Cured but at what Cost?

Long-term consequences of cancer and its treatment

Long-term consequences of cancer and its treatment
Too many people pay a heavy price for surviving cancer – @MacMillanCancer

There are more than two million people living with cancer in the UK today, but

  • not all of them are living well ;
  • cancer and its treatment often leaves a gruelling physical and mental legacy for many years afterwards.

It begs the question – do we really understand the true cost of being cured?

Stain-resistant Chemicals linked to high Blood Pressure during Pregnancy

Serum Perfluorooctanoic Acid and Perfluorooctane Sulfonate Concentrations in Relation to Birth Outcomes

Stain-resistant chemicals linked to high blood pressure during pregnancy
Hypertension during pregnancy can be life-threatening for the mother and child

Mothers’ exposure to chemicals that make consumer products stain – and water – resistant was linked to high blood pressure during pregnancy in an analysis of highly exposed communities in West Virginia and Ohio. Hypertension during pregnancy can be life-threatening for the mother and child.
The study is the first prospective assessment of exposure and subsequent birth outcomes in this population.

Abstract

Background
Previous research suggests perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) may be associated with adverse pregnancy outcomes.

Objective
We conducted a population­based study of PFOA and PFOS and birth outcomes from 2005­2010 in a mid­Ohio Valley community exposed to high levels of PFOA through drinking water contamination.

Methods
Women provided serum for PFOA and PFOS measurement in 2005­2006 and reported reproductive histories in subsequent follow­up interviews. Reported singleton live births among 1330 women after January 1, 2005 were linked to birth records (n=1630) to identify the outcomes of preterm birth (<37 weeks gestation), pregnancy­induced hypertension, low birth weight (<2500 grams), and birth weight (grams) among full­term infants.

Results
We observed little or no evidence of association between maternal serum PFOA or PFOS and preterm birth (n=158) or low birth weight (n=88). Serum PFOA and PFOS were both positively associated with pregnancy­induced hypertension (n=106), with adjusted odds ratios (OR) per log unit increase in PFOA and PFOS of 1.27 (95% CI: 1.05, 1.55) and 1.47 (95% CI: 1.06, 2.04), respectively, but associations did not increase monotonically when categorized by quintiles. Results of subanalyses restricted to pregnancies conceived after blood collection were consistent with the main analyses. There was suggestion of a modest negative association between PFOS and birth weight in full­term infants (­29 grams per log unit increase; 95% CI: ­ 66, 7) which became stronger when restricted to births conceived after the blood sample collection (­49 grams per log unit increase; 95% CI: ­90, ­8). 3 Page 4 of 32

Conclusion
Results provide some evidence of positive associations between measured serum perfluorinated compounds and pregnancy­induced hypertension and a negative association between PFOS and birth weight among full­term infants.

Could a Pregnant Woman’s Exposure to Drugs alter the Brains of her GrandChildren?

A mom’s crusade could help unravel autism mystery

A mom's crusade could help unravel autism mystery
Could a pregnant woman’s exposure to drugs alter the brains of her grandchildren?

Something a pregnant woman is exposed to may alter not just her children, but also her grandchildren – and possibly even subsequent generations.
The power of pharmaceuticals to do just that came to light with DES, a synthetic estrogen that harmed at least two generations of offspring of women who took it.

Thanks to Jill Escher, scientists are considering how mothers taking fertility drugs in the 1950s and ’60s could be responsible for transgenerational abnormalities:

  • From generation to generation
  • A personal quest
  • Searching the epigenome for answers
  • Antidepressants under the microscope
  • FDA petitioned, NIH involved

Read A mom’s crusade could help unravel autism mystery
MNN Health News, 16 Jul 2013, feat. Jill Autism Exposed interview.

DES DiEthylStilbestrol Resources

Doctors Duty to inform Patients: call for better Cancer Fertility Care for young Women in the UK

Discussing fertility preservation at the time of cancer diagnosis: Dissatisfaction of young females

Discussing fertility preservation at the time of cancer diagnosis: Dissatisfaction of young females
Call for better cancer fertility care for young women in the UK

The care for young women needing cancer treatment which could damage their chances of having children needs to be improved, researchers say.

Abstract

Background:
Sperm banking is widely available for post-pubertal male cancer patients but options for females remain limited. Anecdotal evidence suggests that fertility issues may be inadequately discussed with females.
To understand the experience of both sexes in the UK, surveys of young cancer survivors were performed seven years apart.

Procedure:
Data were collected from young cancer survivors aged over 13 years at diagnosis, attending support group conferences held in 2004 and 2011. Data were collected anonymously using remote handsets in response to questions projected on the screen during plenary sessions.

Results:
A total of 81 female and 69 males responded in 2004, and 69 females and 71 males in 2011. In both years, most males reported fertility discussions taking place before treatment started and they were generally satisfied with it. However in both years, fewer females recall a discussion about fertility and they were generally less satisfied. Although in 2011 more females reported a fertility discussion prior to the beginning of treatment, they were no more satisfied than the females in 2004 whose fertility discussion were more likely to take place after treatment had started.

Conclusions:
Whilst male cancer survivors in the UK are generally satisfied about the frequency and timing of discussions about fertility, females are not. Although in 2011 fertility discussions with females more often took place before treatment began, they were no more satisfied than females in 2004. This may reflect the approach by professionals or the absence of effective fertility preservation strategies for them.

Top Reasons Patients sue Doctors: missed Diagnoses and Drug Errors

Identifying early warning signs for diagnostic errors in primary care: a qualitative study

Failure to diagnose is No.1 reason for suing doctors
Failure to diagnose is No.1 reason for suing doctors

Missed diagnoses ― particularly of cancer, heart attack, and meningitis ― and drug errors make up the bulk of malpractice claims brought against doctors in primary care, finds an analysis of published data in BMJ Open.

Abstract

Objective
We investigate the mechanisms of diagnostic error in primary care consultations to detect warning signs for possible error. We aim to identify places in the diagnostic reasoning process associated with major risk indicators.

Design
A qualitative study using semistructured interviews with open-ended questions.

Setting
A 2-month study in primary care conducted in Oxfordshire, UK.

Participants
We approached about 25 experienced general practitioners by email or word of mouth, 15 volunteered for the interviews and were available at a convenient time.

Intervention
Interview transcripts provided 45 cases of error. Three researchers searched these independently for underlying themes in relation to our conceptual framework.

Outcome measures
Locating steps in the diagnostic reasoning process associated with major risk of error and detecting warning signs that can alert clinicians to increased risk of error.

Results
Initiation and closure of the cognitive process are most exposed to risk of error. Cognitive biases developed early in the process lead to errors at the end. These warning signs can be used to alert clinicians to the increased risk of diagnostic error. Ignoring red flags or critical cues was related to processes being biased through the initial frame, but equally well, it could be explained by knowledge gaps.

Conclusions
Cognitive biases developed at the initial framing of the problem relate to errors at the end of the process. We refer to these biases as warning signs that can alert clinicians to the increased risk of diagnostic error. We conclude that lack of knowledge is likely to be an important factor in diagnostic error. Reducing diagnostic errors in primary care should focus on early and systematic recognition of errors including near misses, and a continuing professional development environment that promotes reflection in action to highlight possible causes of process bias and of knowledge gaps.

Hypospadias in Sons of Women exposed to DiEthylStilbestrol in Utero: a cohort Study

Increased Risk of Hypospadias in the DES Sons

Hypospadias in sons of women exposed to diethylstilbestrol in utero: a cohort study
Increased risk of hypospadias in the DES Sons

BACKGROUND:
Transgenerational effects of Diethylstilbestrol (DES) have been reported in animals, but effects in human beings are unknown. Alerted by two case reports, we aimed to establish the risk of hypospadias in the sons of women who were exposed to DES in utero.

METHODS:
We did a cohort study of all sons of a Dutch cohort of 16284 women with a diagnosis of fertility problems. We used a mailed questionnaire assessing late effects of fertility treatment to identify boys with hypospadias. We compared the prevalence rate of hypospadias between boys with and without maternal DES exposure in utero.

FINDINGS:
16284 mothers (response rate 67%) reported 8934 sons. The mothers of 205 boys reported DES exposure in utero. Four of these children were reported to have hypospadias. In the remaining 8729 children, only eight cases of hypospadias were reported (prevalence ratio 21.3 [95% CI 6.5-70.1]). All cases of hypospadias were medically confirmed. Maternal age or fertility treatment did not affect the risk of hypospadias. Children conceived after assisted reproductive techniques such as in-vitro fertilisation were not at increased risk of hypospadias compared with children conceived naturally (1.8, 0.6-5.7).

INTERPRETATION:
Our findings suggest an increased risk of hypospadias in the sons of women exposed to DES in utero. Although the absolute risk of this anomaly is small, this transgenerational effect of DES warrants additional studies.

More DES DiEthylStilbestrol Resources

Long-Term Consequences of Cancer and its Treatment Side-Effects

2013 Warning from Macmillan Cancer Support

Cancer health issues warning by charity
Pain and chronic fatigue,some of the long-term effects of cancer treatment

Hundreds of thousands of people in the UK face poor health or disability after being treated for cancer, says a report from Macmillan Cancer Support. The charity says more should be done to help the one in four affected by long-term problems such as chronic fatigue, pain, sexual and urinary difficulties. These problems can occur when healthy cells are damaged during treatment. Macmillan says patients should be offered continuing support after their treatment for cancer.

Find out more:

Too much Weight Gain early in Pregnancy leads to larger, chubbier Babies

Video by UAlberta, published on July 17, 2013

Moms-to-be who gain too much weight early into their pregnancy are nearly three times as likely to give birth to bigger and fatter babies who are at higher risk of obesity as kids and adults, warns Margie Davenport, University of Alberta Researcher.
Sarah O’Hara, a new mom and registered dietitian who knows the dangers of gaining too much weight too quickly, talks about what she did to help keep her weight gain within recommended guidelines.

Risk of Breast Cancer in Women exposed to DiEthylStilbestrol in Utero, preliminary results

The overall 40% excess risk in DES Daughters, arising exclusively from the subset of estrogen receptor-positive cases, raises a concern calling for continued investigation

DES Follow-up Study Summary

National Cancer Inst logo image
The overall 40% excess risk in DES Daughters, arising exclusively from the subset of estrogen receptor-positive cases, raises a concern calling for continued investigation.

The question of whether daughters of women who took Diethylstilbestrol (DES) while pregnant with them will have a greater chance of getting breast cancer has been of great interest to both the DES population and researchers. Questionnaire data collected in 1994 and 1997 from participants in the combined follow-up study were used to investigate this question. 4821 exposed and 2095 unexposed women completed one or both of the follow-up questionnaires, answering questions on reproductive factors, health habits, and disease outcomes. Reports of breast cancer were confirmed by checking medical records or death certificates. There were 43 cases of breast cancer among the DES-exposed and 15 among the unexposed women.

Overall, exposed daughters did not have a statistically significant increase in the risk of breast cancer. Although the relative risk was 1.4, this elevation could have been a chance finding due to the small number of breast cancer cases. However, among the subgroup of women aged 40 and older, those exposed to DES were estimated to have 2.5 times the risk of breast cancer, and this result was statistically significant. Follow-up in the study has continued, and a new analysis that includes additional cases diagnosed since 1997 has begun. The new analysis will likely provide more definitive results.

2002 Study Abstract

BACKGROUND:
A synthetic estrogen, Diethylstilbestrol (DES), was widely prescribed to pregnant women during the 1950s and 1960s but was later discovered to be associated with an increased risk of clear-cell carcinoma of the vagina and cervix in female offspring. DES has not been linked to other cancers in female offspring, but studies of other prenatal factors such as twin gestation and pre-eclampsia have indicated that in-utero estrogen levels may influence breast cancer risk. We evaluated the relation of in-utero DES exposure to the risk of adult breast cancer.

METHODS:
A cohort of 4821 exposed women and 2095 unexposed women, most of whom were first identified in the mid-1970s, were followed by mailed questionnaires for an average of 19 years. Reported cancer outcomes were validated by medical record review. Breast cancer incidence in DES-exposed daughters was compared with cancer incidence in unexposed daughters with use of Poisson regression analysis, adjusting for year of birth, age at menarche, age at first birth, and number of births.

FINDINGS:
The rate ratio for incidence of invasive breast cancer in exposed versus unexposed women was 1.4 (95% confidence interval (CI) = 0.7-2.6). DES exposure was not associated with an increased risk of breast cancer in women under 40 years, but among women aged 40 and older the rate ratio was 2.5 (95% CI = 1.0-6.3). The rate ratio for the association of DES exposure with estrogen receptor-positive tumors was 1.9 (95% CI = 0.8-4.5).

INTERPRETATION:
While not statistically significant, the overall 40% excess risk, arising exclusively from the subset of estrogen receptor-positive cases, raises a concern calling for continued investigation.

Sources

  • Risk of breast cancer in women exposed to diethylstilbestrol in utero: prelimiinary results (United States),NCBI, PMID: 12420954, 2002 Oct;13(8):753-8.
  • NCI, DES Follow-up Study Published Papers.
More DES DiEthylStilbestrol Resources

Poor Sleep in Pregnancy can disrupt the Immune System and cause Birth-related Complications

Disturbed sleep and inflammatory cytokines in depressed and nondepressed pregnant women: an exploratory analysis of pregnancy outcomes

Poor Sleep in Pregnancy Can Disrupt the Immune System and Cause Birth-Related Complications
Women with depression and poor sleep are at greatest risk for adverse birth-related outcomes

Poor sleep quality and quantity during pregnancy can disrupt normal immune processes and lead to lower birth weights and other complications, finds a University of Pittsburgh School of Medicine study published today in the journal Psychosomatic Medicine. Women with depression also are more likely than non-depressed women to suffer from disturbed sleep and to experience immune system disruption and adverse pregnancy outcomes.

Our results highlight the importance of identifying sleep problems in early pregnancy, especially in women experiencing depression, since sleep is a modifiable behavior,” said Michele Okun, Ph.D., assistant professor of psychiatry at Pitt’s School of Medicine and lead author of the report. “The earlier that sleep problems are identified, the sooner physicians can work with pregnant women to implement solutions.”

Read Poor Sleep in Pregnancy can disrupt the Immune System and cause Birth-related Complications, Science Daily, 17 July 2013.

Sources: Disturbed Sleep and Inflammatory Cytokines in Depressed and Nondepressed Pregnant Women: An Exploratory Analysis of Pregnancy Outcomes. Psychomatic Medicine, 22 June 2012.