(Press-News.org) Geneva, Switzerland: Giving palliative radiotherapy to elderly patients with painful bone metastases can significantly improve their quality of life, a Dutch researcher told the 2nd Forum of the European Society for Radiotherapy and Oncology (ESTRO) today (Monday).
With the number of elderly patients who suffer from metastatic disease on the increase due to the ageing of the population and the ability to prolong the palliative phase of cancers, this finding has important implications for clinical practice, said Dr Paulien Westhoff from the Department of Radiotherapy at the University Medical Centre Utrecht, The Netherlands.
Together with Dr Yvette van der Linden and colleagues, Dr Westhoff extrapolated the new results from the Dutch Bone Metastases Study, the world's largest randomised trial looking at the effectiveness of different radiotherapy fractionation schedules on the treatment of pain arising from bone metastases. The researchers studied a subset of 227 elderly patients aged 75 and over and compared them with younger patients. Although at entry into the trial these patients had more physical impairment of activity than younger patients, they did not rate their overall quality of life as inferior, and they showed a positive response to a single fraction of radiotherapy.
"The patients filled out extensive questionnaires on pain and quality of life at regular intervals," said Dr Westhoff. "Although we knew already that a single fraction of 8 Gy was effective in treating bone pain across the board, we were unsure as to its precise effect in the elderly, and we were pleased to be able to show that this treatment is effective in all age groups. Even though the elderly group responded slightly less well than the others to the treatment, their response was sufficient to justify the use of palliative radiotherapy in these patients."
Reasons why the elderly group responded less well to the treatment may be related to their poorer performance status when they joined the trial and the higher percentage of male patients, who were more likely to have prostate cancer. Women were more likely to have breast cancer, which often responds better to treatment than lung or prostate cancer.
The three main groups of primary tumours in the patients studied were breast (39%), prostate (23%) and lung cancers (25%). The remaining 13% comprised a variety of primary tumours, such as bladder cancer, rectal cancer, and oesophageal cancer. The group was made up 54% men and 46% women.
"We saw that the type of primary tumour had an effect on the response to treatment," said Dr Westhoff. "For example, patients with lung cancer had less chance of response than those with breast or prostate cancer. We believe that this variety in response is due to the aggressiveness of the disease and the limited ability to treat it with systemic agents."
Bone metastases develop when cancer cells from primary tumours migrate to the bone, causing it to weaken over a period of time. They can cause pain, which can be severe and debilitating, compression of the spinal cord, fractures, spinal instability, anaemia, and significant degeneration of quality of life. Bone is one of the most common places for cancer to spread and, once there, the cancer cells settle in their new environment and continue to grow.
The pain from bone metastases arises through stretching of the periosteum, the membrane lining the external surface of the bone and which contains many nerve endings. The stretching activates pain receptors, and chemical mediators of pain such as prostaglandins also play a role. The precise pain-killing mechanism of radiotherapy in these cases is unknown; it is not solely due to tumour shrinkage, say the researchers, because the onset of response can be very rapid. More likely it is a response mechanism involving chemical mediators such as prostaglandin that causes the pain relief.
"Bone metastases can profoundly disrupt a patient's life, particularly when, as is the case with many elderly, they already have other health problems. Strategies for minimising their effect are vital to improving quality of life," Dr Westhoff said.
"Radiotherapy departments across The Netherlands are trying to set up a prospective database to follow up the effectiveness of a number of palliative treatments. Following these encouraging results in the elderly, we intend to focus on this age group in the future," she concluded.
President of ESTRO, Professor Vincenzo Valentini, a radiation oncologist at the Policlinico Universitario A. Gemelli, Rome, Italy, said: "We know that the pain relief from a single fraction of radiotherapy can reduce patients' morphine consumption. Though morphine is an important drug in the control of tumour pain, it has side-effects such as nausea, constipation, and grogginess, which compromise seriously patients' quality of life. This simple pain control strategy allows the morphine dose to be minimised, and also improves quality of life."
###
Abstract no: PD-0533, "Poster Discussion, Clinical: CNS/Hematology", at 14.45 hrs (CEST) on Monday, 22 April, Room F.
Palliative radiotherapy for bone metastases in elderly patients improves quality of life
2013-04-22
ELSE PRESS RELEASES FROM THIS DATE:
New findings on tree nuts and health presented at the Experimental Biology Meeting in Boston, Mass.
2013-04-22
DAVIS, CA, April 22, 2013 – Three new studies involving tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts) were presented this week at the Experimental Biology Meeting in Boston, MA. Tree nut consumption was associated with a better nutrient profile and diet quality; lower body weight and lower prevalence of metabolic syndrome; and a decrease in several cardiovascular risk factors compared to those seen among non-consumers.
First, the Adventist Health Study looked at the effect of nut intake on the risk of metabolic ...
A formula that can calculate a person's speed by just looking at their footprints
2013-04-22
Two Spanish scientists have designed an equation that provides a highly accurate estimate of an individual's speed based on stride length. They used data from professional athletes and walking and running experiments on a beach in order to come up with the equation. The result has applications in the study of fossil trackways of human footprints.
In the spring of 2008, 14 palaeontology students from the Complutense University of Madrid ran along a beach in Asturias (Spain) at the request of a planetary geologist who was a friend of their fieldwork director. Javier Ruiz, ...
Metastasis stem cells in the blood of breast cancer patients discovered
2013-04-22
Individual cancer cells that break away from the original tumor and circulate through the blood stream are considered responsible for the development of metastases. These dreaded secondary tumors are the main cause of cancer-related deaths. Circulating tumor cells (CTCs) detectable in a patient's blood are associated with a poorer prognosis. However, up until now, experimental evidence was lacking as to whether the "stem cell" of metastasis is found among CTCs.
"We were convinced that only very few of the various circulating tumor cells are capable of forming a secondary ...
In India hip fracture is associated with high rates of mortality and disability
2013-04-22
In various studies across different countries the reported one year mortality risks after hip fracture can vary anywhere from 5 to 50 %. In India, however, there has been little research on the risk of mortality and functional impairment following hip fracture.
In an oral presentation held during the European Congress on Osteoporosis & Osteoarthritis in Rome, Italy, held from April 17 to 20 in Rome, Italy, researchers from Maulana Azad Medical College, New Delhi, India presented findings from a prospective study which found that patients had a high rate of one-year mortality ...
Is food truly addictive?
2013-04-22
Philadelphia, PA, April 22, 2013 – Biological Psychiatry is proud to announce this week's publication of a special issue focusing on the question of food as an addiction.
Addiction is the continued or compulsive use of a substance, despite negative and/or harmful consequences. Over the years, addiction has come to be re-defined to include behaviors, as well as substances, and the term is now used to describe significant problems with alcohol, nicotine, drugs, gambling, internet use, and sex. The 'major' addictions, like alcoholism and drug abuse, stimulate significant ...
Surgical delay of more than 48 hours increases mortality in older hip fracture patients
2013-04-22
Although hip fractures in older patients are known to be a major cause of long term disability and increased risk of death, less is known about the relationship between surgical delay after hip fracture and mortality risk.
A study by Belgian investigators shows that that in older patients with hip fracture, surgical delay of more than 48 hours is significantly and independently associated with increased long-term mortality, even after adjusting for age, sex, and co-morbidities. The study analysed data from 32,383 participants with 1 years of follow-up, extracted from ...
Study shows reproductive effects of pesticide exposure span generations
2013-04-22
North Carolina State University researchers studying aquatic organisms called Daphnia have found that exposure to a chemical pesticide has impacts that span multiple generations – causing the so-called "water fleas" to produce more male offspring, and causing reproductive problems in female offspring.
"This work supports the hypothesis that exposure to some environmental chemicals during sensitive periods of development can cause significant health problems for those organisms later in life – and affect their offspring and, possibly, their offspring's offspring," says ...
New review sets international standards for best practice in fracture liaison services
2013-04-22
Fragility fractures due to osteoporosis are a major cause of disability or premature death in older adults. Those at highest risk are patients who have already suffered one fragility fracture; they are at twice the risk of suffering a future fracture compared to others who have not fractured.
Nevertheless health care systems around the world are failing to identify and treat these patients, leaving them exposed to debilitating and life-threatening secondary fractures.
Based on evidence from numerous global studies, a new report, 'Capture the Fracture: A Best Practice ...
Forensic sciences are 'fraught with error'
2013-04-22
Amsterdam, April 22, 2013 – A target article recently published in Journal of Applied Research in Memory and Cognition (JARMAC) reviews various high-profile false convictions. It provides an overview of classic psychological research on expectancy and observer effects and indicates in which ways forensic science examiners may be influenced by information such as confessions, eyewitness identification, and graphical evidence.
The target article authors, Saul Kassin and Jeff Kukucka, of John Jay College of Criminal Justice, and Itiel Dror, University College, London, point ...
Grape intake may protect against metabolic syndrome-related organ damage
2013-04-22
ANN ARBOR, MI - Consuming grapes may help protect against organ damage associated with the progression of metabolic syndrome, according to research presented Monday at the Experimental Biology conference in Boston. Natural components found in grapes, known as polyphenols, are thought to be responsible for these beneficial effects.
The study, led by investigator E. Mitchell Seymour, Ph.D., of the University of Michigan Health System, studied the effects of a high fat, American-style diet both with added grapes and without grapes (the control diet) on the heart, liver, ...