RANKL/OPG pathway in MBD development.

Furthermore, the work could enable scientists to develop new strategies to prevent MBD development and identify which patients might benefit from treatment with existing bone therapies such as bisphosphonates.

“It is really important to understand why some patients with myeloma are severely affected by bone disease,” Dr Houlston said. “This study tells us that at least part of the answer is in the patient’s DNA, greatly improving our understanding of the disease.”

“We want to be able to identify which patients are most at risk and which treatments are most likely to help them. This study gives us clues that can begin to help us do this. In the longer term, understanding the factors that contributed to bone breakdown could help us find new treatments for the disease.”

Osteoclast culture

New research has revealed single-nucleotide polymorphisms (SNPs) that may increase the risk of bone disease in patients with multiple myeloma (MM).

One of these SNPs affects a gene encoding osteoprotegerin (OPG), a signaling protein that helps regulate the density of bones.

In patients with MM bone disease (MBD), bones are broken down faster than they can be repaired, resulting in fractures and lesions.

OPG is known to keep the numbers of osteoclasts in check, so it follows that mutations adversely affecting the gene may contribute to excessive bone breakdown.

Richard Houlston, MD, PhD, of The Institute of Cancer Research in London, UK, and his colleagues reported these findings in Leukemia.

The researchers analyzed the DNA of 3774 MM patients and used imaging techniques to detect which of these patients had MBD and which did not. The team used statistical analysis to compare sequencing data from the group of patients who developed MBD with those who did not.

The analysis revealed 9 SNPs that showed an association with MBD and reached genome-wide significance. They were all located in the same region at 8q24.12 and were in strong linkage disequilibrium (LD).

The strongest association at 8q24.12 was observed with the SNP rs4407910, which localizes 19Kb 3’ to the gene encoding TNFRSF11B, also known as OPG (odds ratio=1.38, P=4.02×10⁻⁹).

The researchers also found a “promising association” for MBD with the SNP rs74676832 at 19q13.43, which is located within a 29 kb region of LD intergenic to ZNF444 and GALP (odds ratio=1.97, P=9.33×10^–7).

The team said these findings demonstrate that germline variation influences MBD, and they highlight the importance of the RANK/RANKL/OPG pathway in MBD development.

Furthermore, the work could enable scientists to develop new strategies to prevent MBD development and identify which patients might benefit from treatment with existing bone therapies such as bisphosphonates.

“It is really important to understand why some patients with myeloma are severely affected by bone disease,” Dr Houlston said. “This study tells us that at least part of the answer is in the patient’s DNA, greatly improving our understanding of the disease.”

“We want to be able to identify which patients are most at risk and which treatments are most likely to help them. This study gives us clues that can begin to help us do this. In the longer term, understanding the factors that contributed to bone breakdown could help us find new treatments for the disease.”

Commemorating the 20th anniversary of BRCA genetic testing, we are increasingly conscious of the social, economic, and medico-legal impacts of genetic cancer risk on both personal and public health. An ever-growing number of medical societies and expert panels have now charged clinicians with the duty to evaluate and manage their patients’ cancer risk profiles, with particular attention to those individuals carrying genetic mutations that confer elevated cancer susceptibility, a process commonly known as hereditary cancer risk assessment, or HCRA.

Click here to download the PDF.

This article is written for women’s health care clinicians, and will address the current status of hereditary cancer genetic testing, focusing on the evolution of pan-cancer, multigene panel testing in the context of value-based medicine.

Click on the video below to watch Dr. Frieder discuss Hereditary Cancer Testing.

Commemorating the 20th anniversary of BRCA genetic testing, we are increasingly conscious of the social, economic, and medico-legal impacts of genetic cancer risk on both personal and public health. An ever-growing number of medical societies and expert panels have now charged clinicians with the duty to evaluate and manage their patients’ cancer risk profiles, with particular attention to those individuals carrying genetic mutations that confer elevated cancer susceptibility, a process commonly known as hereditary cancer risk assessment, or HCRA.

Click here to download the PDF.

This article is written for women’s health care clinicians, and will address the current status of hereditary cancer genetic testing, focusing on the evolution of pan-cancer, multigene panel testing in the context of value-based medicine.

Click on the video below to watch Dr. Frieder discuss Hereditary Cancer Testing.

Commemorating the 20th anniversary of BRCA genetic testing, we are increasingly conscious of the social, economic, and medico-legal impacts of genetic cancer risk on both personal and public health. An ever-growing number of medical societies and expert panels have now charged clinicians with the duty to evaluate and manage their patients’ cancer risk profiles, with particular attention to those individuals carrying genetic mutations that confer elevated cancer susceptibility, a process commonly known as hereditary cancer risk assessment, or HCRA.

Click here to download the PDF.

This article is written for women’s health care clinicians, and will address the current status of hereditary cancer genetic testing, focusing on the evolution of pan-cancer, multigene panel testing in the context of value-based medicine.

Click on the video below to watch Dr. Frieder discuss Hereditary Cancer Testing.

Hepatitis C infection may increase the risk of Parkinson’s disease, according to a nationwide population-based study published online ahead of print December 23, 2015, in Neurology. Researchers analyzed 10 years of data from the Taiwan National Health Insurance Research Database, which included 49,967 patients with viral hepatitis—35,619 with hepatitis B infection, 10,286 with hepatitis C, and 4,062 with both—and 199,868 noninfected controls.

Individuals with hepatitis C infection had a 29% greater incidence of Parkinson’s disease after adjustment for confounders such as sex, age, heart disease, stroke, and head injury. The researchers found no significant associations between hepatitis B or coinfection and Parkinson’s disease risk.

Age was the most common risk factor for Parkinson’s disease across all cohorts, and in the control group, comorbidities such as hyperlipidemia, hypertension, ischemic heart disease, diabetes, and head injury all were associated with a significant increase in the risk of Parkinson’s disease. Among individuals with hepatitis C infection, however, only ischemic heart disease and head injury remained significantly associated with Parkinson’s disease risk.

The possibility of an association between hepatitis C infection and Parkinson’s disease has emerged recently, with evidence showing that the virus is neurotropic and can replicate in the CNS, reported Hsin-Hsi Tsai, MD, a neurologist at the National Taiwan University Hospital in Taipei, and coauthors.

“Parkinsonism is rarely a described feature in patients with hepatitis C virus. However, a recent study has discovered that hepatitis C virus can induce dopaminergic neuron death, suggesting a possible association between hepatitis C virus infection and” Parkinson’s disease, said the authors.

The study also showed that the association between hepatitis C infection and Parkinson’s disease was more significant in individuals younger than 65, who had a 61% greater risk of developing the neurodegenerative disease.

“Some of the risk factors for hepatitis C virus infection, such as illicit drug use and associated behaviors, may be confounding factors in this age group,” said the authors. They pointed out, however, that in Taiwan, use of IV drugs was not known to be a risk factor for infection. Commenting on a possible mechanism for the association between hepatitis C infection and Parkinson’s disease, Dr. Tsai and associates suggested that the hepatitis C virus could be a possible viral candidate for triggering the neuroinflammation that is a characteristic feature of Parkinson’s disease.

“An earlier imaging study that involved using magnetic resonance spectroscopy to investigate the cerebral effect of hepatitis C virus showed that chronic hepatitis C virus infection was associated with elevated choline/creatinine ratios, a biomarker indicating inflammatory and infective conditions, in the basal ganglia and white matter,” they said.

—Bianca Nogrady

Hepatitis C infection may increase the risk of Parkinson’s disease, according to a nationwide population-based study published online ahead of print December 23, 2015, in Neurology. Researchers analyzed 10 years of data from the Taiwan National Health Insurance Research Database, which included 49,967 patients with viral hepatitis—35,619 with hepatitis B infection, 10,286 with hepatitis C, and 4,062 with both—and 199,868 noninfected controls.

Individuals with hepatitis C infection had a 29% greater incidence of Parkinson’s disease after adjustment for confounders such as sex, age, heart disease, stroke, and head injury. The researchers found no significant associations between hepatitis B or coinfection and Parkinson’s disease risk.

Age was the most common risk factor for Parkinson’s disease across all cohorts, and in the control group, comorbidities such as hyperlipidemia, hypertension, ischemic heart disease, diabetes, and head injury all were associated with a significant increase in the risk of Parkinson’s disease. Among individuals with hepatitis C infection, however, only ischemic heart disease and head injury remained significantly associated with Parkinson’s disease risk.

The possibility of an association between hepatitis C infection and Parkinson’s disease has emerged recently, with evidence showing that the virus is neurotropic and can replicate in the CNS, reported Hsin-Hsi Tsai, MD, a neurologist at the National Taiwan University Hospital in Taipei, and coauthors.

“Parkinsonism is rarely a described feature in patients with hepatitis C virus. However, a recent study has discovered that hepatitis C virus can induce dopaminergic neuron death, suggesting a possible association between hepatitis C virus infection and” Parkinson’s disease, said the authors.

The study also showed that the association between hepatitis C infection and Parkinson’s disease was more significant in individuals younger than 65, who had a 61% greater risk of developing the neurodegenerative disease.

“Some of the risk factors for hepatitis C virus infection, such as illicit drug use and associated behaviors, may be confounding factors in this age group,” said the authors. They pointed out, however, that in Taiwan, use of IV drugs was not known to be a risk factor for infection. Commenting on a possible mechanism for the association between hepatitis C infection and Parkinson’s disease, Dr. Tsai and associates suggested that the hepatitis C virus could be a possible viral candidate for triggering the neuroinflammation that is a characteristic feature of Parkinson’s disease.

“An earlier imaging study that involved using magnetic resonance spectroscopy to investigate the cerebral effect of hepatitis C virus showed that chronic hepatitis C virus infection was associated with elevated choline/creatinine ratios, a biomarker indicating inflammatory and infective conditions, in the basal ganglia and white matter,” they said.

—Bianca Nogrady

Hepatitis C infection may increase the risk of Parkinson’s disease, according to a nationwide population-based study published online ahead of print December 23, 2015, in Neurology. Researchers analyzed 10 years of data from the Taiwan National Health Insurance Research Database, which included 49,967 patients with viral hepatitis—35,619 with hepatitis B infection, 10,286 with hepatitis C, and 4,062 with both—and 199,868 noninfected controls.

Individuals with hepatitis C infection had a 29% greater incidence of Parkinson’s disease after adjustment for confounders such as sex, age, heart disease, stroke, and head injury. The researchers found no significant associations between hepatitis B or coinfection and Parkinson’s disease risk.

Age was the most common risk factor for Parkinson’s disease across all cohorts, and in the control group, comorbidities such as hyperlipidemia, hypertension, ischemic heart disease, diabetes, and head injury all were associated with a significant increase in the risk of Parkinson’s disease. Among individuals with hepatitis C infection, however, only ischemic heart disease and head injury remained significantly associated with Parkinson’s disease risk.

The possibility of an association between hepatitis C infection and Parkinson’s disease has emerged recently, with evidence showing that the virus is neurotropic and can replicate in the CNS, reported Hsin-Hsi Tsai, MD, a neurologist at the National Taiwan University Hospital in Taipei, and coauthors.

“Parkinsonism is rarely a described feature in patients with hepatitis C virus. However, a recent study has discovered that hepatitis C virus can induce dopaminergic neuron death, suggesting a possible association between hepatitis C virus infection and” Parkinson’s disease, said the authors.

The study also showed that the association between hepatitis C infection and Parkinson’s disease was more significant in individuals younger than 65, who had a 61% greater risk of developing the neurodegenerative disease.

“Some of the risk factors for hepatitis C virus infection, such as illicit drug use and associated behaviors, may be confounding factors in this age group,” said the authors. They pointed out, however, that in Taiwan, use of IV drugs was not known to be a risk factor for infection. Commenting on a possible mechanism for the association between hepatitis C infection and Parkinson’s disease, Dr. Tsai and associates suggested that the hepatitis C virus could be a possible viral candidate for triggering the neuroinflammation that is a characteristic feature of Parkinson’s disease.

“An earlier imaging study that involved using magnetic resonance spectroscopy to investigate the cerebral effect of hepatitis C virus showed that chronic hepatitis C virus infection was associated with elevated choline/creatinine ratios, a biomarker indicating inflammatory and infective conditions, in the basal ganglia and white matter,” they said.

—Bianca Nogrady

Men with a high plasma urate concentration have a decreased risk of developing Parkinson’s disease, independent of potential risk factors such as age, smoking, and caffeine intake, according to research published online ahead of print January 13 in Neurology. Plasma urate concentration appears to have no association with risk of Parkinson’s disease among women, however. For men, urate could protect against Parkinson’s disease risk or slow the progression of preclinical Parkinson’s disease, according to the authors.

“Our findings, together with previous observations that urate can be elevated by administration of its precursor inosine, which is generally safe and tolerable, in early Parkinson’s disease, provide strong evidence supporting the design of a randomized trial of urate elevation in patients with early Parkinson’s disease or pre-Parkinson syndrome,” said Xiang Gao, MD, PhD, Director of the Nutritional Epidemiology Laboratory at Pennsylvania State University in University Park.

Dr. Gao and colleagues examined blood samples for more than 90,000 men and women who participated in the Health Professionals Follow-up Study, the Nurses’ Health Study, or the Cancer Prevention Study II Nutrition. The researchers confirmed cases of Parkinson’s disease based on a detailed questionnaire that the treating neurologist or internists completed, or through a movement disorder specialist’s review of medical records. Only patients with definite or probable Parkinson’s disease were included in the analysis. Between one and six controls were selected randomly for each case. The investigators used questionnaires to collect data on potential confounders, including age, smoking status, height, weight, chronic diseases, and consumption of caffeinated coffee and alcohol.

Dr. Gao’s group identified 388 new incident cases of Parkinson’s disease since blood collection and matched them with 1,267 controls. Higher baseline urate concentrations were associated with lower risk of Parkinson’s disease in men, but not in women. The multivariate-adjusted risk ratios of Parkinson’s disease, comparing the highest and lowest quartiles of urate, were 0.63 in men and 1.04 in women. Adjusting the data for cardiovascular factors, including history of cardiovascular disease and diabetes, did not affect the results.

The researchers pooled the results of their study with those of three previous investigations that included 325 patients with Parkinson’s disease. The pooled risk ratios comparing the highest and lowest categories of urate were 0.63 in men and 0.89 in women.

Animal and human studies suggest that urate is a neuroprotective agent, noted the authors. Their own previous research indicates that urate may slow disease progression during the preclinical stage of Parkinson’s disease.

The strengths of the current study include its prospective design, large sample size, and availability of information on covariates that may confound the potential association between serum urate and Parkinson’s disease risk, according to the authors. The study was based on a single measure of plasma urate, however, and did not account for within-person variability in urate levels. In addition, the results may be difficult to generalize because the majority of participants were Caucasian and had high educational attainment and socioeconomic status.

—Erik Greb

Men with a high plasma urate concentration have a decreased risk of developing Parkinson’s disease, independent of potential risk factors such as age, smoking, and caffeine intake, according to research published online ahead of print January 13 in Neurology. Plasma urate concentration appears to have no association with risk of Parkinson’s disease among women, however. For men, urate could protect against Parkinson’s disease risk or slow the progression of preclinical Parkinson’s disease, according to the authors.

“Our findings, together with previous observations that urate can be elevated by administration of its precursor inosine, which is generally safe and tolerable, in early Parkinson’s disease, provide strong evidence supporting the design of a randomized trial of urate elevation in patients with early Parkinson’s disease or pre-Parkinson syndrome,” said Xiang Gao, MD, PhD, Director of the Nutritional Epidemiology Laboratory at Pennsylvania State University in University Park.

Dr. Gao and colleagues examined blood samples for more than 90,000 men and women who participated in the Health Professionals Follow-up Study, the Nurses’ Health Study, or the Cancer Prevention Study II Nutrition. The researchers confirmed cases of Parkinson’s disease based on a detailed questionnaire that the treating neurologist or internists completed, or through a movement disorder specialist’s review of medical records. Only patients with definite or probable Parkinson’s disease were included in the analysis. Between one and six controls were selected randomly for each case. The investigators used questionnaires to collect data on potential confounders, including age, smoking status, height, weight, chronic diseases, and consumption of caffeinated coffee and alcohol.

Dr. Gao’s group identified 388 new incident cases of Parkinson’s disease since blood collection and matched them with 1,267 controls. Higher baseline urate concentrations were associated with lower risk of Parkinson’s disease in men, but not in women. The multivariate-adjusted risk ratios of Parkinson’s disease, comparing the highest and lowest quartiles of urate, were 0.63 in men and 1.04 in women. Adjusting the data for cardiovascular factors, including history of cardiovascular disease and diabetes, did not affect the results.

The researchers pooled the results of their study with those of three previous investigations that included 325 patients with Parkinson’s disease. The pooled risk ratios comparing the highest and lowest categories of urate were 0.63 in men and 0.89 in women.

Animal and human studies suggest that urate is a neuroprotective agent, noted the authors. Their own previous research indicates that urate may slow disease progression during the preclinical stage of Parkinson’s disease.

The strengths of the current study include its prospective design, large sample size, and availability of information on covariates that may confound the potential association between serum urate and Parkinson’s disease risk, according to the authors. The study was based on a single measure of plasma urate, however, and did not account for within-person variability in urate levels. In addition, the results may be difficult to generalize because the majority of participants were Caucasian and had high educational attainment and socioeconomic status.

—Erik Greb

Men with a high plasma urate concentration have a decreased risk of developing Parkinson’s disease, independent of potential risk factors such as age, smoking, and caffeine intake, according to research published online ahead of print January 13 in Neurology. Plasma urate concentration appears to have no association with risk of Parkinson’s disease among women, however. For men, urate could protect against Parkinson’s disease risk or slow the progression of preclinical Parkinson’s disease, according to the authors.

“Our findings, together with previous observations that urate can be elevated by administration of its precursor inosine, which is generally safe and tolerable, in early Parkinson’s disease, provide strong evidence supporting the design of a randomized trial of urate elevation in patients with early Parkinson’s disease or pre-Parkinson syndrome,” said Xiang Gao, MD, PhD, Director of the Nutritional Epidemiology Laboratory at Pennsylvania State University in University Park.

Dr. Gao and colleagues examined blood samples for more than 90,000 men and women who participated in the Health Professionals Follow-up Study, the Nurses’ Health Study, or the Cancer Prevention Study II Nutrition. The researchers confirmed cases of Parkinson’s disease based on a detailed questionnaire that the treating neurologist or internists completed, or through a movement disorder specialist’s review of medical records. Only patients with definite or probable Parkinson’s disease were included in the analysis. Between one and six controls were selected randomly for each case. The investigators used questionnaires to collect data on potential confounders, including age, smoking status, height, weight, chronic diseases, and consumption of caffeinated coffee and alcohol.

Dr. Gao’s group identified 388 new incident cases of Parkinson’s disease since blood collection and matched them with 1,267 controls. Higher baseline urate concentrations were associated with lower risk of Parkinson’s disease in men, but not in women. The multivariate-adjusted risk ratios of Parkinson’s disease, comparing the highest and lowest quartiles of urate, were 0.63 in men and 1.04 in women. Adjusting the data for cardiovascular factors, including history of cardiovascular disease and diabetes, did not affect the results.

The researchers pooled the results of their study with those of three previous investigations that included 325 patients with Parkinson’s disease. The pooled risk ratios comparing the highest and lowest categories of urate were 0.63 in men and 0.89 in women.

Animal and human studies suggest that urate is a neuroprotective agent, noted the authors. Their own previous research indicates that urate may slow disease progression during the preclinical stage of Parkinson’s disease.

The strengths of the current study include its prospective design, large sample size, and availability of information on covariates that may confound the potential association between serum urate and Parkinson’s disease risk, according to the authors. The study was based on a single measure of plasma urate, however, and did not account for within-person variability in urate levels. In addition, the results may be difficult to generalize because the majority of participants were Caucasian and had high educational attainment and socioeconomic status.

—Erik Greb