What Do Prostate Cancer Patients Die Of?

A recent rise in the incidence of prostate cancer and a more favorable outcome have increased the proportions of other causes of death in affected men. Extending the survival of prostate cancer patients thus requires knowledge of all causes of death.

Methods. Data on the population, cancers, and causes of death were gathered from the nationwide Swedish Family-Cancer Database. A Cox regression model, comparing prostate cancer patients with all other men, was applied. Hazard ratios (HR) were calculated both for the underlying cause and for dying with a specific cause listed among multiple causes of death.

Findings. Among 686,500 observed deaths, 62,500 were prostate cancer patients. For underlying causes other than prostate cancer, the highest cause-specific HRs were found for external causes (HR, 1.24; 95% confidence interval [CI], 1.16–1.31), diseases of the pulmonary circulation (HR, 1.22; 95% CI, 1.09–1.37), and heart failure (HR, 1.18; 95% CI, 1.11–1.24). For specific multiple causes, the highest HRs were found for anemia (HR, 2.28; 95% CI, 2.14–2.42), diseases of the pulmonary circulation (HR, 1.61; 95% CI, 1.55–1.68), and urinary system disease (HR, 1.90; 95% CI, 1.84–1.96).

Interpretations. Prostate cancer patients have a higher risk for dying from various causes other than prostate cancer, including external causes and heart failure. Mechanisms have been proposed linking these elevated risks to both cancer and treatment. More attention should be paid to comorbidities in men with prostate cancer. The present study fulfills a gap in the knowledge of death causes in prostate cancer patients.

source: the oncologist

The Role of RANK-Ligand Inhibition in Cancer: The Story of Denosumab

The diagnosis of bone metastases is an event with certain consequences for the patient. They often mean pain and can also mean pathological fractures, hypercalcemia, and spinal cord compression, all synonymous with a diminished quality of life and often also hospitalization. Since the advent of the intravenous bisphosphonates, things began to look a bit brighter for patients with bone metastases—bone destruction was kept at bay a little longer. The next generation of bone metastasis treatments is well on its way in clinical development, and among them, the most advanced drug is denosumab. Denosumab is a fully human monoclonal antibody that inhibits osteoclast maturation, activation, and function by binding to receptor activator of nuclear factor kappa B ligand, with the final result being a reduced rate of bone resorption. In this review, we give an overview of relevant preclinical and clinical data regarding the use of denosumab in patients with solid tumors in general and prostate cancer in particular.

source: the oncologist

Reducing Diagnostic Errors: Another Role for Checklists?

Diagnostic errors are a widespread problem, although the true magnitude is unknown because they cannot currently be measured validly. These errors have received relatively little attention despite alarming estimates of associated harm and death. One promising intervention to reduce preventable harm is the checklist. This intervention has proven successful in aviation, in which situations are linear and deterministic (one alarm goes off and a checklist guides the flight crew to evaluate the cause). In health care, problems are multifactorial and complex. A checklist has been used to reduce central-line-associated bloodstream infections in intensive care units. Nevertheless, this checklist was incorporated in a culture-based safety program that engaged and changed behaviors and used robust measurement of infections to evaluate progress. In this issue, Ely and colleagues describe how three checklists could reduce the cognitive biases and mental shortcuts that underlie diagnostic errors, but point out that these tools still need to be tested. To be effective, they must reduce diagnostic errors (efficacy) and be routinely used in practice (effectiveness). Such tools must intuitively support how the human brain works, and under time pressures, clinicians rarely think in conditional probabilities when making decisions. To move forward, it is necessary to accurately measure diagnostic errors (which could come from mapping out the diagnostic process as the medication process has done and measuring errors at each step) and pilot test interventions such as these checklists to determine whether they work.

source: academic medicine

Broadened Exposure to Environmental Microbes and Childhood Asthma

Children’s asthma risks seem lessened by their exposure to a wider-than-usual variety of environmental microorganisms, especially as found in farming environments, according to a New England Journal of Medicine study.

Researchers examined the diversity of microbial exposure among some 17,000 Central European children with two approaches. In one, mattress dust was collected and analyzed for bacterial DNA signatures; in the other, airborne dust was collected from children’s bedrooms and cultured for microbes.

Children living on family farms were found to have been exposed to a wider range of microorganisms than their non-farm contemporaries. That broadened exposure was associated with a significantly lower risk for asthma. Atopy, although also significantly less prevalent among farm dwellers, was only weakly affected by microbial diversity.

An editorialist, writing that the results provide “only a low-resolution picture,” expresses hope that the findings will lead to new preventive strategies.