Anesthesia Technique May Affect Survival After Breast Cancer Surgery: Study

By Kathleen Doheny
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — The anesthesia technique used during breast cancer surgery may affect cancer recurrence and survival, Danish researchers report.

In a small study that followed 77 breast cancer patients, researchers found the combination of a general anesthetic plus injections of a nerve block resulted in increased survival and fewer recurrences, said Dr. Palle Steen Carlsson, a researcher at the Aarhus University Hospital in Denmark.

A six-year follow-up found that 13 percent of patients who got the combination had their cancer recur versus 37 percent of those who got anesthesia alone. And 10 percent of those in the combination group died compared to 32 percent of those given anesthesia alone.

The idea that the anesthesia technique used during breast cancer surgery affects results is evolving, anesthesiologists say, and needs more study. Carlsson found a link between the two, but her study didn’t show a direct cause-and-effect relationship. She is scheduled to report her findings Oct. 15 at the American Society of Anesthesiologists’ annual meeting in San Francisco.

Carlsson acknowledged the study’s limitations. “The weakness of our study is the size,” she said.

During cancer surgery, tumor cells released into the blood can implant in lymph nodes and other organs, she said. The immune system kicks in to fight these cells, but surgery and anesthesia can impair the immune system.

Carlsson can’t say for sure why women who got the nerve block plus anesthesia tended to fare better. One theory is that better pain relief during and after surgery reduces the stress response to the procedure, she said. Or perhaps the need for fewer narcotic painkillers after surgery reduces the risk of cancer spreading.

In the study, Carlsson randomly assigned the 77 patients to general anesthesia plus injections of saline or general anesthesia plus injections of local anesthetic (this is called a paravertebral block) about an inch from the middle of the spine.

Besides differences in recurrence and survival, medical records six years later showed fewer opioids for pain relief were needed by the women who got the combination approach.

In an earlier study, researchers found that the combination of general anesthesia and regional anesthesia reduced recurrences and the spread of breast cancer four-fold, but that study looked back at medical records. Carlsson said her study is believed to be the first to follow patients forward.

The concept has been a hot topic for several years among anesthesiologists, said Dr. Michael Lew, professor and chairman of anesthesiology at the City of Hope Comprehensive Cancer Center in Duarte, Calif. Lew was not involved in the study.

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Popular Morning Sickness Drug Safe in Pregnancy, Study Finds

By Dennis Thompson
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — The anti-nausea medication metoclopramide appears to be a safe and effective treatment for morning sickness, Danish researchers report.

More than 40,000 women exposed to metoclopramide while pregnant did not face any increased risk of birth defects or miscarriage, according to a study published Oct. 16 in the Journal of the American Medical Association.

“This is by far the largest study on metoclopramide safety in pregnancy, and as such it expands substantially on the published evidence,” said co-author Dr. Bjorn Pasternak of the Statens Serum Institute in Copenhagen. “It found that metoclopramide use in pregnancy was not associated with increased risk of major adverse outcomes, including major malformations and fetal death, and as such supports what is known about the safety profile of this drug.”

More than half of pregnant women experience nausea and vomiting, usually early in their pregnancy, the study authors noted.

Most women deal with these symptoms with little treatment, but about 10 percent to 15 percent eventually will require medication because they face more serious complications such as dehydration or weight loss.

But many pregnant women have grave concerns regarding any sort of nausea medication because of the horrific birth defects associated with the drug thalidomide, which was used to treat morning sickness in the late 1950s and early 1960s. Thalidomide’s tragic history led to the strengthening of the U.S. Food and Drug Administration (FDA) and the development of regulations regarding medication use during pregnancy.

“There’s a general feeling to take no medications during pregnancy,” said Dr. Siobhan Dolan, associate professor of obstetrics and gynecology at Montefiore Medical Center in New York City and medical adviser to the March of Dimes. “The truth is in the first trimester when the organs are forming we’re cautious about any medication the women take. But there’s a growing appreciation that there can be risks to not treating symptoms like nausea and vomiting.”

Metoclopramide, sold under the brand name Reglan, is one of the most commonly used prescription medications in pregnancy, the authors noted.

The drug has FDA approval for use as a treatment for patients suffering heartburn and esophagitis due to acid reflux. It’s also used to treat nausea caused by surgery or chemotherapy, and is often recommended as a treatment for morning sickness if other therapies have failed.

Pasternak said there aren’t many alternatives for the treatment of nausea and vomiting in pregnancy. “There appears to be some degree of individual variation in response to drug treatment, so some women may be helped by one drug and others by another. Therefore, different treatment alternatives are needed,” he said.

In this study, researchers reviewed more than 1.2 million pregnancies in Denmark from 1997 to 2011 and compared outcomes between women who used metoclopramide and those who did not.

The investigators compared 28,486 infants exposed to metoclopramide in the first trimester of pregnancy to 113,698 unexposed infants, and found no associations between the nausea drug and any major malformations.

The study also found no increased risk of miscarriage, stillbirth, preterm birth, low birth weight or fetal growth restriction associated with metoclopramide use in pregnancy.

Because birth defects are rare, it can be difficult to assess a drug’s safety in small-scale studies, Dolan said. A study looking at tens of thousands of pregnancies is more likely to find patterns and associations between a medication and the risk of birth defects, if such risk exists.

“We can take from this some reassurance” of metoclopramide’s safety, Dolan said. “What’s powerful about a study like this is they looked at all the births in Denmark between 1997 and 2011. That’s a lot of births.”

Regardless, Dolan said further study into the safety of this and other medications used during pregnancy will always be needed.

“We need good data to have good understanding so women can be cared for, and their symptoms can be treated and they can have successful pregnancy outcomes,” she said. “Women need to understand the risks of any medication they choose to take.”

More information

Visit the U.S. National Library of Medicine to learn more about morning sickness.

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Use of Donor Sperm by Lesbians Rises in Canada, Study Finds

TUESDAY, Oct. 15 (HealthDay News) — Use of donor sperm by lesbian couples increased significantly after gay marriage was legalized in the province of Ontario, Canada, a new study finds.

Researchers in Toronto analyzed data from their sperm donor program over the past 17 years and found that the proportion of lesbian couples using the program increased from 15 percent to 20 percent of their patients after gay marriage was legalized in 2003.

The number of units of donor sperm used by lesbian couples increased fourfold, from 133 to 561, according to the findings, which were scheduled for presentation Tuesday at the annual meeting of the International Federation of Fertility Societies and the American Society for Reproduction Medicine, in Boston.

“There is no question that broad social trends have a huge impact on reproduction, and on reproductive medicine,” IFFS President Joe Leigh Simpson said in a federation news release. “It is nice to have some actual data which documents how some of these trends impact our profession and, more importantly, our patients.”

The study also found that 15 percent of single women and women in heterosexual relationships used donor sperm for in vitro fertilization, compared with 7 percent of lesbian women.

Data and conclusions presented at medical meetings typically are considered preliminary until published in a peer-reviewed medical journal.

More information

The American Academy of Pediatrics offers advice for gay and lesbian parents.

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Study Sees Link Between Psoriasis, Kidney Problems

TUESDAY, Oct. 15 (HealthDay News) — People with moderate to severe psoriasis are at increased risk for chronic kidney disease and need to be closely monitored for kidney problems, a large new study suggests.

Researchers in Philadelphia analyzed data from nearly 144,000 people, aged 19 to 90, with psoriasis, and a comparison (control) group of nearly 690,000 adults without the condition.

During seven years of follow-up, people with psoriasis were more likely to develop chronic kidney disease than those in the control group. Those with severe psoriasis had a nearly two-fold higher risk of developing kidney disease and a more than fourfold higher risk of developing kidney failure requiring dialysis, according to a journal news release

Further investigation that focused on the amount of skin area affected by psoriasis showed that people with moderate to severe psoriasis were at greater risk of developing chronic kidney disease. People with moderate psoriasis have 3 percent to 10 percent of skin area affected, while those with severe psoriasis have more than 10 percent of skin area affected.

Psoriasis is a chronic condition involving scaly skin patches that can lead to itching, cracking and bleeding. As many as 7.5 million Americans have the autoimmune condition, according to the National Psoriasis Foundation.

Moderate and severe psoriasis affect more than 20 percent of patients worldwide, according to the study, which appears Oct. 15 in the journal BMJ.

Although the study found an association between having psoriasis and a higher risk of kidney problems, it did not establish a cause-and-effect relationship.

The researchers also found that the risk of chronic kidney disease linked to psoriasis increases with age. In patients aged 40 to 50 with severe disease, psoriasis accounted for one extra case of chronic kidney disease per 134 patients yearly. In those aged 50 to 60, it accounted for one extra case yearly per 62 patients.

Further research is needed to confirm the study findings, determine how psoriasis can cause kidney disease and examine how psoriasis treatment affects the risk for kidney disease, the researchers concluded.

More information

The American Academy of Family Physicians has more about psoriasis.

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IUD Won’t Hurt Future Fertility, Study Contends

WEDNESDAY, Oct. 16 (HealthDay News) — Intrauterine devices, commonly known as IUDs, do not impair women’s future fertility, according to a new study.

Researchers in Guangdong, China found that once these contraceptive devices are removed, women have relatively high pregnancy rates and normal pregnancy results.

The study’s findings were scheduled for presentation Wednesday in Boston at a meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine.

“Being able to exercise some control over when they reproduce is a great emancipator for women,” Richard Kennedy, Secretary General of the International Federation of Fertility Societies, said in a meeting news release. “The fact that IUD use has no long-lasting effect on subsequent ability to conceive is reassuring news.”

In conducting the study, the researchers surveyed 562 women who had an IUD removed between 2012 and 2013 because they wanted to have a child.

The researchers found that about three-quarters of the women were able to conceive a child after their IUD was removed. Although the women’s age and how long they used an IUD played a role, on average it took 11 months to get pregnant.

Most of the IUDs used were copper, and pregnancy rates after IUD removal for the copper IUDs was about 78 percent. Pregnancy rates were about 74 percent for women who used IUDs that contained the emergency contraceptive levonorgestrel. The researchers said this difference was statistically insignificant.

The study also showed the rate of pelvic inflammatory disease was about 11 percent. Although 12 women experienced ectopic pregnancies, there was no increase in pregnancy complications or negative results, the researchers said.

The IUD is a small, T-shaped device inserted into the uterus.

The stigma associated with IUDs is related to the Dalkon Shield, made by the millions in the 1970s and later linked to infections, including pelvic inflammatory disease, miscarriage, ectopic pregnancy and some deaths. The Dalkon Shield, which had a design flaw that carried bacteria into the uterus, is no longer on the market.

Data and conclusions presented at medical meetings are typically considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. Centers for Disease Control and Prevention provides more information on IUDs and other forms of contraception.

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Blood Test Shows Promise for Cancer Detection, Study Finds

By Randy Dotinga
HealthDay Reporter

TUESDAY, Oct. 15 (HealthDay News) — Researchers say they’ve developed a blood test that can detect some cases of early stage lung and prostate cancer.

Although the test has limited accuracy and only a small number of people have tried it, it potentially could provide doctors more information when they suspect a patient has a tumor.

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