Melinda Tanzola

MIAMI — Patellofemoral pain syndrome is the most common sports-related overuse injury in young athletes, occurring in an estimated 30%–40% of female athletes at some point in their career, Dr. Joseph Congeni said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Athletes need to understand the process of PFS and how it is treated, rather than play through their pain or stop sports altogether without seeking treatment.

The syndrome, also known as runner's knee, is usually caused by improper tracking of the kneecap in the patellofemoral groove. A few cases do not involve tracking but result from compression of the kneecap, which can develop if the hamstring muscle is significantly stronger than the quadriceps. This type of PFS more often occurs in younger children who have just gone through their growth spurt or teenage boys.

The incidence of tracking PFS is about five times greater in girls than in boys. Several anatomical factors contribute to PFS, including femoral anteversion, kneecaps pointing toward each other (“squinting patella”), genu varum (bowleg), and tibia varum. The feet compensate for the malalignment by pronating, and these factors together result in pain, said Dr. Congeni, medical director of the sports medicine center at the Children's Hospital Medical Center of Akron (Ohio).

Chronic overuse injuries like PFS can be more difficult to diagnose and treat than are acute injuries. Many factors are at play, including anatomy, biomechanics, hormonal issues, nutrition, genetics, training errors, and micro- and macrotrauma.

Children with tracking PFS present with pain around the knee that emerges gradually without any specific injury. They may or may not have swelling around the kneecap. Clinicians may see that the patella tracks in a “J” pattern when the leg is extended, because the patella moves inward as it moves up along the knee. Increased ligament laxity or instability also is common in these patients.

The functional tests of a minisquat and a catcher's squat, which will likely be painful in PFS, can help in the diagnosis.

Aside from having a thorough patellar exam, athletes with suspected PFS should undergo a full structural exam—including a careful examination of the hip—to rule out a slipped capital femoral epiphysis (SCFE). Dr. Congeni recommended, at the very least, clinical evaluation of the internal and external rotation of the hip in these children, as vague knee pain is one of the signs of SCFE. “This is a problem where kids sometimes walk with a limp the rest of their life if we miss it,” he said.

PFS is usually a straightforward clinical diagnosis based on history and physical exam, and does not require additional tests. Dr. Congeni recommended x-rays for children who do not improve after a month to rule out other causes and to assess the state of the kneecap.

Dr. Congeni explained that the clinical course of PFS is likely to be a roller coaster of good and bad days, weeks, or months, as activity levels change. Sitting for long periods and walking on stairs or hills can aggravate symptoms.

Treating PFS is a slow process that involves rest and rehabilitation through strengthening (quadriceps and gluteals) and increasing flexibility (quadriceps, hamstrings, and iliotibial band). Bracing can provide some help through a short-term situation. Orthotics can be helpful for correcting mechanical issues, and Dr. Congeni is moving toward orthotics and away from bracing when treating athletes with PFS in his own practice.

He also suggested asking about the use of nonsteroidal anti-inflammatory drugs. The first goal of treatment in those patients is to help reduce and eventually discontinue the use of these medications.

Many athletes with the syndrome have a high-riding kneecap, as shown above. Courtesy Dr. Joseph Congeni

MIAMI — Patellofemoral pain syndrome is the most common sports-related overuse injury in young athletes, occurring in an estimated 30%–40% of female athletes at some point in their career, Dr. Joseph Congeni said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Athletes need to understand the process of PFS and how it is treated, rather than play through their pain or stop sports altogether without seeking treatment.

The syndrome, also known as runner's knee, is usually caused by improper tracking of the kneecap in the patellofemoral groove. A few cases do not involve tracking but result from compression of the kneecap, which can develop if the hamstring muscle is significantly stronger than the quadriceps. This type of PFS more often occurs in younger children who have just gone through their growth spurt or teenage boys.

The incidence of tracking PFS is about five times greater in girls than in boys. Several anatomical factors contribute to PFS, including femoral anteversion, kneecaps pointing toward each other (“squinting patella”), genu varum (bowleg), and tibia varum. The feet compensate for the malalignment by pronating, and these factors together result in pain, said Dr. Congeni, medical director of the sports medicine center at the Children's Hospital Medical Center of Akron (Ohio).

Chronic overuse injuries like PFS can be more difficult to diagnose and treat than are acute injuries. Many factors are at play, including anatomy, biomechanics, hormonal issues, nutrition, genetics, training errors, and micro- and macrotrauma.

Children with tracking PFS present with pain around the knee that emerges gradually without any specific injury. They may or may not have swelling around the kneecap. Clinicians may see that the patella tracks in a “J” pattern when the leg is extended, because the patella moves inward as it moves up along the knee. Increased ligament laxity or instability also is common in these patients.

The functional tests of a minisquat and a catcher's squat, which will likely be painful in PFS, can help in the diagnosis.

Aside from having a thorough patellar exam, athletes with suspected PFS should undergo a full structural exam—including a careful examination of the hip—to rule out a slipped capital femoral epiphysis (SCFE). Dr. Congeni recommended, at the very least, clinical evaluation of the internal and external rotation of the hip in these children, as vague knee pain is one of the signs of SCFE. “This is a problem where kids sometimes walk with a limp the rest of their life if we miss it,” he said.

PFS is usually a straightforward clinical diagnosis based on history and physical exam, and does not require additional tests. Dr. Congeni recommended x-rays for children who do not improve after a month to rule out other causes and to assess the state of the kneecap.

Dr. Congeni explained that the clinical course of PFS is likely to be a roller coaster of good and bad days, weeks, or months, as activity levels change. Sitting for long periods and walking on stairs or hills can aggravate symptoms.

Treating PFS is a slow process that involves rest and rehabilitation through strengthening (quadriceps and gluteals) and increasing flexibility (quadriceps, hamstrings, and iliotibial band). Bracing can provide some help through a short-term situation. Orthotics can be helpful for correcting mechanical issues, and Dr. Congeni is moving toward orthotics and away from bracing when treating athletes with PFS in his own practice.

He also suggested asking about the use of nonsteroidal anti-inflammatory drugs. The first goal of treatment in those patients is to help reduce and eventually discontinue the use of these medications.

Many athletes with the syndrome have a high-riding kneecap, as shown above. Courtesy Dr. Joseph Congeni

MIAMI — Patellofemoral pain syndrome is the most common sports-related overuse injury in young athletes, occurring in an estimated 30%–40% of female athletes at some point in their career, Dr. Joseph Congeni said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Athletes need to understand the process of PFS and how it is treated, rather than play through their pain or stop sports altogether without seeking treatment.

The syndrome, also known as runner's knee, is usually caused by improper tracking of the kneecap in the patellofemoral groove. A few cases do not involve tracking but result from compression of the kneecap, which can develop if the hamstring muscle is significantly stronger than the quadriceps. This type of PFS more often occurs in younger children who have just gone through their growth spurt or teenage boys.

The incidence of tracking PFS is about five times greater in girls than in boys. Several anatomical factors contribute to PFS, including femoral anteversion, kneecaps pointing toward each other (“squinting patella”), genu varum (bowleg), and tibia varum. The feet compensate for the malalignment by pronating, and these factors together result in pain, said Dr. Congeni, medical director of the sports medicine center at the Children's Hospital Medical Center of Akron (Ohio).

Chronic overuse injuries like PFS can be more difficult to diagnose and treat than are acute injuries. Many factors are at play, including anatomy, biomechanics, hormonal issues, nutrition, genetics, training errors, and micro- and macrotrauma.

Children with tracking PFS present with pain around the knee that emerges gradually without any specific injury. They may or may not have swelling around the kneecap. Clinicians may see that the patella tracks in a “J” pattern when the leg is extended, because the patella moves inward as it moves up along the knee. Increased ligament laxity or instability also is common in these patients.

The functional tests of a minisquat and a catcher's squat, which will likely be painful in PFS, can help in the diagnosis.

Aside from having a thorough patellar exam, athletes with suspected PFS should undergo a full structural exam—including a careful examination of the hip—to rule out a slipped capital femoral epiphysis (SCFE). Dr. Congeni recommended, at the very least, clinical evaluation of the internal and external rotation of the hip in these children, as vague knee pain is one of the signs of SCFE. “This is a problem where kids sometimes walk with a limp the rest of their life if we miss it,” he said.

PFS is usually a straightforward clinical diagnosis based on history and physical exam, and does not require additional tests. Dr. Congeni recommended x-rays for children who do not improve after a month to rule out other causes and to assess the state of the kneecap.

Dr. Congeni explained that the clinical course of PFS is likely to be a roller coaster of good and bad days, weeks, or months, as activity levels change. Sitting for long periods and walking on stairs or hills can aggravate symptoms.

Treating PFS is a slow process that involves rest and rehabilitation through strengthening (quadriceps and gluteals) and increasing flexibility (quadriceps, hamstrings, and iliotibial band). Bracing can provide some help through a short-term situation. Orthotics can be helpful for correcting mechanical issues, and Dr. Congeni is moving toward orthotics and away from bracing when treating athletes with PFS in his own practice.

He also suggested asking about the use of nonsteroidal anti-inflammatory drugs. The first goal of treatment in those patients is to help reduce and eventually discontinue the use of these medications.

Many athletes with the syndrome have a high-riding kneecap, as shown above. Courtesy Dr. Joseph Congeni

MIAMI — Physicians performing the preparticipation physical evaluation (PPE) required for children to participate in sports activities should be aware of some changes to the recommended exam based on the third edition of the PPE monograph, Dr. Andrew Gregory said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The new monograph, published in 2005, includes a separate clearance form that incorporates a more extensive cardiovascular history, additional medical history questions, administrative and legal concerns, and a greater emphasis on athletes with special needs.

Dr. Gregory, a pediatrician at Vanderbilt University in Nashville, Tenn., reviewed these changes and encouraged pediatricians to purchase the new monograph through the AAP to learn more.

The cardiovascular history has been revised based on the American Heart Association guidelines. New questions ask families about any previous denial of participation by a physician, previous orders for cardiac tests, and family history regarding deaths of unknown cause, heart problems, and Marfan syndrome.

Dr. Gregory explained that the cardiovascular physical exam should include the following components:

▸ Precordial auscultation with child supine and standing to identify heart murmurs related to dynamic left ventricular outflow obstruction.

▸ Measurement of femoral artery pulse to rule out coarctation of the aorta.

▸ Assessment for physical signs of Marfan syndrome.

▸ Measurement of brachial blood pressure with child sitting.

One new element of the medical history addresses supplement use. In using the old forms, families might not have considered supplements to be medication and they might have omitted them from the medication list. Now, asking specifically about supplements gives physicians the chance to talk with families about any supplements the child may be taking.

There are also questions about previous anaphylaxis and paired organs. Dr. Gregory said in general, the absence of a paired organ does not limit the athlete from competing if protective devices are used.

Children are now asked about their recent history of viral illness, in hopes of identifying children with mononucleosis who should avoid activity for 3 weeks and contact sports for 4 weeks.

Also included are questions about sickle cell trait or disease. “We really need to counsel our patients with even sickle cell trait [about] the importance of acclimatization and hydration in the heat,” explained Dr. Gregory, noting recent accounts of an increased risk of sickling, rhabdomyolysis, or death in extreme conditions.

To comply with HIPAA regulations, the physicians should treat the PPE like a medical record and secure it appropriately. The layout of the PPE form has been altered to ensure privacy—the clearance form is now separated from the remainder of the document containing the more detailed health information. A signed release is required for someone to receive the entire form.

Some situations do require health information to be disclosed to public health authorities. Examples would include reactions to medication, reportable diseases, or disease exposures.

The new monograph also addresses the status of athletes with special needs. The benefits of sports for these children are clear in terms of health, proprioception, and proficiency with prosthetic devices. However, there are issues that should be investigated during the PPE, such as seizures in children with mental retardation and cardiac, renal, joint, and spinal problems in children with Down syndrome.

During the physical exam, clinicians should be especially thorough in evaluating cardiovascular, neurologic, dermatologic, and musculoskeletal problems and vision in athletes with disabilities.

Even patients with sickle cell trait should be counseled about acclimatization and hydration in the heat. DR. GREGORY

MIAMI — Physicians performing the preparticipation physical evaluation (PPE) required for children to participate in sports activities should be aware of some changes to the recommended exam based on the third edition of the PPE monograph, Dr. Andrew Gregory said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The new monograph, published in 2005, includes a separate clearance form that incorporates a more extensive cardiovascular history, additional medical history questions, administrative and legal concerns, and a greater emphasis on athletes with special needs.

Dr. Gregory, a pediatrician at Vanderbilt University in Nashville, Tenn., reviewed these changes and encouraged pediatricians to purchase the new monograph through the AAP to learn more.

The cardiovascular history has been revised based on the American Heart Association guidelines. New questions ask families about any previous denial of participation by a physician, previous orders for cardiac tests, and family history regarding deaths of unknown cause, heart problems, and Marfan syndrome.

Dr. Gregory explained that the cardiovascular physical exam should include the following components:

▸ Precordial auscultation with child supine and standing to identify heart murmurs related to dynamic left ventricular outflow obstruction.

▸ Measurement of femoral artery pulse to rule out coarctation of the aorta.

▸ Assessment for physical signs of Marfan syndrome.

▸ Measurement of brachial blood pressure with child sitting.

One new element of the medical history addresses supplement use. In using the old forms, families might not have considered supplements to be medication and they might have omitted them from the medication list. Now, asking specifically about supplements gives physicians the chance to talk with families about any supplements the child may be taking.

There are also questions about previous anaphylaxis and paired organs. Dr. Gregory said in general, the absence of a paired organ does not limit the athlete from competing if protective devices are used.

Children are now asked about their recent history of viral illness, in hopes of identifying children with mononucleosis who should avoid activity for 3 weeks and contact sports for 4 weeks.

Also included are questions about sickle cell trait or disease. “We really need to counsel our patients with even sickle cell trait [about] the importance of acclimatization and hydration in the heat,” explained Dr. Gregory, noting recent accounts of an increased risk of sickling, rhabdomyolysis, or death in extreme conditions.

To comply with HIPAA regulations, the physicians should treat the PPE like a medical record and secure it appropriately. The layout of the PPE form has been altered to ensure privacy—the clearance form is now separated from the remainder of the document containing the more detailed health information. A signed release is required for someone to receive the entire form.

Some situations do require health information to be disclosed to public health authorities. Examples would include reactions to medication, reportable diseases, or disease exposures.

The new monograph also addresses the status of athletes with special needs. The benefits of sports for these children are clear in terms of health, proprioception, and proficiency with prosthetic devices. However, there are issues that should be investigated during the PPE, such as seizures in children with mental retardation and cardiac, renal, joint, and spinal problems in children with Down syndrome.

During the physical exam, clinicians should be especially thorough in evaluating cardiovascular, neurologic, dermatologic, and musculoskeletal problems and vision in athletes with disabilities.

Even patients with sickle cell trait should be counseled about acclimatization and hydration in the heat. DR. GREGORY

MIAMI — Physicians performing the preparticipation physical evaluation (PPE) required for children to participate in sports activities should be aware of some changes to the recommended exam based on the third edition of the PPE monograph, Dr. Andrew Gregory said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

The new monograph, published in 2005, includes a separate clearance form that incorporates a more extensive cardiovascular history, additional medical history questions, administrative and legal concerns, and a greater emphasis on athletes with special needs.

Dr. Gregory, a pediatrician at Vanderbilt University in Nashville, Tenn., reviewed these changes and encouraged pediatricians to purchase the new monograph through the AAP to learn more.

The cardiovascular history has been revised based on the American Heart Association guidelines. New questions ask families about any previous denial of participation by a physician, previous orders for cardiac tests, and family history regarding deaths of unknown cause, heart problems, and Marfan syndrome.

Dr. Gregory explained that the cardiovascular physical exam should include the following components:

▸ Precordial auscultation with child supine and standing to identify heart murmurs related to dynamic left ventricular outflow obstruction.

▸ Measurement of femoral artery pulse to rule out coarctation of the aorta.

▸ Assessment for physical signs of Marfan syndrome.

▸ Measurement of brachial blood pressure with child sitting.

One new element of the medical history addresses supplement use. In using the old forms, families might not have considered supplements to be medication and they might have omitted them from the medication list. Now, asking specifically about supplements gives physicians the chance to talk with families about any supplements the child may be taking.

There are also questions about previous anaphylaxis and paired organs. Dr. Gregory said in general, the absence of a paired organ does not limit the athlete from competing if protective devices are used.

Children are now asked about their recent history of viral illness, in hopes of identifying children with mononucleosis who should avoid activity for 3 weeks and contact sports for 4 weeks.

Also included are questions about sickle cell trait or disease. “We really need to counsel our patients with even sickle cell trait [about] the importance of acclimatization and hydration in the heat,” explained Dr. Gregory, noting recent accounts of an increased risk of sickling, rhabdomyolysis, or death in extreme conditions.

To comply with HIPAA regulations, the physicians should treat the PPE like a medical record and secure it appropriately. The layout of the PPE form has been altered to ensure privacy—the clearance form is now separated from the remainder of the document containing the more detailed health information. A signed release is required for someone to receive the entire form.

Some situations do require health information to be disclosed to public health authorities. Examples would include reactions to medication, reportable diseases, or disease exposures.

The new monograph also addresses the status of athletes with special needs. The benefits of sports for these children are clear in terms of health, proprioception, and proficiency with prosthetic devices. However, there are issues that should be investigated during the PPE, such as seizures in children with mental retardation and cardiac, renal, joint, and spinal problems in children with Down syndrome.

During the physical exam, clinicians should be especially thorough in evaluating cardiovascular, neurologic, dermatologic, and musculoskeletal problems and vision in athletes with disabilities.

Even patients with sickle cell trait should be counseled about acclimatization and hydration in the heat. DR. GREGORY

MIAMI — In young children, think apophysitis instead of tendonitis, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Apophysitis is a traction injury that can occur wherever a tendon attaches to bone in an open apophyseal center. Even though these are growth-related injuries, they usually occur on only one side, and stem from differences in the use of each limb in many sports.

Dr. McCambridge of Johns Hopkins University, Baltimore, emphasized that excessive participation in a single sport is often a culprit. “When you do year-round sports of the same thing, you're stressing the same growth plate over and over, and that's why they are breaking down.”

The American Academy of Pediatrics recommends restricting organized sports participation to children at least 6 years of age, while specialization in one sport should be reserved for adolescents.

The way a young tennis player grips her racket or the placement of cleats on a soccer player's shoes can contribute to an overuse injury such as apophysitis. Dr. McCambridge advised looking for fixable causes and consulting with a coach or if it's not clear what to look for in a particular sport.

Although apophyseal centers close in a distal-to-proximal fashion, the exact timing of their appearance and disappearance varies by joint and by individual. The last apophyseal centers to close in the lower extremity are those in the hips, and, therefore, clinicians should watch for apophysitis of the hip in older adolescent athletes.

Calcaneal apophysitis, or Sever's disease, tends to occur early in the growth spurt, at age 8–12 in girls or age 10–14 in boys. It is most common in sports in which children wear cleats, such as lacrosse and soccer, or do not wear shoes, as in gymnastics or dance.

Children with calcaneal apophysitis often complain of ankle pain, although upon closer examination the source of the pain turns out to be the heel. Dr. McCambridge said that x-rays are generally not warranted except in certain instances, such as children with atypical features or nighttime pain, those on the extremes of the expected age range, and those who do not improve after treatment.

Other potential causes of joint pain in children, including tendonitis and, rarely, stress fractures, osteomas, tumors, or rheumatologic conditions.

Rest is a critical treatment for apophysitis. Children with calcaneal apophysitis also can use ice and should avoid walking barefoot. Dr. McCambridge suggested that when the child has no pain with daily living, he can return to sport with modifications such as the use of heel cups and supportive shoes and the removal of cleats, especially for practice.

Another common traction apophysitis is Osgood-Schlatter disease (OSD), which occurs at the tibial tuberosity in children aged 11–15 years. Children often present with pain over the anterior tibia, pain with activity, and pain with full flexion. They also tend to have swelling and palpable tenderness at the tibial tuberosity.

Chronic OSD carries the risk of long-term problems due to the formation of painful, nonunited ossicles resulting from fragmentation of the tibial tuberosity. Because of this risk, Dr. McCambridge tends to radiograph OSD more than any other apophyseal injury to try to prevent the condition from getting to that point.

For children with significant fragmentation, she recommends using a knee immobilizer for 2 weeks, followed by rehabilitation. These athletes tend to remain out of activity for 4–6 weeks.

Fracture extension into the epiphyseal plate is another potential risk of OSD, although it only occurs rarely. Rest is the most important treatment measure for OSD. Children can benefit from stretching and strengthening exercises and the use of a patellar strap.

The way a young tennis player grips her racket can contribute to an overuse injury such as apophysitis. DR. MCCAMBRIDGE

MIAMI — In young children, think apophysitis instead of tendonitis, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Apophysitis is a traction injury that can occur wherever a tendon attaches to bone in an open apophyseal center. Even though these are growth-related injuries, they usually occur on only one side, and stem from differences in the use of each limb in many sports.

Dr. McCambridge of Johns Hopkins University, Baltimore, emphasized that excessive participation in a single sport is often a culprit. “When you do year-round sports of the same thing, you're stressing the same growth plate over and over, and that's why they are breaking down.”

The American Academy of Pediatrics recommends restricting organized sports participation to children at least 6 years of age, while specialization in one sport should be reserved for adolescents.

The way a young tennis player grips her racket or the placement of cleats on a soccer player's shoes can contribute to an overuse injury such as apophysitis. Dr. McCambridge advised looking for fixable causes and consulting with a coach or if it's not clear what to look for in a particular sport.

Although apophyseal centers close in a distal-to-proximal fashion, the exact timing of their appearance and disappearance varies by joint and by individual. The last apophyseal centers to close in the lower extremity are those in the hips, and, therefore, clinicians should watch for apophysitis of the hip in older adolescent athletes.

Calcaneal apophysitis, or Sever's disease, tends to occur early in the growth spurt, at age 8–12 in girls or age 10–14 in boys. It is most common in sports in which children wear cleats, such as lacrosse and soccer, or do not wear shoes, as in gymnastics or dance.

Children with calcaneal apophysitis often complain of ankle pain, although upon closer examination the source of the pain turns out to be the heel. Dr. McCambridge said that x-rays are generally not warranted except in certain instances, such as children with atypical features or nighttime pain, those on the extremes of the expected age range, and those who do not improve after treatment.

Other potential causes of joint pain in children, including tendonitis and, rarely, stress fractures, osteomas, tumors, or rheumatologic conditions.

Rest is a critical treatment for apophysitis. Children with calcaneal apophysitis also can use ice and should avoid walking barefoot. Dr. McCambridge suggested that when the child has no pain with daily living, he can return to sport with modifications such as the use of heel cups and supportive shoes and the removal of cleats, especially for practice.

Another common traction apophysitis is Osgood-Schlatter disease (OSD), which occurs at the tibial tuberosity in children aged 11–15 years. Children often present with pain over the anterior tibia, pain with activity, and pain with full flexion. They also tend to have swelling and palpable tenderness at the tibial tuberosity.

Chronic OSD carries the risk of long-term problems due to the formation of painful, nonunited ossicles resulting from fragmentation of the tibial tuberosity. Because of this risk, Dr. McCambridge tends to radiograph OSD more than any other apophyseal injury to try to prevent the condition from getting to that point.

For children with significant fragmentation, she recommends using a knee immobilizer for 2 weeks, followed by rehabilitation. These athletes tend to remain out of activity for 4–6 weeks.

Fracture extension into the epiphyseal plate is another potential risk of OSD, although it only occurs rarely. Rest is the most important treatment measure for OSD. Children can benefit from stretching and strengthening exercises and the use of a patellar strap.

The way a young tennis player grips her racket can contribute to an overuse injury such as apophysitis. DR. MCCAMBRIDGE

MIAMI — In young children, think apophysitis instead of tendonitis, Dr. Teri McCambridge said at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Apophysitis is a traction injury that can occur wherever a tendon attaches to bone in an open apophyseal center. Even though these are growth-related injuries, they usually occur on only one side, and stem from differences in the use of each limb in many sports.

Dr. McCambridge of Johns Hopkins University, Baltimore, emphasized that excessive participation in a single sport is often a culprit. “When you do year-round sports of the same thing, you're stressing the same growth plate over and over, and that's why they are breaking down.”

The American Academy of Pediatrics recommends restricting organized sports participation to children at least 6 years of age, while specialization in one sport should be reserved for adolescents.

The way a young tennis player grips her racket or the placement of cleats on a soccer player's shoes can contribute to an overuse injury such as apophysitis. Dr. McCambridge advised looking for fixable causes and consulting with a coach or if it's not clear what to look for in a particular sport.

Although apophyseal centers close in a distal-to-proximal fashion, the exact timing of their appearance and disappearance varies by joint and by individual. The last apophyseal centers to close in the lower extremity are those in the hips, and, therefore, clinicians should watch for apophysitis of the hip in older adolescent athletes.

Calcaneal apophysitis, or Sever's disease, tends to occur early in the growth spurt, at age 8–12 in girls or age 10–14 in boys. It is most common in sports in which children wear cleats, such as lacrosse and soccer, or do not wear shoes, as in gymnastics or dance.

Children with calcaneal apophysitis often complain of ankle pain, although upon closer examination the source of the pain turns out to be the heel. Dr. McCambridge said that x-rays are generally not warranted except in certain instances, such as children with atypical features or nighttime pain, those on the extremes of the expected age range, and those who do not improve after treatment.

Other potential causes of joint pain in children, including tendonitis and, rarely, stress fractures, osteomas, tumors, or rheumatologic conditions.

Rest is a critical treatment for apophysitis. Children with calcaneal apophysitis also can use ice and should avoid walking barefoot. Dr. McCambridge suggested that when the child has no pain with daily living, he can return to sport with modifications such as the use of heel cups and supportive shoes and the removal of cleats, especially for practice.

Another common traction apophysitis is Osgood-Schlatter disease (OSD), which occurs at the tibial tuberosity in children aged 11–15 years. Children often present with pain over the anterior tibia, pain with activity, and pain with full flexion. They also tend to have swelling and palpable tenderness at the tibial tuberosity.

Chronic OSD carries the risk of long-term problems due to the formation of painful, nonunited ossicles resulting from fragmentation of the tibial tuberosity. Because of this risk, Dr. McCambridge tends to radiograph OSD more than any other apophyseal injury to try to prevent the condition from getting to that point.

For children with significant fragmentation, she recommends using a knee immobilizer for 2 weeks, followed by rehabilitation. These athletes tend to remain out of activity for 4–6 weeks.

Fracture extension into the epiphyseal plate is another potential risk of OSD, although it only occurs rarely. Rest is the most important treatment measure for OSD. Children can benefit from stretching and strengthening exercises and the use of a patellar strap.

The way a young tennis player grips her racket can contribute to an overuse injury such as apophysitis. DR. MCCAMBRIDGE

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Baseball is a relatively safe sport, as most injuries sustained by young baseball players include minor contusions, sprains, and strains. However, the highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview.

He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed some pitching restrictions that were designed to minimize the likelihood of pitchers developing an overuse injury. (See box.) He recommended that physicians have handouts with baseball safety tips to give to parents.

About one-third of Little League pitchers never play in high school because of overuse in their younger years. DR. GREGORY

A fragmented medial epicondyle apophysis is a typical overuse injury. Courtesy Dr. Andrew Gregory

Prevention Strategies

Observe these pitch count limits:

▸ 9- to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

▸ 11- to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

▸ 13- to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

In addition, ensure that players:

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Baseball is a relatively safe sport, as most injuries sustained by young baseball players include minor contusions, sprains, and strains. However, the highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview.

He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed some pitching restrictions that were designed to minimize the likelihood of pitchers developing an overuse injury. (See box.) He recommended that physicians have handouts with baseball safety tips to give to parents.

About one-third of Little League pitchers never play in high school because of overuse in their younger years. DR. GREGORY

A fragmented medial epicondyle apophysis is a typical overuse injury. Courtesy Dr. Andrew Gregory

Prevention Strategies

Observe these pitch count limits:

▸ 9- to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

▸ 11- to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

▸ 13- to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

In addition, ensure that players:

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.

MIAMI — For serious young baseball players, adherence to recommended pitching limitations and proper management of overuse injuries can help ensure continued healthy pitching, Dr. Andrew Gregory explained at a meeting on pediatric sports medicine sponsored by the American Academy of Pediatrics.

Baseball is a relatively safe sport, as most injuries sustained by young baseball players include minor contusions, sprains, and strains. However, the highly repetitive action of pitching can result in overuse injuries of two joints, generally referred to as Little League elbow or Little League shoulder.

Young pitchers are often serious in their sport, sometimes playing on multiple teams at once in hopes of earning a college scholarship or playing professionally. Such intense participation at an early age, however, can have long-term consequences. About one-third of Little League pitchers never play in high school because of overuse in their younger years, according to Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University in Nashville, Tenn.

This number may seem high, but pain is a common occurrence in pitching. According to a review of 476 pitchers aged 9–14 years, 7% of youth pitching results in pain, and 28% of pitchers report elbow pain at least once in a season. As Dr. Gregory explained, “They're subjecting themselves to this maximal force over and over again, by trying to throw as hard as they can every time.”

Most young pitchers with Little League elbow will present with medial elbow pain that occurs only with throwing; they also may not be able to fully straighten the arm. “It is a constellation of problems, the first being stress injury to the medial epicondyle apophysis,” Dr. Gregory said in an interview.

He explained that continuing to pitch through the pain can lead to a loss of blood supply to the joint and irritation of the ulnar nerve.

The main treatment should be rest from all throwing. Treatment also should include ice, NSAIDs for pain, scapular and core stabilization, and a gradual return to throwing after 6–12 weeks, when throwing no longer hurts. Pitching should be resumed only when the athlete can throw without any pain.

Dr. Gregory said that patients should be referred in the following cases: an acute injury with a “pop,” significant widening of the apophysis visible on x-ray, opening with valgus stress, or persistent pain with throwing despite following treatment measures.

Little League elbow is seen in players aged 9–14 years. After the medial epicondylar apophysis closes at age 15–17 years in boys (age 14 in girls), these symptoms are likely caused by injury to the ligament instead.

Dr. Gregory reviewed some pitching restrictions that were designed to minimize the likelihood of pitchers developing an overuse injury. (See box.) He recommended that physicians have handouts with baseball safety tips to give to parents.

About one-third of Little League pitchers never play in high school because of overuse in their younger years. DR. GREGORY

A fragmented medial epicondyle apophysis is a typical overuse injury. Courtesy Dr. Andrew Gregory

Prevention Strategies

Observe these pitch count limits:

▸ 9- to 10-year-olds: 50 pitches/game, 75/week, 1,000/season, 2,000/year

▸ 11- to 12-year-olds: 75 pitches/game, 100/week, 1,000/season, 3,000/year

▸ 13- to 14-year-olds: 75 pitches/game, 125/week, 1,000/season, 3,000/year

In addition, ensure that players:

▸ Do not throw curveballs before age 14 or sliders before age 16.

▸ Avoid pitching “showcases.”

▸ Pitch for only one team at a time.

▸ Do not pitch and catch for the same team.

ATLANTA — Transdermal testosterone was no better than placebo for improving libido in female cancer survivors after 4 weeks, according to results of a randomized, blinded, crossover study presented at the annual meeting of the American Society of Clinical Oncology.

In the 131 women who completed the study, testosterone and placebo provided similar significant improvements in libido.

The North Central Cancer Treatment Group's N02C3 study randomized 150 women to receive 10 mg/day transdermal testosterone in Vanicream (Pharmaceutical Specialties, Inc.) or placebo (vehicle alone) for 4 weeks, followed by a crossover to the opposite treatment arm for 4 weeks.

All of the women were postmenopausal with no active disease, and all had reported decreased sexual desire. Those with comorbidities that might confound results were excluded. The women were an average of 52 years old; 31% were receiving aromatase inhibitors during the study, and 47% were receiving tamoxifen. Most (72%) had at least one intact ovary, 80% had received prior chemotherapy, and only 7% had received pelvic radiotherapy.

Efficacy was measured using the Changes in Sexual Functioning Questionnaire (CSFQ) after each 4-week period. The average CSFQ score was 5.5 with testosterone and 4.4 with placebo after the first period and 8.8 and 8.1, respectively, after the second period.

“These results might seem very surprising, given the plethora of evidence that shows that transdermal testosterone is effective,” said study author Debra L. Barton, Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., in her presentation. She suggested the exclusion of women on supplemental estradiol in this trial and the relatively short study duration might account for these differences.

ATLANTA — Transdermal testosterone was no better than placebo for improving libido in female cancer survivors after 4 weeks, according to results of a randomized, blinded, crossover study presented at the annual meeting of the American Society of Clinical Oncology.

In the 131 women who completed the study, testosterone and placebo provided similar significant improvements in libido.

The North Central Cancer Treatment Group's N02C3 study randomized 150 women to receive 10 mg/day transdermal testosterone in Vanicream (Pharmaceutical Specialties, Inc.) or placebo (vehicle alone) for 4 weeks, followed by a crossover to the opposite treatment arm for 4 weeks.

All of the women were postmenopausal with no active disease, and all had reported decreased sexual desire. Those with comorbidities that might confound results were excluded. The women were an average of 52 years old; 31% were receiving aromatase inhibitors during the study, and 47% were receiving tamoxifen. Most (72%) had at least one intact ovary, 80% had received prior chemotherapy, and only 7% had received pelvic radiotherapy.

Efficacy was measured using the Changes in Sexual Functioning Questionnaire (CSFQ) after each 4-week period. The average CSFQ score was 5.5 with testosterone and 4.4 with placebo after the first period and 8.8 and 8.1, respectively, after the second period.

“These results might seem very surprising, given the plethora of evidence that shows that transdermal testosterone is effective,” said study author Debra L. Barton, Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., in her presentation. She suggested the exclusion of women on supplemental estradiol in this trial and the relatively short study duration might account for these differences.

ATLANTA — Transdermal testosterone was no better than placebo for improving libido in female cancer survivors after 4 weeks, according to results of a randomized, blinded, crossover study presented at the annual meeting of the American Society of Clinical Oncology.

In the 131 women who completed the study, testosterone and placebo provided similar significant improvements in libido.

The North Central Cancer Treatment Group's N02C3 study randomized 150 women to receive 10 mg/day transdermal testosterone in Vanicream (Pharmaceutical Specialties, Inc.) or placebo (vehicle alone) for 4 weeks, followed by a crossover to the opposite treatment arm for 4 weeks.

All of the women were postmenopausal with no active disease, and all had reported decreased sexual desire. Those with comorbidities that might confound results were excluded. The women were an average of 52 years old; 31% were receiving aromatase inhibitors during the study, and 47% were receiving tamoxifen. Most (72%) had at least one intact ovary, 80% had received prior chemotherapy, and only 7% had received pelvic radiotherapy.

Efficacy was measured using the Changes in Sexual Functioning Questionnaire (CSFQ) after each 4-week period. The average CSFQ score was 5.5 with testosterone and 4.4 with placebo after the first period and 8.8 and 8.1, respectively, after the second period.

“These results might seem very surprising, given the plethora of evidence that shows that transdermal testosterone is effective,” said study author Debra L. Barton, Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., in her presentation. She suggested the exclusion of women on supplemental estradiol in this trial and the relatively short study duration might account for these differences.

ATLANTA — Automated external defibrillators can be a lifesaver in sudden cardiac arrest, the No. 1 cause of death in young athletes, but planning, preparation, and education are essential.

“The single most important determinant of survival is the time from cardiac arrest to defibrillation,” Dr. Jonathan A. Drezner said at a press briefing held during a meeting of the National Athletic Trainers' Association.

Without CPR, survival decreases by 10% with every minute that passes without defibrillation, said Dr. Drezner of the University of Washington in Seattle.

Between 40% and 70% of people with sudden cardiac arrest (SCA) survive if treated with CPR and an automated external defibrillator (AED). In contrast, survival rates after SCA in young athletes are much lower, around 10%–15%. Possible explanations for this discrepancy include a delayed recognition of SCA and delayed defibrillation; only 25%–50% of schools have an AED.

To improve these outcomes, an interassociation task force, cochaired by Dr. Drezner and Ron Courson, director of sports medicine at the University of Georgia, Athens, has developed formal guidelines to help schools and other organizations prepare for SCA and to manage it should it occur.

The guidelines suggest that all collapsed and unresponsive athletes should be treated as if they have SCA until they demonstrate otherwise. The collapsed person should receive CPR until the AED arrives, though this wait should be as short as possible. The first shock from an AED should be applied within 3–5 minutes of the collapse.

This rapid response requires that the AED is easily accessible from every venue; that individuals know where it is and can retrieve it quickly; and that someone is trained in using the device.

“Our recommendation, consistent with the American Heart Association, supports an AED program in any school where the time from activating the emergency response system to the delivery of a shock will be greater than 5 minutes,” Dr. Drezner said.

All schools and institutions that sponsor athletic activities should have a written, structured emergency action plan specific to each venue, the guidelines state. Components of the plan should include communication, personnel, equipment, and transportation to an emergency facility. Additionally, all first responders should be trained in AED and CPR.

It is important that EMS personnel, school officials, and first responders are involved in the development of the plan, and that, just as with fire drills, these procedures are practiced by the individuals who would be involved in an actual incident.

The first responder should resume chest compressions immediately after the first shock. The guidelines recommend repeat rhythm analysis after 2 minutes or five cycles of CPR until advanced life support arrives or until the person begins moving.

SCA is relatively uncommon in the United States, with incidence rates between 1:50,000 and 1:200,000. However, when a child dies from SCA the impact can be catastrophic, affecting not only the child's family, but the entire school and community.

Complete prevention is difficult because in many cases, occult heart disease goes undetected with no signs or symptoms until the SCA occurs. Preparticipation screening is not likely to detect hypertrophic cardiomyopathy, the abnormality usually associated with SCA.

Moreover, SCA also can occur after a blow to the chest above the heart (commotio cordis). Although proper equipment can minimize the chance of this developing, a small risk remains.

ATLANTA — Automated external defibrillators can be a lifesaver in sudden cardiac arrest, the No. 1 cause of death in young athletes, but planning, preparation, and education are essential.

“The single most important determinant of survival is the time from cardiac arrest to defibrillation,” Dr. Jonathan A. Drezner said at a press briefing held during a meeting of the National Athletic Trainers' Association.

Without CPR, survival decreases by 10% with every minute that passes without defibrillation, said Dr. Drezner of the University of Washington in Seattle.

Between 40% and 70% of people with sudden cardiac arrest (SCA) survive if treated with CPR and an automated external defibrillator (AED). In contrast, survival rates after SCA in young athletes are much lower, around 10%–15%. Possible explanations for this discrepancy include a delayed recognition of SCA and delayed defibrillation; only 25%–50% of schools have an AED.

To improve these outcomes, an interassociation task force, cochaired by Dr. Drezner and Ron Courson, director of sports medicine at the University of Georgia, Athens, has developed formal guidelines to help schools and other organizations prepare for SCA and to manage it should it occur.

The guidelines suggest that all collapsed and unresponsive athletes should be treated as if they have SCA until they demonstrate otherwise. The collapsed person should receive CPR until the AED arrives, though this wait should be as short as possible. The first shock from an AED should be applied within 3–5 minutes of the collapse.

This rapid response requires that the AED is easily accessible from every venue; that individuals know where it is and can retrieve it quickly; and that someone is trained in using the device.

“Our recommendation, consistent with the American Heart Association, supports an AED program in any school where the time from activating the emergency response system to the delivery of a shock will be greater than 5 minutes,” Dr. Drezner said.

All schools and institutions that sponsor athletic activities should have a written, structured emergency action plan specific to each venue, the guidelines state. Components of the plan should include communication, personnel, equipment, and transportation to an emergency facility. Additionally, all first responders should be trained in AED and CPR.

It is important that EMS personnel, school officials, and first responders are involved in the development of the plan, and that, just as with fire drills, these procedures are practiced by the individuals who would be involved in an actual incident.

The first responder should resume chest compressions immediately after the first shock. The guidelines recommend repeat rhythm analysis after 2 minutes or five cycles of CPR until advanced life support arrives or until the person begins moving.

SCA is relatively uncommon in the United States, with incidence rates between 1:50,000 and 1:200,000. However, when a child dies from SCA the impact can be catastrophic, affecting not only the child's family, but the entire school and community.

Complete prevention is difficult because in many cases, occult heart disease goes undetected with no signs or symptoms until the SCA occurs. Preparticipation screening is not likely to detect hypertrophic cardiomyopathy, the abnormality usually associated with SCA.

Moreover, SCA also can occur after a blow to the chest above the heart (commotio cordis). Although proper equipment can minimize the chance of this developing, a small risk remains.

ATLANTA — Automated external defibrillators can be a lifesaver in sudden cardiac arrest, the No. 1 cause of death in young athletes, but planning, preparation, and education are essential.

“The single most important determinant of survival is the time from cardiac arrest to defibrillation,” Dr. Jonathan A. Drezner said at a press briefing held during a meeting of the National Athletic Trainers' Association.

Without CPR, survival decreases by 10% with every minute that passes without defibrillation, said Dr. Drezner of the University of Washington in Seattle.

Between 40% and 70% of people with sudden cardiac arrest (SCA) survive if treated with CPR and an automated external defibrillator (AED). In contrast, survival rates after SCA in young athletes are much lower, around 10%–15%. Possible explanations for this discrepancy include a delayed recognition of SCA and delayed defibrillation; only 25%–50% of schools have an AED.

To improve these outcomes, an interassociation task force, cochaired by Dr. Drezner and Ron Courson, director of sports medicine at the University of Georgia, Athens, has developed formal guidelines to help schools and other organizations prepare for SCA and to manage it should it occur.

The guidelines suggest that all collapsed and unresponsive athletes should be treated as if they have SCA until they demonstrate otherwise. The collapsed person should receive CPR until the AED arrives, though this wait should be as short as possible. The first shock from an AED should be applied within 3–5 minutes of the collapse.

This rapid response requires that the AED is easily accessible from every venue; that individuals know where it is and can retrieve it quickly; and that someone is trained in using the device.

“Our recommendation, consistent with the American Heart Association, supports an AED program in any school where the time from activating the emergency response system to the delivery of a shock will be greater than 5 minutes,” Dr. Drezner said.

All schools and institutions that sponsor athletic activities should have a written, structured emergency action plan specific to each venue, the guidelines state. Components of the plan should include communication, personnel, equipment, and transportation to an emergency facility. Additionally, all first responders should be trained in AED and CPR.

It is important that EMS personnel, school officials, and first responders are involved in the development of the plan, and that, just as with fire drills, these procedures are practiced by the individuals who would be involved in an actual incident.

The first responder should resume chest compressions immediately after the first shock. The guidelines recommend repeat rhythm analysis after 2 minutes or five cycles of CPR until advanced life support arrives or until the person begins moving.

SCA is relatively uncommon in the United States, with incidence rates between 1:50,000 and 1:200,000. However, when a child dies from SCA the impact can be catastrophic, affecting not only the child's family, but the entire school and community.

Complete prevention is difficult because in many cases, occult heart disease goes undetected with no signs or symptoms until the SCA occurs. Preparticipation screening is not likely to detect hypertrophic cardiomyopathy, the abnormality usually associated with SCA.

Moreover, SCA also can occur after a blow to the chest above the heart (commotio cordis). Although proper equipment can minimize the chance of this developing, a small risk remains.

ATLANTA — Anxiety, depression, and pain are often overlooked in older cancer survivors, according to results of a study presented at the annual meeting of the American Society of Clinical Oncology.

In this study of 153 men who had been diagnosed with cancer an average of 3 years prior, pain, anxiety, and depression were common, occurring in 64%, 26%, and 21% of men, respectively, according to prospective analysis of responses to a questionnaire.

Despite the high frequency of these issues, in many cases, oncologists did not discuss pain and well-being with their patients. According to blinded retrospective chart reviews, oncologists did not inquire about pain in 22% of the men.

Inquiries about mental health were more infrequent: 95% of men were not asked about anxiety, and 88% of men were not asked about depression.

This failure to inquire about pain and mental health resulted in a significant proportion of men with each condition going overlooked, including 18% of men with pain, 85% of men with anxiety, and 75% of men with depression.

In an interview during his poster presentation, Dr. Harvey Jay Cohen said this information is very relevant for primary care physicians. “People need to be aware that cancer survivors, older ones at least, not infrequently are anxious and showing signs of depression, said Dr. Cohen, professor and interim chair in the department of medicine and director of the Center for the Study of Aging and Human Development at Duke University Medical Center in Durham, N.C. “That's something people at least need to inquire about.”

In the study, Dr. Cohen and his colleagues evaluated 153 male patients who visited a single oncology clinic at a Veterans Affairs Medical Center.

ATLANTA — Anxiety, depression, and pain are often overlooked in older cancer survivors, according to results of a study presented at the annual meeting of the American Society of Clinical Oncology.

In this study of 153 men who had been diagnosed with cancer an average of 3 years prior, pain, anxiety, and depression were common, occurring in 64%, 26%, and 21% of men, respectively, according to prospective analysis of responses to a questionnaire.

Despite the high frequency of these issues, in many cases, oncologists did not discuss pain and well-being with their patients. According to blinded retrospective chart reviews, oncologists did not inquire about pain in 22% of the men.

Inquiries about mental health were more infrequent: 95% of men were not asked about anxiety, and 88% of men were not asked about depression.

This failure to inquire about pain and mental health resulted in a significant proportion of men with each condition going overlooked, including 18% of men with pain, 85% of men with anxiety, and 75% of men with depression.

In an interview during his poster presentation, Dr. Harvey Jay Cohen said this information is very relevant for primary care physicians. “People need to be aware that cancer survivors, older ones at least, not infrequently are anxious and showing signs of depression, said Dr. Cohen, professor and interim chair in the department of medicine and director of the Center for the Study of Aging and Human Development at Duke University Medical Center in Durham, N.C. “That's something people at least need to inquire about.”

In the study, Dr. Cohen and his colleagues evaluated 153 male patients who visited a single oncology clinic at a Veterans Affairs Medical Center.

ATLANTA — Anxiety, depression, and pain are often overlooked in older cancer survivors, according to results of a study presented at the annual meeting of the American Society of Clinical Oncology.

In this study of 153 men who had been diagnosed with cancer an average of 3 years prior, pain, anxiety, and depression were common, occurring in 64%, 26%, and 21% of men, respectively, according to prospective analysis of responses to a questionnaire.

Despite the high frequency of these issues, in many cases, oncologists did not discuss pain and well-being with their patients. According to blinded retrospective chart reviews, oncologists did not inquire about pain in 22% of the men.

Inquiries about mental health were more infrequent: 95% of men were not asked about anxiety, and 88% of men were not asked about depression.

This failure to inquire about pain and mental health resulted in a significant proportion of men with each condition going overlooked, including 18% of men with pain, 85% of men with anxiety, and 75% of men with depression.

In an interview during his poster presentation, Dr. Harvey Jay Cohen said this information is very relevant for primary care physicians. “People need to be aware that cancer survivors, older ones at least, not infrequently are anxious and showing signs of depression, said Dr. Cohen, professor and interim chair in the department of medicine and director of the Center for the Study of Aging and Human Development at Duke University Medical Center in Durham, N.C. “That's something people at least need to inquire about.”

In the study, Dr. Cohen and his colleagues evaluated 153 male patients who visited a single oncology clinic at a Veterans Affairs Medical Center.

ATLANTA — Calcium plus vitamin D supplementation in postmenopausal women does not appear to reduce their risk of breast cancer, according to results from a Women's Health Initiative randomized trial presented at the annual meeting of the American Society of Clinical Oncology.

After a median of 7 years, women who received 1,000 mg of calcium carbonate plus 400 IU of vitamin D₃ were no less likely to develop breast cancer than were women who received placebo. In the study, Dr. Rowan T. Chlebowski and his colleagues randomized 36,282 women aged 50–79 years with no prior breast cancer who were already enrolled in the WHI diet or hormone trials to receive calcium plus vitamin D or placebo. Supplements were provided by GlaxoSmithKline.

In her discussion of the study, Dr. Carol Fabian suggested that several variables could have contributed to the lack of effect observed in the study. First, the mean calcium intake at baseline was 1,165 mg/day in both arms, already approaching the recommended optimal intake.

Second, women in either arm could, on their own, use supplements of up to 1,000 mg of calcium and 1,000 IU of vitamin D per day. During the fifth year of the trial, nonprotocol supplement use on average totaled 200 mg of calcium and 400 IU of vitamin D—an amount of vitamin D equivalent to the study dose, noted Dr. Chlebowski, a professor of medicine at the University of California, Los Angeles, in his presentation. This reduced the difference in vitamin D intake between the experimental and control arms.

Dr. Fabian, a professor of medicine at the University of Kansas Medical Center in Kansas City, said that recent studies indicate that the amount of vitamin D needed to see a benefit for breast cancer reduction may be quite high, about 3,000 IU per day. This is significantly higher than the study dose of 400 IU per day.

“I would like to suggest, although we don't know, that the intervention did not provide nearly enough vitamin D,” Dr. Fabian said. She recommended that women strive to get 15–20 minutes of sun per day or take 1,000–2,000 IU vitamin D₃ per day. “If this sounds like a high level to you, I will point out … a number of vitamin D experts who think that the current recommendations that we see for vitamin D are way too low, and we must increase the levels to at least 1,000 units of vitamin D per day.”

Whereas calcium intake at baseline was already high, women entering the study had fairly low vitamin D levels at baseline; 85% of women had a serum 25-hydroxyvitamin D level below 30 ng/mL, suggesting vitamin D insufficiency. Among the 19,115 women not using vitamin D supplements at baseline, those in the calcium plus vitamin D group had a significant 18% reduction in breast cancer risk. Dr. Fabian also said that by enrolling postmenopausal women, the trial could have started supplementation too late in the precancerous process.

The primary end point of the trial, the incidence of hip fracture, was not significantly different between arms (N. Engl. J. Med. 2006;354:669–83), nor was the incidence of colorectal cancer (N. Engl. J. Med. 2006;354:684–96). As previously reported, there was a significant 17% increased incidence of kidney stones with calcium plus vitamin D.

The current analysis found no relationship between baseline serum 25-hydroxyvitamin D levels and arthritis incidence. Moreover, after 2 years, calcium plus vitamin D had no effect on joint pain or swelling. Estrogen use did appear to significantly reduce joint pain. After 3 years, the incidence of joint pain in women taking estrogen was 70.6%, compared with 77.2% in those not taking estrogen.

ATLANTA — Calcium plus vitamin D supplementation in postmenopausal women does not appear to reduce their risk of breast cancer, according to results from a Women's Health Initiative randomized trial presented at the annual meeting of the American Society of Clinical Oncology.

After a median of 7 years, women who received 1,000 mg of calcium carbonate plus 400 IU of vitamin D₃ were no less likely to develop breast cancer than were women who received placebo. In the study, Dr. Rowan T. Chlebowski and his colleagues randomized 36,282 women aged 50–79 years with no prior breast cancer who were already enrolled in the WHI diet or hormone trials to receive calcium plus vitamin D or placebo. Supplements were provided by GlaxoSmithKline.

In her discussion of the study, Dr. Carol Fabian suggested that several variables could have contributed to the lack of effect observed in the study. First, the mean calcium intake at baseline was 1,165 mg/day in both arms, already approaching the recommended optimal intake.

Second, women in either arm could, on their own, use supplements of up to 1,000 mg of calcium and 1,000 IU of vitamin D per day. During the fifth year of the trial, nonprotocol supplement use on average totaled 200 mg of calcium and 400 IU of vitamin D—an amount of vitamin D equivalent to the study dose, noted Dr. Chlebowski, a professor of medicine at the University of California, Los Angeles, in his presentation. This reduced the difference in vitamin D intake between the experimental and control arms.

Dr. Fabian, a professor of medicine at the University of Kansas Medical Center in Kansas City, said that recent studies indicate that the amount of vitamin D needed to see a benefit for breast cancer reduction may be quite high, about 3,000 IU per day. This is significantly higher than the study dose of 400 IU per day.

“I would like to suggest, although we don't know, that the intervention did not provide nearly enough vitamin D,” Dr. Fabian said. She recommended that women strive to get 15–20 minutes of sun per day or take 1,000–2,000 IU vitamin D₃ per day. “If this sounds like a high level to you, I will point out … a number of vitamin D experts who think that the current recommendations that we see for vitamin D are way too low, and we must increase the levels to at least 1,000 units of vitamin D per day.”

Whereas calcium intake at baseline was already high, women entering the study had fairly low vitamin D levels at baseline; 85% of women had a serum 25-hydroxyvitamin D level below 30 ng/mL, suggesting vitamin D insufficiency. Among the 19,115 women not using vitamin D supplements at baseline, those in the calcium plus vitamin D group had a significant 18% reduction in breast cancer risk. Dr. Fabian also said that by enrolling postmenopausal women, the trial could have started supplementation too late in the precancerous process.

The primary end point of the trial, the incidence of hip fracture, was not significantly different between arms (N. Engl. J. Med. 2006;354:669–83), nor was the incidence of colorectal cancer (N. Engl. J. Med. 2006;354:684–96). As previously reported, there was a significant 17% increased incidence of kidney stones with calcium plus vitamin D.

The current analysis found no relationship between baseline serum 25-hydroxyvitamin D levels and arthritis incidence. Moreover, after 2 years, calcium plus vitamin D had no effect on joint pain or swelling. Estrogen use did appear to significantly reduce joint pain. After 3 years, the incidence of joint pain in women taking estrogen was 70.6%, compared with 77.2% in those not taking estrogen.

ATLANTA — Calcium plus vitamin D supplementation in postmenopausal women does not appear to reduce their risk of breast cancer, according to results from a Women's Health Initiative randomized trial presented at the annual meeting of the American Society of Clinical Oncology.

After a median of 7 years, women who received 1,000 mg of calcium carbonate plus 400 IU of vitamin D₃ were no less likely to develop breast cancer than were women who received placebo. In the study, Dr. Rowan T. Chlebowski and his colleagues randomized 36,282 women aged 50–79 years with no prior breast cancer who were already enrolled in the WHI diet or hormone trials to receive calcium plus vitamin D or placebo. Supplements were provided by GlaxoSmithKline.

In her discussion of the study, Dr. Carol Fabian suggested that several variables could have contributed to the lack of effect observed in the study. First, the mean calcium intake at baseline was 1,165 mg/day in both arms, already approaching the recommended optimal intake.

Second, women in either arm could, on their own, use supplements of up to 1,000 mg of calcium and 1,000 IU of vitamin D per day. During the fifth year of the trial, nonprotocol supplement use on average totaled 200 mg of calcium and 400 IU of vitamin D—an amount of vitamin D equivalent to the study dose, noted Dr. Chlebowski, a professor of medicine at the University of California, Los Angeles, in his presentation. This reduced the difference in vitamin D intake between the experimental and control arms.

Dr. Fabian, a professor of medicine at the University of Kansas Medical Center in Kansas City, said that recent studies indicate that the amount of vitamin D needed to see a benefit for breast cancer reduction may be quite high, about 3,000 IU per day. This is significantly higher than the study dose of 400 IU per day.

“I would like to suggest, although we don't know, that the intervention did not provide nearly enough vitamin D,” Dr. Fabian said. She recommended that women strive to get 15–20 minutes of sun per day or take 1,000–2,000 IU vitamin D₃ per day. “If this sounds like a high level to you, I will point out … a number of vitamin D experts who think that the current recommendations that we see for vitamin D are way too low, and we must increase the levels to at least 1,000 units of vitamin D per day.”

Whereas calcium intake at baseline was already high, women entering the study had fairly low vitamin D levels at baseline; 85% of women had a serum 25-hydroxyvitamin D level below 30 ng/mL, suggesting vitamin D insufficiency. Among the 19,115 women not using vitamin D supplements at baseline, those in the calcium plus vitamin D group had a significant 18% reduction in breast cancer risk. Dr. Fabian also said that by enrolling postmenopausal women, the trial could have started supplementation too late in the precancerous process.

The primary end point of the trial, the incidence of hip fracture, was not significantly different between arms (N. Engl. J. Med. 2006;354:669–83), nor was the incidence of colorectal cancer (N. Engl. J. Med. 2006;354:684–96). As previously reported, there was a significant 17% increased incidence of kidney stones with calcium plus vitamin D.

The current analysis found no relationship between baseline serum 25-hydroxyvitamin D levels and arthritis incidence. Moreover, after 2 years, calcium plus vitamin D had no effect on joint pain or swelling. Estrogen use did appear to significantly reduce joint pain. After 3 years, the incidence of joint pain in women taking estrogen was 70.6%, compared with 77.2% in those not taking estrogen.

ATLANTA — Salpingo-oophorectomy appears to significantly reduce the incidence of gynecologic cancers in all women with BRCA mutations and the incidence of breast cancer in women with BRCA2 mutations.

This conclusion is based on the results of a multicenter, prospective study presented at the annual meeting of the American Society of Clinical Oncology.

After about 3 years of follow-up, the 546 women who elected to receive risk-reducing salpingo-oophorectomy had a 90% reduction in gynecologic cancers and a 47% reduction in breast cancer incidence compared with the 325 women who chose not receive surgery.

However, the risk reduction in breast cancer was limited to women with BRCA2 mutations. “BRCA1 and BRCA2 cause related but distinct cancer susceptibility syndromes,” explained Dr. Noah D. Kauff in his presentation. He therefore thought it was important to examine the benefit of risk-reducing salpingo-oophorectomy in each population.

In all, 597 women with breast tissue at risk at the start of follow-up were included in the breast cancer risk analysis. Among women carrying the BRCA1 mutation, 15 of 190 patients treated with risk-reducing salpingo-oophorectomy developed breast cancer, compared with 19 of 178 patients not treated with surgery, a 39% risk reduction that was not statistically significant.

Among BRCA2 carriers, the incidence with surgery vs. surveillance was 4 of 113 patients and 9 of 116 patients, respectively, resulting in a significant 72% reduction in cancer risk.

The study, led by Dr. Kauff, of the Memorial Sloan-Kettering Cancer Center in New York, evaluated two prospective cohorts of women carrying a BRCA mutation. Compared with women who chose not to receive risk-reducing salpingo-oophorectomy, those treated with surgery were significantly older (mean age, 47 vs. 43 years), were more likely to have had breast cancer in the past (59% vs. 46%), were more likely to have taken hormone therapy (11% vs. 7%), and were significantly more likely to have given birth (83% vs. 74%).

An exploratory analysis showed an overall 78% risk reduction in estrogen receptor-positive cancer, compared with no significant change in the incidence of ER-negative breast cancer.

“Since most breast cancers related to BRCA1 mutations are ER-negative, it could be postulated that hormonal manipulation—in this case, risk-reducing salpingo-oophorectomy—might not be effective in this population,” said Dr. Banu Arun in her discussion of the study.

Dr. Arun, of the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, Houston, suggested that future prospective studies should evaluate risk-reducing salpingo-oophorectomy plus a nonhormonal preventive agent, such as cyclooxygenase-2 inhibitors, retinoids, statins, or other agents, for women with BRCA1 mutations.

ATLANTA — Salpingo-oophorectomy appears to significantly reduce the incidence of gynecologic cancers in all women with BRCA mutations and the incidence of breast cancer in women with BRCA2 mutations.

This conclusion is based on the results of a multicenter, prospective study presented at the annual meeting of the American Society of Clinical Oncology.

After about 3 years of follow-up, the 546 women who elected to receive risk-reducing salpingo-oophorectomy had a 90% reduction in gynecologic cancers and a 47% reduction in breast cancer incidence compared with the 325 women who chose not receive surgery.

However, the risk reduction in breast cancer was limited to women with BRCA2 mutations. “BRCA1 and BRCA2 cause related but distinct cancer susceptibility syndromes,” explained Dr. Noah D. Kauff in his presentation. He therefore thought it was important to examine the benefit of risk-reducing salpingo-oophorectomy in each population.

In all, 597 women with breast tissue at risk at the start of follow-up were included in the breast cancer risk analysis. Among women carrying the BRCA1 mutation, 15 of 190 patients treated with risk-reducing salpingo-oophorectomy developed breast cancer, compared with 19 of 178 patients not treated with surgery, a 39% risk reduction that was not statistically significant.

Among BRCA2 carriers, the incidence with surgery vs. surveillance was 4 of 113 patients and 9 of 116 patients, respectively, resulting in a significant 72% reduction in cancer risk.

The study, led by Dr. Kauff, of the Memorial Sloan-Kettering Cancer Center in New York, evaluated two prospective cohorts of women carrying a BRCA mutation. Compared with women who chose not to receive risk-reducing salpingo-oophorectomy, those treated with surgery were significantly older (mean age, 47 vs. 43 years), were more likely to have had breast cancer in the past (59% vs. 46%), were more likely to have taken hormone therapy (11% vs. 7%), and were significantly more likely to have given birth (83% vs. 74%).

An exploratory analysis showed an overall 78% risk reduction in estrogen receptor-positive cancer, compared with no significant change in the incidence of ER-negative breast cancer.

“Since most breast cancers related to BRCA1 mutations are ER-negative, it could be postulated that hormonal manipulation—in this case, risk-reducing salpingo-oophorectomy—might not be effective in this population,” said Dr. Banu Arun in her discussion of the study.

Dr. Arun, of the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, Houston, suggested that future prospective studies should evaluate risk-reducing salpingo-oophorectomy plus a nonhormonal preventive agent, such as cyclooxygenase-2 inhibitors, retinoids, statins, or other agents, for women with BRCA1 mutations.

ATLANTA — Salpingo-oophorectomy appears to significantly reduce the incidence of gynecologic cancers in all women with BRCA mutations and the incidence of breast cancer in women with BRCA2 mutations.

This conclusion is based on the results of a multicenter, prospective study presented at the annual meeting of the American Society of Clinical Oncology.

After about 3 years of follow-up, the 546 women who elected to receive risk-reducing salpingo-oophorectomy had a 90% reduction in gynecologic cancers and a 47% reduction in breast cancer incidence compared with the 325 women who chose not receive surgery.

However, the risk reduction in breast cancer was limited to women with BRCA2 mutations. “BRCA1 and BRCA2 cause related but distinct cancer susceptibility syndromes,” explained Dr. Noah D. Kauff in his presentation. He therefore thought it was important to examine the benefit of risk-reducing salpingo-oophorectomy in each population.

In all, 597 women with breast tissue at risk at the start of follow-up were included in the breast cancer risk analysis. Among women carrying the BRCA1 mutation, 15 of 190 patients treated with risk-reducing salpingo-oophorectomy developed breast cancer, compared with 19 of 178 patients not treated with surgery, a 39% risk reduction that was not statistically significant.

Among BRCA2 carriers, the incidence with surgery vs. surveillance was 4 of 113 patients and 9 of 116 patients, respectively, resulting in a significant 72% reduction in cancer risk.

The study, led by Dr. Kauff, of the Memorial Sloan-Kettering Cancer Center in New York, evaluated two prospective cohorts of women carrying a BRCA mutation. Compared with women who chose not to receive risk-reducing salpingo-oophorectomy, those treated with surgery were significantly older (mean age, 47 vs. 43 years), were more likely to have had breast cancer in the past (59% vs. 46%), were more likely to have taken hormone therapy (11% vs. 7%), and were significantly more likely to have given birth (83% vs. 74%).

An exploratory analysis showed an overall 78% risk reduction in estrogen receptor-positive cancer, compared with no significant change in the incidence of ER-negative breast cancer.

“Since most breast cancers related to BRCA1 mutations are ER-negative, it could be postulated that hormonal manipulation—in this case, risk-reducing salpingo-oophorectomy—might not be effective in this population,” said Dr. Banu Arun in her discussion of the study.

Dr. Arun, of the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center, Houston, suggested that future prospective studies should evaluate risk-reducing salpingo-oophorectomy plus a nonhormonal preventive agent, such as cyclooxygenase-2 inhibitors, retinoids, statins, or other agents, for women with BRCA1 mutations.

ATLANTA — Cognitive impairment occurs in some patients during chemotherapy but usually resolves after treatment is over, according to several longitudinal studies presented at the annual meeting of the American Society of Clinical Oncology.

In a study of 54 patients with breast cancer, about one-third of patients had cognitive impairment during chemotherapy, but by 6 months after the end of treatment, 87% of patients had no impairment, Dr. Lynn I. Wagner reported.

About 25% of patients had cognitive impairment before the beginning of treatment, a phenomenon that has been observed previously. The mechanism underlying this finding remains unknown.

The study enrolled patients with breast cancer who were about to undergo adjuvant chemotherapy. The patients, of whom 96% were female, took a panel of neuropsychological tests and provided self-reported data on fatigue, cognitive dysfunction, anxiety, depression, and sleep before, during, and 6 months after chemotherapy. Cognitive impairment was defined based on performance on the tests, compared with published norms.

The investigators assessed cognitive function at three time points: within the 2 weeks before starting treatment, within 2 weeks of finishing treatment, and 6 months later.

Of the 54 patients with complete results, nearly two-thirds of patients (63%) had no impairment before, during, or 6 months after treatment. Another 14% had transient impairment during treatment, 4% of patients developed impairment during treatment that did not resolve, and 7% had impairment at all assessments. The remaining patients (11%) started out with impairment but had either sustained (9%) or transient (2%) improvement.

“One suspicion I have is that perhaps these patients had anemia or some other problems that were corrected during the course of chemotherapy,” explained Dr. Wagner, of the department of psychiatry and behavioral sciences at the Northwestern University, Chicago.

Another longitudinal prospective study, presented by Dr. Sadhna Kohli, evaluated cognitive impairment in 595 patients with cancer, most of whom had breast cancer (54%) or prostate cancer (20%). All patients were scheduled to undergo treatment but had not yet received radiation therapy or chemotherapy. Most patients received chemotherapy, either alone (37%) or with radiation (23%), and the other 40% received radiation alone.

Patients were an average of 57 years old, and 66% were female. About half of the patients (54%) had some college education. This study defined impairment according to performance on a 10-point scale of memory and concentration.

As in the first study, cognitive impairment was common at baseline, with memory problems present in 50%–55% of patients in each group. Of the patients who received chemotherapy alone or with radiation, the frequency of memory problems increased significantly during treatment to 81.8% and 75.4%, respectively, by the end of treatment. Memory problems subsequently resolved in about 5% of patients, leaving 76.4% and 70.6% of patients, respectively, with memory problems 6 months after the end of treatment.

Among the patients who received radiation alone, the frequency of memory problems remained more stable, with 48.5% and 59.0% experiencing problems at the end of treatment and after 6 months, respectively. However, the severity of memory problems increased at each assessment among patients treated with radiation. Overall, problems with concentration followed a similar pattern in each group.

“These changes are usually subtle … and are, more often than not, known to the patient only,” explained Dr. Kohli in her presentation.

Dr. Kohli, of the department of radiation oncology and a cancer control fellow at the University of Rochester (N.Y.), added that these subtle changes can significantly affect a patient's quality of life.

In a discussion of these studies, Tim A. Ahles, Ph.D., said that definitions are important when it comes to evaluating subtle cognitive deficits.

“For many people, 'deficit' isn't really the correct word—it is more of a reduction in function from pretreatment levels,” said Dr. Ahles, an attending clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York.

ATLANTA — Cognitive impairment occurs in some patients during chemotherapy but usually resolves after treatment is over, according to several longitudinal studies presented at the annual meeting of the American Society of Clinical Oncology.

In a study of 54 patients with breast cancer, about one-third of patients had cognitive impairment during chemotherapy, but by 6 months after the end of treatment, 87% of patients had no impairment, Dr. Lynn I. Wagner reported.

About 25% of patients had cognitive impairment before the beginning of treatment, a phenomenon that has been observed previously. The mechanism underlying this finding remains unknown.

The study enrolled patients with breast cancer who were about to undergo adjuvant chemotherapy. The patients, of whom 96% were female, took a panel of neuropsychological tests and provided self-reported data on fatigue, cognitive dysfunction, anxiety, depression, and sleep before, during, and 6 months after chemotherapy. Cognitive impairment was defined based on performance on the tests, compared with published norms.

The investigators assessed cognitive function at three time points: within the 2 weeks before starting treatment, within 2 weeks of finishing treatment, and 6 months later.

Of the 54 patients with complete results, nearly two-thirds of patients (63%) had no impairment before, during, or 6 months after treatment. Another 14% had transient impairment during treatment, 4% of patients developed impairment during treatment that did not resolve, and 7% had impairment at all assessments. The remaining patients (11%) started out with impairment but had either sustained (9%) or transient (2%) improvement.

“One suspicion I have is that perhaps these patients had anemia or some other problems that were corrected during the course of chemotherapy,” explained Dr. Wagner, of the department of psychiatry and behavioral sciences at the Northwestern University, Chicago.

Another longitudinal prospective study, presented by Dr. Sadhna Kohli, evaluated cognitive impairment in 595 patients with cancer, most of whom had breast cancer (54%) or prostate cancer (20%). All patients were scheduled to undergo treatment but had not yet received radiation therapy or chemotherapy. Most patients received chemotherapy, either alone (37%) or with radiation (23%), and the other 40% received radiation alone.

Patients were an average of 57 years old, and 66% were female. About half of the patients (54%) had some college education. This study defined impairment according to performance on a 10-point scale of memory and concentration.

As in the first study, cognitive impairment was common at baseline, with memory problems present in 50%–55% of patients in each group. Of the patients who received chemotherapy alone or with radiation, the frequency of memory problems increased significantly during treatment to 81.8% and 75.4%, respectively, by the end of treatment. Memory problems subsequently resolved in about 5% of patients, leaving 76.4% and 70.6% of patients, respectively, with memory problems 6 months after the end of treatment.

Among the patients who received radiation alone, the frequency of memory problems remained more stable, with 48.5% and 59.0% experiencing problems at the end of treatment and after 6 months, respectively. However, the severity of memory problems increased at each assessment among patients treated with radiation. Overall, problems with concentration followed a similar pattern in each group.

“These changes are usually subtle … and are, more often than not, known to the patient only,” explained Dr. Kohli in her presentation.

Dr. Kohli, of the department of radiation oncology and a cancer control fellow at the University of Rochester (N.Y.), added that these subtle changes can significantly affect a patient's quality of life.

In a discussion of these studies, Tim A. Ahles, Ph.D., said that definitions are important when it comes to evaluating subtle cognitive deficits.

“For many people, 'deficit' isn't really the correct word—it is more of a reduction in function from pretreatment levels,” said Dr. Ahles, an attending clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York.

ATLANTA — Cognitive impairment occurs in some patients during chemotherapy but usually resolves after treatment is over, according to several longitudinal studies presented at the annual meeting of the American Society of Clinical Oncology.

In a study of 54 patients with breast cancer, about one-third of patients had cognitive impairment during chemotherapy, but by 6 months after the end of treatment, 87% of patients had no impairment, Dr. Lynn I. Wagner reported.

About 25% of patients had cognitive impairment before the beginning of treatment, a phenomenon that has been observed previously. The mechanism underlying this finding remains unknown.

The study enrolled patients with breast cancer who were about to undergo adjuvant chemotherapy. The patients, of whom 96% were female, took a panel of neuropsychological tests and provided self-reported data on fatigue, cognitive dysfunction, anxiety, depression, and sleep before, during, and 6 months after chemotherapy. Cognitive impairment was defined based on performance on the tests, compared with published norms.

The investigators assessed cognitive function at three time points: within the 2 weeks before starting treatment, within 2 weeks of finishing treatment, and 6 months later.

Of the 54 patients with complete results, nearly two-thirds of patients (63%) had no impairment before, during, or 6 months after treatment. Another 14% had transient impairment during treatment, 4% of patients developed impairment during treatment that did not resolve, and 7% had impairment at all assessments. The remaining patients (11%) started out with impairment but had either sustained (9%) or transient (2%) improvement.

“One suspicion I have is that perhaps these patients had anemia or some other problems that were corrected during the course of chemotherapy,” explained Dr. Wagner, of the department of psychiatry and behavioral sciences at the Northwestern University, Chicago.

Another longitudinal prospective study, presented by Dr. Sadhna Kohli, evaluated cognitive impairment in 595 patients with cancer, most of whom had breast cancer (54%) or prostate cancer (20%). All patients were scheduled to undergo treatment but had not yet received radiation therapy or chemotherapy. Most patients received chemotherapy, either alone (37%) or with radiation (23%), and the other 40% received radiation alone.

Patients were an average of 57 years old, and 66% were female. About half of the patients (54%) had some college education. This study defined impairment according to performance on a 10-point scale of memory and concentration.

As in the first study, cognitive impairment was common at baseline, with memory problems present in 50%–55% of patients in each group. Of the patients who received chemotherapy alone or with radiation, the frequency of memory problems increased significantly during treatment to 81.8% and 75.4%, respectively, by the end of treatment. Memory problems subsequently resolved in about 5% of patients, leaving 76.4% and 70.6% of patients, respectively, with memory problems 6 months after the end of treatment.

Among the patients who received radiation alone, the frequency of memory problems remained more stable, with 48.5% and 59.0% experiencing problems at the end of treatment and after 6 months, respectively. However, the severity of memory problems increased at each assessment among patients treated with radiation. Overall, problems with concentration followed a similar pattern in each group.

“These changes are usually subtle … and are, more often than not, known to the patient only,” explained Dr. Kohli in her presentation.

Dr. Kohli, of the department of radiation oncology and a cancer control fellow at the University of Rochester (N.Y.), added that these subtle changes can significantly affect a patient's quality of life.

In a discussion of these studies, Tim A. Ahles, Ph.D., said that definitions are important when it comes to evaluating subtle cognitive deficits.

“For many people, 'deficit' isn't really the correct word—it is more of a reduction in function from pretreatment levels,” said Dr. Ahles, an attending clinical psychologist at Memorial Sloan-Kettering Cancer Center in New York.