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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_406"
                     title="AAPM: Opioid Gains Long-Term Control of Neuropathic Cancer Pain (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18316?impressionId=1265794162963"
                     
      &lt;p&gt;SAN ANTONIO  --  Patients with neuropathic cancer pain obtained consistent, long-term pain control with extended-release oxymorphone (Opana), according to results of a one-year, open-label extension study.&lt;/p&gt;
&lt;p&gt;Patients reported pain in the mild range throughout most of the follow-up, and only 11% discontinued because of lack of efficacy, Errol Gould, PhD, of Endo Pharmaceuticals in Chadds Ford, Pa., reported here at the American Academy of Pain Medicine meeting. The company manufactures Opana.&lt;/p&gt;
&lt;p&gt;No unexpected adverse events occurred.&lt;/p&gt;
&lt;p&gt;&quot;Current clinical guidelines recommend opioids as second- or third-line treatment for chronic neuropathic pain,&quot; Gould said in an interview. &quot;These results suggest that oxymorphone extended release may be a viable long-term option for patients with neuropathic pain.&quot;&lt;/p&gt;
&lt;p&gt;The findings came from a one-year extension of a multicenter, open-label, noncontrolled short-term study of patients with cancer-related chronic pain.&lt;/p&gt;
&lt;p&gt;Of 44 patients who entered the extension phase, 27 had pain that was primarily neuropathic in origin. The diagnosis of neuropathic pain was based on clinician judgment, with no prespecified diagnostic criteria for guidance.&lt;/p&gt;
&lt;p&gt;Patients began treatment in the extension phase with their ending dose from the short-term study. Dose adjustments to improve pain control or tolerability were allowed throughout the 52-week extension phase.&lt;/p&gt;
&lt;p&gt;Ten of the 27 patients completed the extension study. Principal reasons for withdrawal were adverse events, patient request, loss of effectiveness, and nonadherence.&lt;/p&gt;
&lt;p&gt;The median duration from initiation of long-term maintenance to final visit was 22 weeks. Baseline pain intensity averaged 32.9 on a 100-point scale and 32.6 at final visit. Mean least pain intensity was 13.8 at baseline and 16.2 at final visit, and worst pain intensity averaged 76.3 at baseline and 66.5 at final visit.&lt;/p&gt;
&lt;p&gt;&quot;Regression analysis showed that pain intensity changed very little throughout follow-up,&quot; Gould said.&lt;/p&gt;
&lt;p&gt;The median oxymorphone dose increased from 80 mg at baseline to 160 mg at 52 weeks.&lt;/p&gt;
&lt;p&gt;Eleven (41%) patients reported at least one treatment-related adverse event. The most common events were dry mouth, constipation, and fatigue. The only serious adverse event was an episode of depressed consciousness.&lt;/p&gt;
&lt;p&gt;&quot;Patients required some gradual increases in dosage over time, but that&apos;s consistent with the nature of the disease,&quot; said Gould.&lt;/p&gt;
&lt;p&gt;Not long ago opioids were considered ineffective for neuropathic pain, he added. This study provided additional evidence in support of opioids&apos; effectiveness in controlling neuropathic pain.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Endo Pharmaceuticals, which manufactures Opana.&lt;/p&gt;&lt;p&gt;Gould and another co-author are employees of Endo Pharmaceuticals.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265794162963"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_267"
                     title="Public-Private Divide Found in Prostate Cancer Treatment (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/HematologyOncology/ProstateCancer/tb/18118?impressionId=1265794162963"
                     
      &lt;p&gt;Treatment that men receive for prostate cancer may depend less on their condition and more on where they are treated, a new study found.&lt;/p&gt;
&lt;p&gt;Moreover, men treated by private hospitals were nearly two and a half times more likely to receive radiation therapy (OR 2.36; 95% CI 1.37 to 4.07) and more than four and a half times more likely to receive primary androgen deprivation therapy (OR 4.71; 95% CI 2.15 to 10.36) than surgery, which was the predominant treatment at county hospitals, according to findings published Jan. 25 in &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Patients in private hospitals were also more likely to be white.&lt;/p&gt;
&lt;p&gt;&quot;This is the first study to compare prostate cancer treatments between private and public institutions, and it reveals a novel variable influencing treatment choice: healthcare venue,&quot; J. Kellogg Parsons, MD, MHS, of the University of California San Diego, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;Men treated at county hospitals were significantly more likely to undergo surgery, whereas those treated by private providers were more likely to undergo radiotherapy or primary androgen deprivation, irrespective of age, race, comorbidity status, clinical tumor stage, Gleason sum, and D&apos;Amico risk stratification.&quot;&lt;/p&gt;
&lt;p&gt;&quot;A likely explanation for this imparity is that the initial provider in the county hospitals was always a urologist, whereas at the private venues the initial providers were a mix of urologists, radiation oncologists, and medical oncologists,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;In the U.S. in 2009, more than 190,000 men were diagnosed with prostate cancer and more than 27,000 men died from the disease, according to the National Cancer Institute. Although life expectancy, other illnesses, cancer severity, and patient preference may play a role in treatment choice, the common treatments for localized prostate cancer  --  surgery, radiation, and hormone therapy  --  all have pros and cons, and experts differ on which option is more effective.&lt;/p&gt;
&lt;p&gt;Parsons and colleagues explored whether treatment location might play a role in determining what therapy a patient receives. They analyzed the records of 559 men enrolled in a state-funded public assistance program for low-income patients, known as Improving Access, Counseling and Treatment for Californians with Prostate Cancer (IMPACT), who received prostate cancer treatment between 2001 and 2006.&lt;/p&gt;
&lt;p&gt;The researchers noted that a limitation of the study was the population included in the IMPACT database -- generally patients with more severe cancer than in the general U.S. population; thus the findings may not reflect patients from other regions and socioeconomic groups.&lt;/p&gt;
&lt;p&gt;Of the participants, 315 received treatment from county hospitals and 244 received care from private facilities. No significant difference existed between the two groups in terms of age and tumor characteristics, yet the patients received varying therapies.&lt;/p&gt;
&lt;p&gt;&quot;In this economically disadvantaged cohort, prostate cancer treatments differed significantly between county hospitals and private providers,&quot; the authors wrote. &quot;These data reveal substantial variations in treatment patterns between different types of healthcare institutions that  --  given the implications for health policy and quality of care  --  merit further scrutiny.&quot;&lt;/p&gt;
&lt;p&gt;To help patients make informed decisions, develop appropriate expectations, and avoid making decisions they will regret, the authors proposed that patients with localized prostate cancer be provided access to multiple care providers so that they will be exposed to a variety of opinions and information about their disease.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers did not report specific support for this analysis but the IMPACT program is supported by the state of California.&lt;/p&gt;&lt;p&gt;The reseachers reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_262"
                     title="Unequal Outcomes Despite Equal Treatment (CME/CE)"
                     score="-0"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18110?impressionId=1265794162963"
                     
      &lt;p&gt;Race and income determined the likelihood of surviving liver cancer even when patients&apos; treatment appeared the same, researchers said.&lt;/p&gt;
&lt;p&gt;Data from the CDC&apos;s Surveillance, Epidemiology, and End Results (SEER) database for nearly 15,000 patients diagnosed with hepatocellular carcinoma from 1973 to 2004 found that blacks had a 15% higher death rate than whites (95% CI 9% to 22%), according to Joseph Kim, MD, of City of Hope in Duarte, Calif., and colleagues.&lt;/p&gt;
&lt;p&gt;Unadjusted five-year survival rates were about 6% for blacks, compared with about 9% for whites with liver cancer, the researchers reported online in &lt;em&gt;Cancer&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Moreover, middle and high income levels were associated with better survival than low income (hazard ratio for death 0.89 and 0.95, respectively, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.03 for both versus low income), the researchers wrote.&lt;/p&gt;
&lt;p&gt;The results reflected adjustments for types of treatments administered, such as tumor ablation or resection or liver transplantation, for tumor grade at diagnosis, and for other factors.&lt;/p&gt;
&lt;p&gt;&quot;Our study demonstrates that black patients and lower income patients continue to have the worst survival,&quot; Kim and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The findings conflict with other studies suggesting that race was not a predictor of liver-cancer survival when treatment types were taken into account.&lt;/p&gt;
&lt;p&gt;That earlier research concluded that blacks with liver cancer were less likely to undergo surgery for localized disease, and that this difference in treatment fully accounted for racial differences in survival.&lt;/p&gt;
&lt;p&gt;So Kim and colleagues also took a closer look at treatment of patients in the SEER database with localized liver tumors diagnosed since 1998.&lt;/p&gt;
&lt;p&gt;Such patients would have been most appropriate for surgery, the researchers indicated. They found that, in line with the earlier studies, blacks had the lowest rates of surgery and transplantation (31% versus 38% for whites, &lt;em&gt;P&lt;/em&gt; not reported).&lt;/p&gt;
&lt;p&gt;But among those patients receiving orthotopic liver transplant, data from the United Network for Organ Sharing (UNOS) showed that blacks had lower rates of graft survival and overall survival compared with whites and other racial-ethnic groups.&lt;/p&gt;
&lt;p&gt;(Throughout the study, Asians tended to have the best outcomes after adjusting for other factors, and Hispanics generally had similar outcomes to whites.)&lt;/p&gt;
&lt;p&gt;The hazard ratio for graft loss among blacks versus whites was 1.63 (95% CI 1.29 to 2.04) and for overall survival it was 1.66 (95% CI 1.29 to 2.12).&lt;/p&gt;
&lt;p&gt;&quot;Therefore, our study demonstrates that survival disparities by race and ethnicity cannot be explained by access issues alone, and other factors need to be considered,&quot; according to Kim and colleagues.&lt;/p&gt;
&lt;p&gt;On the other hand, they acknowledged that there could have been differences in treatment not captured in the SEER and UNOS data.&lt;/p&gt;
&lt;p&gt;Comorbidities and hepatitis C virus-related cirrhosis were also not evaluable, making it possible that black patients were generally sicker and therefore less likely to survive.&lt;/p&gt;
&lt;p&gt;In other findings from the SEER data, Kim and colleagues noted that survival rates had increased markedly over time, and in racial-ethnic and income subgroups.&lt;/p&gt;
&lt;p&gt;Relative to patients diagnosed in the 1970s, those diagnosed from 2000 to 2004 were four times as likely to survive (HR 0.25, 95% CI 0.22 to 0.28). Five-year unadjusted survival rates increased from about 2% to 15% during this span.&lt;/p&gt;
&lt;p&gt;&quot;All racial/ethnic and income groups . . . have benefited to some degree from advances in screening, diagnosis, and treatment,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Survival rates in women have been somewhat better than in men (HR for death 0.92, 95% CI 0.86 to 0.96).&lt;/p&gt;
&lt;p&gt;Patients undergoing resection or transplantation also fared much better than those not having surgery of any kind, (HR for death 0.27, 95% CI 0.25 to 0.28). Tumor ablation or destruction was also highly beneficial (HR 0.40, 95% CI 0.36 to 0.44 relative to no surgery).&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the analysis was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_1627"
                     title="ICD: Higher CLL Mortality Linked to Earlier Skin Cancer"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14376?impressionId=1265794162963"
                     
      PRAGUE, May 26 -- A prior diagnosis of nonmelanoma skin cancer predicts an increased mortality risk in patients with chronic lymphocytic leukemia (CLL), investigators from the National Cancer Institute reported here.
              &lt;p&gt;
              &lt;p&gt;Overall, such patients had a 30% greater risk of death, which almost doubled in the subgroup of patients whose skin cancer was squamous cell, said Patrick Blake, a medical student at the Cleveland Clinic on leave at the National Cancer Institute.
              &lt;p&gt;
              &lt;p&gt;In a third of the CLL cases, a diagnosis of nonmelanoma skin cancer preceded the leukemia diagnosis by less than a year, increasing to 44% for squamous cell cancer.
              &lt;p&gt;
              &lt;p&gt;&quot;CLL patients with a previous diagnosis of nonmelanoma skin cancer have a significantly decreased survival compared with CLL patients without nonmelanoma skin cancer,&quot; Blake and colleagues reported during a poster session at the International Congress of Dermatology.
              &lt;p&gt;
              &lt;p&gt;Several case reports have documented incidental identification of subclinical CLL related to excision of squamous cell or basal cell skin cancer. A Scandinavian study of patients with squamous cell skin cancer demonstrated a twofold increased risk of CLL.
              &lt;p&gt;
              &lt;p&gt;Two other recent studies documented increased mortality in lymphoma patients with a history of skin cancer. However, investigators in both studies included CLL patients with those who had non-Hodgkin lymphoma.
              &lt;p&gt;
              &lt;p&gt;To clarify the link between CLL and nonmelanoma skin cancer, the investigators analyzed data from a population-based study of more than 12,000 cases of CLL diagnosed in Sweden between 1973 and 2003.
              &lt;p&gt;
              &lt;p&gt;Complete medical history was available for the patients, and cause of death was ascertained by data from Sweden&apos;s national death registry.
              &lt;p&gt;
              &lt;p&gt;The investigators identified 236 CLL patients with a prior diagnosis of nonmelanoma skin cancer and compared them with 11,805 patients with no history of skin cancer.
              &lt;p&gt;
              &lt;p&gt;Those with a history of nonmelanoma skin cancer were:
              &lt;ul&gt;
                &lt;li&gt; Older (78.5 versus 71)
                &lt;li&gt; Substantially more likely to be age 70 or older at diagnosis of CLL (80.9% versus 54.1%)
                &lt;li&gt; More likely to be male (69.9% versus 62%)
                &lt;li&gt; Diagnosed more recently (1993 versus 1984)
                 &lt;/ul&gt;
                              &lt;p&gt;
                              &lt;p&gt;Among the 236 CLL patients with a history of nonmelanoma skin cancer, investigators found that 80 (33%) had a skin cancer diagnosis less than a year before the CLL diagnosis.
                              &lt;p&gt;
                              &lt;p&gt;Of 111 patients with squamous cell skin cancer, 49 (44%) had a skin cancer diagnosis less than a year before the CLL diagnosis.
                              &lt;p&gt;
                              &lt;p&gt;CLL patients with a prior diagnosis of nonmelanoma skin cancer had a mortality hazard ratio of 1.29 compared with CLL patients who did not have a prior skin cancer diagnosis.
                              &lt;p&gt;
                              &lt;p&gt;In the subgroup of patients with squamous cell skin cancer, the CLL mortality hazard ratio increased to 1.86.
                              &lt;p&gt;
                              &lt;p&gt;Both findings differed significantly from patients with no skin cancer history (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
                              &lt;p&gt;
                              &lt;p&gt;The five-year survival of CLL patients with no history of skin cancer was 43% compared with 31% for patients with a history of nonmelanoma skin cancer and 28% for the subgroup with squamous cell cancer (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001).
                              &lt;p&gt;
                              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The study was funded by the National Cancer Institute.
                              &lt;p&gt;
                              &lt;p&gt;Blake and his co-authors reported no disclosures.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
                           
    </recommendedItem>
</recommendedContent>
