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Isotretinoin treatment reorganizes dermal microbiome in acne patients
GRAND CAYMAN, CAYMAN ISLANDS – Isotretinoin, the go-to guy for severe acne, may not be so much a local cop as a community organizer, Kenneth B. Gordon, MD, said at the meeting provided by Global Academy for Medical Education.
“It now appears that with and that the microbial community is replenished with the types associated with healthy skin,” said Dr. Gordon, professor and chair of dermatology at the Medical College of Wisconsin, Milwaukee. When these new bacteria move in, they push pathogenic species out of the neighborhood “and create a new skin microbial community. Maybe this is the real reason our patients tend to stay better, once we get them better with isotretinoin.”
Dr. Gordon discussed new data published last October in the Journal of Investigative Dermatology (J Invest Dermatol. 2018 Oct 24. doi: 10.1016/j.jid.2018.09.023). In a letter to the editor, William H. McCoy, IV, MD, PhD, of Washington University, St. Louis, and his associates suggest that isotretinoin induces a “sebaceous drought,” which shifts the skin microbiome from pathogenic to normophysiological.
Isotretinoin is the gold standard treatment for severe acne, but its method of action has never been fully elucidated, Dr. Gordon said. It clearly targets the sebaceous gland – decreasing sebocyte proliferation and suppressing sebum production – but an emerging body of research suggests that the drug also markedly affects dermal microbial colonization.
The entire concept of a skin microbiome is nearly as new as this new concept of isotretinoin’s effect upon it. Only in the last few years have researchers begun to characterize the complex microbial film that keeps skin healthy and resistant to infection. Dermal dysbiosis has now been associated with acne, psoriasis and psoriatic arthritis, and atopic dermatitis.
The 2-year pilot study compared the dermal microbiome of isotretinoin-treated acne patients with that of patients with untreated acne and normal skin. Skin samples underwent genomic analysis before isotretinoin treatment, at several periods during treatment, and about 5 months after treatment stopped. Untreated controls were evaluated at baseline and at 2, 5, and 10 months.
Not surprisingly, before treatment the microbiome was similar in both acne groups, but markedly different from that seen in normal skin. As isotretinoin’s “oil drought” dragged on, levels of Cutibacterium acnes (the new appellation for P. acnes) declined. Staphylococcus species initially increased, but then declined as well. Simultaneously, four new taxa (Rothia, Flavobacterium, Enterobacter, and Micrococcus) increased. Most patients had a restructuring of their Propionibacterium community, populated largely by the less-pathogenic strains found on normal skin.
“We suggest that isotretinoin creates a Propionibacterium ‘population bottleneck’ that selects for ‘healthy’ Propionibacterium communities and other sebaceous skin taxa that persist after treatment, resulting in long-term acne remission [i.e., normal skin],” the investigators wrote.
This is a new and very exciting finding, Dr. Gordon commented. “It appears that the reason our isotretinoin patients stay better once they get better is not from targeting the sebaceous gland itself, but by repairing the skin’s microbiome and getting it back to normal.”
Dr. Gordon reported financial relationships with numerous pharmaceutical companies. Global Academy and this news organization are owned by the same parent company.
This article was updated 2/1/19.
GRAND CAYMAN, CAYMAN ISLANDS – Isotretinoin, the go-to guy for severe acne, may not be so much a local cop as a community organizer, Kenneth B. Gordon, MD, said at the meeting provided by Global Academy for Medical Education.
“It now appears that with and that the microbial community is replenished with the types associated with healthy skin,” said Dr. Gordon, professor and chair of dermatology at the Medical College of Wisconsin, Milwaukee. When these new bacteria move in, they push pathogenic species out of the neighborhood “and create a new skin microbial community. Maybe this is the real reason our patients tend to stay better, once we get them better with isotretinoin.”
Dr. Gordon discussed new data published last October in the Journal of Investigative Dermatology (J Invest Dermatol. 2018 Oct 24. doi: 10.1016/j.jid.2018.09.023). In a letter to the editor, William H. McCoy, IV, MD, PhD, of Washington University, St. Louis, and his associates suggest that isotretinoin induces a “sebaceous drought,” which shifts the skin microbiome from pathogenic to normophysiological.
Isotretinoin is the gold standard treatment for severe acne, but its method of action has never been fully elucidated, Dr. Gordon said. It clearly targets the sebaceous gland – decreasing sebocyte proliferation and suppressing sebum production – but an emerging body of research suggests that the drug also markedly affects dermal microbial colonization.
The entire concept of a skin microbiome is nearly as new as this new concept of isotretinoin’s effect upon it. Only in the last few years have researchers begun to characterize the complex microbial film that keeps skin healthy and resistant to infection. Dermal dysbiosis has now been associated with acne, psoriasis and psoriatic arthritis, and atopic dermatitis.
The 2-year pilot study compared the dermal microbiome of isotretinoin-treated acne patients with that of patients with untreated acne and normal skin. Skin samples underwent genomic analysis before isotretinoin treatment, at several periods during treatment, and about 5 months after treatment stopped. Untreated controls were evaluated at baseline and at 2, 5, and 10 months.
Not surprisingly, before treatment the microbiome was similar in both acne groups, but markedly different from that seen in normal skin. As isotretinoin’s “oil drought” dragged on, levels of Cutibacterium acnes (the new appellation for P. acnes) declined. Staphylococcus species initially increased, but then declined as well. Simultaneously, four new taxa (Rothia, Flavobacterium, Enterobacter, and Micrococcus) increased. Most patients had a restructuring of their Propionibacterium community, populated largely by the less-pathogenic strains found on normal skin.
“We suggest that isotretinoin creates a Propionibacterium ‘population bottleneck’ that selects for ‘healthy’ Propionibacterium communities and other sebaceous skin taxa that persist after treatment, resulting in long-term acne remission [i.e., normal skin],” the investigators wrote.
This is a new and very exciting finding, Dr. Gordon commented. “It appears that the reason our isotretinoin patients stay better once they get better is not from targeting the sebaceous gland itself, but by repairing the skin’s microbiome and getting it back to normal.”
Dr. Gordon reported financial relationships with numerous pharmaceutical companies. Global Academy and this news organization are owned by the same parent company.
This article was updated 2/1/19.
GRAND CAYMAN, CAYMAN ISLANDS – Isotretinoin, the go-to guy for severe acne, may not be so much a local cop as a community organizer, Kenneth B. Gordon, MD, said at the meeting provided by Global Academy for Medical Education.
“It now appears that with and that the microbial community is replenished with the types associated with healthy skin,” said Dr. Gordon, professor and chair of dermatology at the Medical College of Wisconsin, Milwaukee. When these new bacteria move in, they push pathogenic species out of the neighborhood “and create a new skin microbial community. Maybe this is the real reason our patients tend to stay better, once we get them better with isotretinoin.”
Dr. Gordon discussed new data published last October in the Journal of Investigative Dermatology (J Invest Dermatol. 2018 Oct 24. doi: 10.1016/j.jid.2018.09.023). In a letter to the editor, William H. McCoy, IV, MD, PhD, of Washington University, St. Louis, and his associates suggest that isotretinoin induces a “sebaceous drought,” which shifts the skin microbiome from pathogenic to normophysiological.
Isotretinoin is the gold standard treatment for severe acne, but its method of action has never been fully elucidated, Dr. Gordon said. It clearly targets the sebaceous gland – decreasing sebocyte proliferation and suppressing sebum production – but an emerging body of research suggests that the drug also markedly affects dermal microbial colonization.
The entire concept of a skin microbiome is nearly as new as this new concept of isotretinoin’s effect upon it. Only in the last few years have researchers begun to characterize the complex microbial film that keeps skin healthy and resistant to infection. Dermal dysbiosis has now been associated with acne, psoriasis and psoriatic arthritis, and atopic dermatitis.
The 2-year pilot study compared the dermal microbiome of isotretinoin-treated acne patients with that of patients with untreated acne and normal skin. Skin samples underwent genomic analysis before isotretinoin treatment, at several periods during treatment, and about 5 months after treatment stopped. Untreated controls were evaluated at baseline and at 2, 5, and 10 months.
Not surprisingly, before treatment the microbiome was similar in both acne groups, but markedly different from that seen in normal skin. As isotretinoin’s “oil drought” dragged on, levels of Cutibacterium acnes (the new appellation for P. acnes) declined. Staphylococcus species initially increased, but then declined as well. Simultaneously, four new taxa (Rothia, Flavobacterium, Enterobacter, and Micrococcus) increased. Most patients had a restructuring of their Propionibacterium community, populated largely by the less-pathogenic strains found on normal skin.
“We suggest that isotretinoin creates a Propionibacterium ‘population bottleneck’ that selects for ‘healthy’ Propionibacterium communities and other sebaceous skin taxa that persist after treatment, resulting in long-term acne remission [i.e., normal skin],” the investigators wrote.
This is a new and very exciting finding, Dr. Gordon commented. “It appears that the reason our isotretinoin patients stay better once they get better is not from targeting the sebaceous gland itself, but by repairing the skin’s microbiome and getting it back to normal.”
Dr. Gordon reported financial relationships with numerous pharmaceutical companies. Global Academy and this news organization are owned by the same parent company.
This article was updated 2/1/19.
REPORTING FROM THE CARIBBEAN DERMATOLOGY SYMPOSIUM
Suicide trends among youth on Medicaid
The risk for acute myeloid leukemia and myeloma is higher for breast cancer survivors, matched transplant improves stroke risk indicator in sickle cell anemia, and a diet low in free sugars shows some promise for adolescent non-alcoholic fatty liver disease.
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The risk for acute myeloid leukemia and myeloma is higher for breast cancer survivors, matched transplant improves stroke risk indicator in sickle cell anemia, and a diet low in free sugars shows some promise for adolescent non-alcoholic fatty liver disease.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
The risk for acute myeloid leukemia and myeloma is higher for breast cancer survivors, matched transplant improves stroke risk indicator in sickle cell anemia, and a diet low in free sugars shows some promise for adolescent non-alcoholic fatty liver disease.
Amazon Alexa
Apple Podcasts
Google Podcasts
Spotify
A Safe Treatment Switch for Patients With Prostate Cancer
Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?
Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.
Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%). Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.
The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.
Source:
Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.
doi: 10.1186/s12610-018-0074-2.
Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?
Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.
Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%). Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.
The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.
Source:
Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.
doi: 10.1186/s12610-018-0074-2.
Degarelix was developed as a novel gonadotropin-releasing hormone (GnRH) antagonist, with the aim of counteracting the testosterone surge often experienced with GnRH agonists. Degarelix blocks the GnRH receptors in the pituitary gland, rapidly reducing testosterone production, but the effects last only for a month. It is common practice to switch from degarelix to a GnRH agonist once the testosterone levels are down and stable. Degarelix is safe and effective for the short term, but what about the long term?
Researchers from Osaka City University and Bell Land General Hospital in Japan evaluated 5-year survival and time to castration-resistant prostate cancer (CRPC) in 108 patients with prostate cancer treated with degarelix. In the study, 57 patients were switched from degarelix to a GnRH agonist; 51 continued on degarelix.
Overall 5-year survival was high (89%) but statistically superior in the changed group (97% vs 74%). The 5-year cancer-specific survival also was longer in the changed group (100% vs 85%). Average time to CRCP was comparable in both groups (43 months in the changed group, 35 months in the continued group). The CRPC conversion did not reach the median at the time of data analysis. The median percentage decrease in prostate-specific antigen level for all patients treated with degarelix was 99.7%. The lowered levels were maintained even after switching to GnRH agonists.
The researchers say theirs is the first report of long-term data on degarelix and the first study to report that changing the treatment from a GnRH antagonist to a GnRH agonist did not affect the oncologic outcomes in patients with hormone-sensitive prostate cancer.
Source:
Asakawa J, Iguchi T, Tamada S, et al. Basic Clin Androl. 2018;28:9.
doi: 10.1186/s12610-018-0074-2.
Potential antidepressant overprescribing found in 24% of elderly cohort
Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.
In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). , 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.
Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).
Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.
“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”
The authors reported no conflicts of interest.
SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.
Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.
In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). , 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.
Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).
Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.
“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”
The authors reported no conflicts of interest.
SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.
Almost a quarter of an elderly U.S. population who were prescribed an antidepressant potentially received an overprescription, according to William V. Bobo, MD, MPH, of the Mayo Clinic in Jacksonville, Fla., and his associates.
In a study published in Pharmacology Research & Perspectives, the authors drew data from the Rochester Epidemiology Project and included 3,199 incident antidepressant prescriptions from adults aged at least 65 years who lived in Olmsted County, Minn., from 2005 to 2012. Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed medication (40%), followed by trazodone/nefazodone (20%), tricyclic antidepressants (16%), and mirtazapine (12%). , 22% were for nonspecific symptoms, and 21% were for general medical diagnoses, Dr. Bobo and his associates reported.
Potential antidepressant overprescribing occurred in 24% of all prescriptions; SSRIs were most commonly overprescribed, accounting for 74% of all overprescriptions, followed by mirtazapine (19%). Overprescription was most common when antidepressants were prescribed for nonspecific psychiatric symptoms (18%), compared with specific psychiatric indications (3.5%) and general medical diagnoses (2.5%).
Other factors associated with antidepressant overprescription included living in a nursing home, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, more commonly using urgent or acute care in the year prior to index prescription, and being prescribed antidepressants via telephone, email, or patient portal.
“Potential antidepressant overprescribing in a large cohort of elderly patients mainly involved the use of newer antidepressants for nonspecific psychiatric symptoms and indications,” the investigators wrote. “However, the majority of incident antidepressant starts did not represent potential overprescribing. When overprescribing occurred, it was associated with factors representing higher multimorbidity, clinical complexity, and severity – and with antidepressant prescribing that did not involve face-to-face interaction of patients with prescribers.”
The authors reported no conflicts of interest.
SOURCE: Bobo WV et al. Pharmacol Res Perspect. 2019 Jan 24. doi: 10.1002/prp2.461.
FROM PHARMACOLOGY RESEARCH & PERSPECTIVES
Growing cyst on face
The FP suspected this was more than just a simple cyst, and his differential diagnosis included basal cell carcinoma and squamous cell carcinoma (SCC). The FP advised the patient that a punch biopsy was needed to determine the diagnosis and that it was not possible to just remove the cyst. The patient consented to the biopsy, and the FP performed a 4-mm punch biopsy. (See the Watch & Learn video on “Punch biopsy.”)
The pathology showed an invasive SCC. Note that cutaneous SCCs can appear cystic on presentation. Due to the location and size of the SCC, the patient was referred to Head and Neck Surgery for resection of the tumor and flap repair. The temporal branch of the facial nerve was spared. And, while it appeared that the red lines radiating down the cheek from the tumor were lymphangitic spread, the pathology at the time of the tumor resection did not show this. The surgery achieved clear margins, and the patient recovered well.
On a follow-up visit, the FP performed a total body skin exam to look for other skin cancers and found none. He also counseled the patient on sun avoidance, the consistent use of a hat outdoors, and the use of sunscreen when exposed to the sun.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Karnes J, Usatine R. Squamous cell carcinoma. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:999-1007.
To learn more about the newest 3rd edition of the Color Atlas and Synopsis of Family Medicine, see: https://www.amazon.com/Color-Atlas-Synopsis-Family-Medicine/dp/1259862046/
You can get the Color Atlas of Family Medicine app by clicking on this link: usatinemedia.com
The FP suspected this was more than just a simple cyst, and his differential diagnosis included basal cell carcinoma and squamous cell carcinoma (SCC). The FP advised the patient that a punch biopsy was needed to determine the diagnosis and that it was not possible to just remove the cyst. The patient consented to the biopsy, and the FP performed a 4-mm punch biopsy. (See the Watch & Learn video on “Punch biopsy.”)
The pathology showed an invasive SCC. Note that cutaneous SCCs can appear cystic on presentation. Due to the location and size of the SCC, the patient was referred to Head and Neck Surgery for resection of the tumor and flap repair. The temporal branch of the facial nerve was spared. And, while it appeared that the red lines radiating down the cheek from the tumor were lymphangitic spread, the pathology at the time of the tumor resection did not show this. The surgery achieved clear margins, and the patient recovered well.
On a follow-up visit, the FP performed a total body skin exam to look for other skin cancers and found none. He also counseled the patient on sun avoidance, the consistent use of a hat outdoors, and the use of sunscreen when exposed to the sun.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Karnes J, Usatine R. Squamous cell carcinoma. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:999-1007.
To learn more about the newest 3rd edition of the Color Atlas and Synopsis of Family Medicine, see: https://www.amazon.com/Color-Atlas-Synopsis-Family-Medicine/dp/1259862046/
You can get the Color Atlas of Family Medicine app by clicking on this link: usatinemedia.com
The FP suspected this was more than just a simple cyst, and his differential diagnosis included basal cell carcinoma and squamous cell carcinoma (SCC). The FP advised the patient that a punch biopsy was needed to determine the diagnosis and that it was not possible to just remove the cyst. The patient consented to the biopsy, and the FP performed a 4-mm punch biopsy. (See the Watch & Learn video on “Punch biopsy.”)
The pathology showed an invasive SCC. Note that cutaneous SCCs can appear cystic on presentation. Due to the location and size of the SCC, the patient was referred to Head and Neck Surgery for resection of the tumor and flap repair. The temporal branch of the facial nerve was spared. And, while it appeared that the red lines radiating down the cheek from the tumor were lymphangitic spread, the pathology at the time of the tumor resection did not show this. The surgery achieved clear margins, and the patient recovered well.
On a follow-up visit, the FP performed a total body skin exam to look for other skin cancers and found none. He also counseled the patient on sun avoidance, the consistent use of a hat outdoors, and the use of sunscreen when exposed to the sun.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Karnes J, Usatine R. Squamous cell carcinoma. In: Usatine R, Smith M, Mayeaux EJ, et al. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:999-1007.
To learn more about the newest 3rd edition of the Color Atlas and Synopsis of Family Medicine, see: https://www.amazon.com/Color-Atlas-Synopsis-Family-Medicine/dp/1259862046/
You can get the Color Atlas of Family Medicine app by clicking on this link: usatinemedia.com
Stigma against gay fathers still common, especially in low-equality states
Gay men who become fathers still commonly experience barriers and stigma, but those living in states that offer legal protections experienced less stigma and fewer barriers, according to Ellen C. Perrin, MD, of Tufts Medical Center in Boston and her associates.
A total of 732 fathers living in 47 states, with 1,316 children (average age, 13 years), responded to a survey, they wrote in Pediatrics. More than 80% had a male partner, 64% had earned a bachelor degree or higher, and 81% were white and non-Hispanic.
In 35% of cases, children entered a family through adoption and/or foster care, 14% through the assistance of a pregnancy carrier or surrogate, and 39% through a heterosexual relationship. Families in states with fewer legal protections were more likely to have been formed through heterosexual relationships (odds ratio, 1.42; 95% confidence interval, 1.11-1.81), while families in states with a greater equality rating were more likely to have been formed through a pregnancy surrogate (OR, 1.41; 95% CI, 1.08-1.84). A total of 41% of fathers reported facing barriers to adoption, and 33% reported having difficulty arranging custody of children born in a heterosexual relationship.
Active stigma experienced by the fathers was most commonly experienced in a religious setting, reported by 35%, with other common sources including neighbors (28%), service providers (26%), family members (24%), gay friends (24%), the child’s school (18%), the workplace (16%), and in health care (11%). Children most often experienced active stigma by their friends (33%), followed by a religious setting (17%), school (16%), neighbors (15%), family (11%), and in health care settings (4%).
Active and avoidant stigma was more likely in states with a low equality rating, especially in religious settings and among family members and neighbors, the investigators noted.
“Given their important role as leaders in the community’s support for all families, pediatricians caring for children and their gay fathers should recognize the likelihood that stigma may be a part of the family’s experience and help both families and communities to counteract it. Pediatricians also have the opportunity to be leaders in opposing discrimination in religious and other community institutions,” Dr. Perrin and her associates wrote.
The study received funding from the Gil Foundation, the Arcus Foundation, and private donations. The study authors reported no relevant financial disclosures or conflicts of interest.
SOURCE: Perrin EC et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-0683.
Gay men who become fathers still commonly experience barriers and stigma, but those living in states that offer legal protections experienced less stigma and fewer barriers, according to Ellen C. Perrin, MD, of Tufts Medical Center in Boston and her associates.
A total of 732 fathers living in 47 states, with 1,316 children (average age, 13 years), responded to a survey, they wrote in Pediatrics. More than 80% had a male partner, 64% had earned a bachelor degree or higher, and 81% were white and non-Hispanic.
In 35% of cases, children entered a family through adoption and/or foster care, 14% through the assistance of a pregnancy carrier or surrogate, and 39% through a heterosexual relationship. Families in states with fewer legal protections were more likely to have been formed through heterosexual relationships (odds ratio, 1.42; 95% confidence interval, 1.11-1.81), while families in states with a greater equality rating were more likely to have been formed through a pregnancy surrogate (OR, 1.41; 95% CI, 1.08-1.84). A total of 41% of fathers reported facing barriers to adoption, and 33% reported having difficulty arranging custody of children born in a heterosexual relationship.
Active stigma experienced by the fathers was most commonly experienced in a religious setting, reported by 35%, with other common sources including neighbors (28%), service providers (26%), family members (24%), gay friends (24%), the child’s school (18%), the workplace (16%), and in health care (11%). Children most often experienced active stigma by their friends (33%), followed by a religious setting (17%), school (16%), neighbors (15%), family (11%), and in health care settings (4%).
Active and avoidant stigma was more likely in states with a low equality rating, especially in religious settings and among family members and neighbors, the investigators noted.
“Given their important role as leaders in the community’s support for all families, pediatricians caring for children and their gay fathers should recognize the likelihood that stigma may be a part of the family’s experience and help both families and communities to counteract it. Pediatricians also have the opportunity to be leaders in opposing discrimination in religious and other community institutions,” Dr. Perrin and her associates wrote.
The study received funding from the Gil Foundation, the Arcus Foundation, and private donations. The study authors reported no relevant financial disclosures or conflicts of interest.
SOURCE: Perrin EC et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-0683.
Gay men who become fathers still commonly experience barriers and stigma, but those living in states that offer legal protections experienced less stigma and fewer barriers, according to Ellen C. Perrin, MD, of Tufts Medical Center in Boston and her associates.
A total of 732 fathers living in 47 states, with 1,316 children (average age, 13 years), responded to a survey, they wrote in Pediatrics. More than 80% had a male partner, 64% had earned a bachelor degree or higher, and 81% were white and non-Hispanic.
In 35% of cases, children entered a family through adoption and/or foster care, 14% through the assistance of a pregnancy carrier or surrogate, and 39% through a heterosexual relationship. Families in states with fewer legal protections were more likely to have been formed through heterosexual relationships (odds ratio, 1.42; 95% confidence interval, 1.11-1.81), while families in states with a greater equality rating were more likely to have been formed through a pregnancy surrogate (OR, 1.41; 95% CI, 1.08-1.84). A total of 41% of fathers reported facing barriers to adoption, and 33% reported having difficulty arranging custody of children born in a heterosexual relationship.
Active stigma experienced by the fathers was most commonly experienced in a religious setting, reported by 35%, with other common sources including neighbors (28%), service providers (26%), family members (24%), gay friends (24%), the child’s school (18%), the workplace (16%), and in health care (11%). Children most often experienced active stigma by their friends (33%), followed by a religious setting (17%), school (16%), neighbors (15%), family (11%), and in health care settings (4%).
Active and avoidant stigma was more likely in states with a low equality rating, especially in religious settings and among family members and neighbors, the investigators noted.
“Given their important role as leaders in the community’s support for all families, pediatricians caring for children and their gay fathers should recognize the likelihood that stigma may be a part of the family’s experience and help both families and communities to counteract it. Pediatricians also have the opportunity to be leaders in opposing discrimination in religious and other community institutions,” Dr. Perrin and her associates wrote.
The study received funding from the Gil Foundation, the Arcus Foundation, and private donations. The study authors reported no relevant financial disclosures or conflicts of interest.
SOURCE: Perrin EC et al. Pediatrics. 2019 Jan 14. doi: 10.1542/peds.2018-0683.
FROM PEDIATRICS
Products being developed for AKs therapy may appeal to patients
GRAND CAYMAN, CAYMAN ISLANDS – It’s unanimous: Patients with actinic keratoses (AKs) want them to go away quickly, painlessly, and pretty much invisibly. In fact, they’d rather risk developing cancer than deal with weeks of painful, red, oozing crusts.
But unless Ronco comes up with the AK-Away Wand, dermatologists and patients have to face facts, Theodore Rosen, MD, said at the Caribbean Dermatology Symposium, provided by Global Academy for Medical Education.
“Some AKs are going to just go away, and some are going to just sit there unchanging. Not all AKs are going to turn into squamous cell cancer. But you can’t tell which ones will, and because you can’t predict, they should all be treated. It’s our job to make patients care about this.”
That job starts with the very first conversation, said Dr. Rosen, professor of dermatology, Baylor University, Houston. “The way you frame the information at the very beginning is so important. You have to get the word ‘cancer’ in there.”
Most patients don’t fully grasp the serious threat that a transformed AK can pose, as illustrated by a survey of patients at the Milton S. Hershey Medical Center in Hershey, Pa.. The survey also highlighted the importance of the first discussion with the physician. Almost 550 dermatology clinic patients completed the survey, which presented five AK treatment decision scenarios, asking patients how likely they would be to pursue treatment in each situation (JAMA Dermatol. 2017;153[5]:421-6). Each scenario was factual, but the emphasis on facts varied. The first four questions characterized the lesions as sun damage and stressed the low incidence of malignant transformation (0.5%), and the large percentage that remain unchanged (75%) and spontaneously disappear (25%).
The last question was much simpler and more direct: “Actinic keratoses are precancers. Based on this statement, how likely are you to want treatment?”
“When AK was presented without the word ‘cancer’ in the description, there were lower proportions of individuals who said they would want to receive treatment [about 60%],” Dr. Rosen said. “Presenting AK as a precancer had the highest proportion of patients saying they would prefer treatment – about 92%.”
But current treatments aren’t ideal, at least from the standpoint of patients who prefer fast results with a minimum of erythema, oozing, crusting, and pain. Dr. Rosen looked into his crystal ball and saw a few encouraging treatment options coming down the drug development pike. To make it past regulatory hurdles, though, any new treatment has to hit the sweet spot of approximately 80% lesion clearance, with less than 40% recurrence at 1 year. Whether these investigational protocols can complete that journey remains to be seen.
VDA-1102
VDA-1102, in an ointment formulation, is based on a stress response chemical found in the jasmine plant. It contains a synthetic derivative of methyl jasmonate, a plant stress hormone found in jasmine. According to the patent record for VDA-1102, jasmonates are released in extreme ultraviolet radiation, osmotic shock, heat shock, and pathogen attack to initiate injury response and repair cascades.
The drug stops tumor growth by inhibiting glycolysis; it removes hexokinase 2 (HK2) from mitochondria. HK2 is found only in malignant cells; normal cells have the hexokinase 1 variant. Hexokinase is a key modulator of the transformation of adenosine triphosphate to adenosine diphosphate. As an HK2 modulator, VDA-1102 should, therefore, only induce apoptosis in the malignant cells, Dr. Rosen said.
“In preclinical studies in a hairless mouse model, they were approaching that 80% mark with lesion regression.” But the drug doesn’t induce necrosis or inflammation – a huge plus for patients. “There’s almost nothing in terms of redness, scaling, inflammation, or pain. This could be a really attractive addition to the AK toolkit. Improved aesthetics during treatment translates into improved patient willingness to undergo recurrent treatments. It may also be useful for treating large fields of AK, and in immunosuppressed patients.”
An Israeli company, Vidac Pharma, is conducting a phase 2b study of 150 patients with AK. The big question? Duration of effect – something that can’t be determined in the 21-week study. The company is aiming to launch a phase 3 trial next year.
KX-01
KX-01 (formerly KX2-391), being developed by Athenex, is a dual-action anticancer agent compounded into a 1% ointment. It inhibits both Src kinase and tubulin polymerization. Src regulates several signaling pathways in tumor cells, including proliferation, survival, migration, invasion, and angiogenesis. Tubulin formation is critical for cell replication: Without tubulin polymerization, mitotic spindles can’t form.
The drug passed two phase 3 studies (NCT03285477 and NCT03285490) with flying colors last year, clearing 100% of AK lesions by day 57 when used as field therapy on the head and neck. The studies comprised 702 subjects who applied the active ointment or vehicle once daily for 5 days.
“Local skin reactions were very low and resolved very quickly,” Dr. Rosen said. “But we don’t have any longterm data yet ... we need the 1-year clearance rate to see if it falls in that 40% sweet spot.”
Dr. Rosen disclosed being a consultant for Valeant (Ortho) and Cutanea Life Sciences.
Global Academy and this news organization are owned by the same parent company.
GRAND CAYMAN, CAYMAN ISLANDS – It’s unanimous: Patients with actinic keratoses (AKs) want them to go away quickly, painlessly, and pretty much invisibly. In fact, they’d rather risk developing cancer than deal with weeks of painful, red, oozing crusts.
But unless Ronco comes up with the AK-Away Wand, dermatologists and patients have to face facts, Theodore Rosen, MD, said at the Caribbean Dermatology Symposium, provided by Global Academy for Medical Education.
“Some AKs are going to just go away, and some are going to just sit there unchanging. Not all AKs are going to turn into squamous cell cancer. But you can’t tell which ones will, and because you can’t predict, they should all be treated. It’s our job to make patients care about this.”
That job starts with the very first conversation, said Dr. Rosen, professor of dermatology, Baylor University, Houston. “The way you frame the information at the very beginning is so important. You have to get the word ‘cancer’ in there.”
Most patients don’t fully grasp the serious threat that a transformed AK can pose, as illustrated by a survey of patients at the Milton S. Hershey Medical Center in Hershey, Pa.. The survey also highlighted the importance of the first discussion with the physician. Almost 550 dermatology clinic patients completed the survey, which presented five AK treatment decision scenarios, asking patients how likely they would be to pursue treatment in each situation (JAMA Dermatol. 2017;153[5]:421-6). Each scenario was factual, but the emphasis on facts varied. The first four questions characterized the lesions as sun damage and stressed the low incidence of malignant transformation (0.5%), and the large percentage that remain unchanged (75%) and spontaneously disappear (25%).
The last question was much simpler and more direct: “Actinic keratoses are precancers. Based on this statement, how likely are you to want treatment?”
“When AK was presented without the word ‘cancer’ in the description, there were lower proportions of individuals who said they would want to receive treatment [about 60%],” Dr. Rosen said. “Presenting AK as a precancer had the highest proportion of patients saying they would prefer treatment – about 92%.”
But current treatments aren’t ideal, at least from the standpoint of patients who prefer fast results with a minimum of erythema, oozing, crusting, and pain. Dr. Rosen looked into his crystal ball and saw a few encouraging treatment options coming down the drug development pike. To make it past regulatory hurdles, though, any new treatment has to hit the sweet spot of approximately 80% lesion clearance, with less than 40% recurrence at 1 year. Whether these investigational protocols can complete that journey remains to be seen.
VDA-1102
VDA-1102, in an ointment formulation, is based on a stress response chemical found in the jasmine plant. It contains a synthetic derivative of methyl jasmonate, a plant stress hormone found in jasmine. According to the patent record for VDA-1102, jasmonates are released in extreme ultraviolet radiation, osmotic shock, heat shock, and pathogen attack to initiate injury response and repair cascades.
The drug stops tumor growth by inhibiting glycolysis; it removes hexokinase 2 (HK2) from mitochondria. HK2 is found only in malignant cells; normal cells have the hexokinase 1 variant. Hexokinase is a key modulator of the transformation of adenosine triphosphate to adenosine diphosphate. As an HK2 modulator, VDA-1102 should, therefore, only induce apoptosis in the malignant cells, Dr. Rosen said.
“In preclinical studies in a hairless mouse model, they were approaching that 80% mark with lesion regression.” But the drug doesn’t induce necrosis or inflammation – a huge plus for patients. “There’s almost nothing in terms of redness, scaling, inflammation, or pain. This could be a really attractive addition to the AK toolkit. Improved aesthetics during treatment translates into improved patient willingness to undergo recurrent treatments. It may also be useful for treating large fields of AK, and in immunosuppressed patients.”
An Israeli company, Vidac Pharma, is conducting a phase 2b study of 150 patients with AK. The big question? Duration of effect – something that can’t be determined in the 21-week study. The company is aiming to launch a phase 3 trial next year.
KX-01
KX-01 (formerly KX2-391), being developed by Athenex, is a dual-action anticancer agent compounded into a 1% ointment. It inhibits both Src kinase and tubulin polymerization. Src regulates several signaling pathways in tumor cells, including proliferation, survival, migration, invasion, and angiogenesis. Tubulin formation is critical for cell replication: Without tubulin polymerization, mitotic spindles can’t form.
The drug passed two phase 3 studies (NCT03285477 and NCT03285490) with flying colors last year, clearing 100% of AK lesions by day 57 when used as field therapy on the head and neck. The studies comprised 702 subjects who applied the active ointment or vehicle once daily for 5 days.
“Local skin reactions were very low and resolved very quickly,” Dr. Rosen said. “But we don’t have any longterm data yet ... we need the 1-year clearance rate to see if it falls in that 40% sweet spot.”
Dr. Rosen disclosed being a consultant for Valeant (Ortho) and Cutanea Life Sciences.
Global Academy and this news organization are owned by the same parent company.
GRAND CAYMAN, CAYMAN ISLANDS – It’s unanimous: Patients with actinic keratoses (AKs) want them to go away quickly, painlessly, and pretty much invisibly. In fact, they’d rather risk developing cancer than deal with weeks of painful, red, oozing crusts.
But unless Ronco comes up with the AK-Away Wand, dermatologists and patients have to face facts, Theodore Rosen, MD, said at the Caribbean Dermatology Symposium, provided by Global Academy for Medical Education.
“Some AKs are going to just go away, and some are going to just sit there unchanging. Not all AKs are going to turn into squamous cell cancer. But you can’t tell which ones will, and because you can’t predict, they should all be treated. It’s our job to make patients care about this.”
That job starts with the very first conversation, said Dr. Rosen, professor of dermatology, Baylor University, Houston. “The way you frame the information at the very beginning is so important. You have to get the word ‘cancer’ in there.”
Most patients don’t fully grasp the serious threat that a transformed AK can pose, as illustrated by a survey of patients at the Milton S. Hershey Medical Center in Hershey, Pa.. The survey also highlighted the importance of the first discussion with the physician. Almost 550 dermatology clinic patients completed the survey, which presented five AK treatment decision scenarios, asking patients how likely they would be to pursue treatment in each situation (JAMA Dermatol. 2017;153[5]:421-6). Each scenario was factual, but the emphasis on facts varied. The first four questions characterized the lesions as sun damage and stressed the low incidence of malignant transformation (0.5%), and the large percentage that remain unchanged (75%) and spontaneously disappear (25%).
The last question was much simpler and more direct: “Actinic keratoses are precancers. Based on this statement, how likely are you to want treatment?”
“When AK was presented without the word ‘cancer’ in the description, there were lower proportions of individuals who said they would want to receive treatment [about 60%],” Dr. Rosen said. “Presenting AK as a precancer had the highest proportion of patients saying they would prefer treatment – about 92%.”
But current treatments aren’t ideal, at least from the standpoint of patients who prefer fast results with a minimum of erythema, oozing, crusting, and pain. Dr. Rosen looked into his crystal ball and saw a few encouraging treatment options coming down the drug development pike. To make it past regulatory hurdles, though, any new treatment has to hit the sweet spot of approximately 80% lesion clearance, with less than 40% recurrence at 1 year. Whether these investigational protocols can complete that journey remains to be seen.
VDA-1102
VDA-1102, in an ointment formulation, is based on a stress response chemical found in the jasmine plant. It contains a synthetic derivative of methyl jasmonate, a plant stress hormone found in jasmine. According to the patent record for VDA-1102, jasmonates are released in extreme ultraviolet radiation, osmotic shock, heat shock, and pathogen attack to initiate injury response and repair cascades.
The drug stops tumor growth by inhibiting glycolysis; it removes hexokinase 2 (HK2) from mitochondria. HK2 is found only in malignant cells; normal cells have the hexokinase 1 variant. Hexokinase is a key modulator of the transformation of adenosine triphosphate to adenosine diphosphate. As an HK2 modulator, VDA-1102 should, therefore, only induce apoptosis in the malignant cells, Dr. Rosen said.
“In preclinical studies in a hairless mouse model, they were approaching that 80% mark with lesion regression.” But the drug doesn’t induce necrosis or inflammation – a huge plus for patients. “There’s almost nothing in terms of redness, scaling, inflammation, or pain. This could be a really attractive addition to the AK toolkit. Improved aesthetics during treatment translates into improved patient willingness to undergo recurrent treatments. It may also be useful for treating large fields of AK, and in immunosuppressed patients.”
An Israeli company, Vidac Pharma, is conducting a phase 2b study of 150 patients with AK. The big question? Duration of effect – something that can’t be determined in the 21-week study. The company is aiming to launch a phase 3 trial next year.
KX-01
KX-01 (formerly KX2-391), being developed by Athenex, is a dual-action anticancer agent compounded into a 1% ointment. It inhibits both Src kinase and tubulin polymerization. Src regulates several signaling pathways in tumor cells, including proliferation, survival, migration, invasion, and angiogenesis. Tubulin formation is critical for cell replication: Without tubulin polymerization, mitotic spindles can’t form.
The drug passed two phase 3 studies (NCT03285477 and NCT03285490) with flying colors last year, clearing 100% of AK lesions by day 57 when used as field therapy on the head and neck. The studies comprised 702 subjects who applied the active ointment or vehicle once daily for 5 days.
“Local skin reactions were very low and resolved very quickly,” Dr. Rosen said. “But we don’t have any longterm data yet ... we need the 1-year clearance rate to see if it falls in that 40% sweet spot.”
Dr. Rosen disclosed being a consultant for Valeant (Ortho) and Cutanea Life Sciences.
Global Academy and this news organization are owned by the same parent company.
REPORTING FROM CARIBBEAN DERMATOLOGY SYMPOSIUM
Gametes for back pain, Alice in Wonderland syndrome, and liver-saving beer
A case of emission and injection
In what might win “Most Bizarre Attempt at Home Medicine” of 2019, a 33-year-old Irish man was hospitalized after injecting himself with his own semen … in his arm … multiple times … to reduce back pain. Whew. Does this count as holistic medicine?
This at-home remedy did not cure his back pain, shockingly enough. The patient instead developed a subcutaneous abscess after a year and a half of monthly intramuscular and intravenous injections, during which the semen has leaked into the soft tissues. He reported to a Dublin hospital after suffering severe back pain and a swollen arm, and eventually revealed to doctors his miracle cure.
The doctors did some Googling and found studies where rats and rabbits were injected with semen – possibly the research that inspired this trailblazer. Or, possibly, this was just an extreme case of reduce, reuse, and recycle.
In case you’re concerned, the man was given a course of more traditional medicine, and his back pain improved greatly. The patient chose to discharge himself before doctors could drain the “local collection” – perhaps he was proud of his work.
Down the rabbit hole
Imagine sitting at your computer when suddenly the icons begin to move off the screen and hover directly in front of your eyes. Your first thought might be that someone spiked your morning coffee with acid – and you’re not far off.
This curious occurrence happened to a 54-year-old man who was diagnosed with the rare perceptual disorder Alice in Wonderland syndrome (AIWS). AIWS causes people to develop a misperception of their body or surrounding space, and can be caused by a number of things, including migraine.
In this case, the man’s LSD-like visions were caused by a glioblastoma in the left temporal-occipital region of the brain. Tumors there can interfere with spatial perception, hence the temporary trip down the rabbit hole for this patient. After chemotherapy and radiation, the tumor was defeated, and the patient is back to feeling happier than the Mad Hatter at a tea party.
Must have been some party
On Dec. 25 in the Vietnamese province of Quang Tri, a 48-year-old man was taken to a hospital with a case of alcohol poisoning. Specifically, his body contained more than 1,000 times the recommended limit of methanol.
While the two types of alcohol, ethanol and methanol, are both toxic to the human body to some degree, the liver processes methanol differently and more slowly, making it far more dangerous than ethanol, the key ingredient in commercially available alcoholic beverages. Methanol is found in bootleg liquor and in such products as gasoline, paint, ink, and cleaning products. It can cause blindness, nervous system depression, and death.
However, there is a happy ending to this story. To save their patient’s life, his doctors hit upon an ingenious solution – one that would make Homer Simpson proud.
They administered cans of beer.
When the man was admitted, the doctors immediately gave him 3 cans’ worth, and then transfused an additional 12 at the rate of 1 can per hour. The liver will always prioritize processing ethanol over methanol. By feeding the patient a steady stream of relatively friendly and ethanol-rich beer, the doctors had enough time to perform dialysis and remove the methanol from the man’s system.
So, as Homer himself might declare, here’s to alcohol – truly the cause of, and solution to, all of life’s problems.
A mistake of the bloody type
Nurse: Mr. Smeggins, I need to clear up some of the answers on your new-patient information form.
Patient: I filled the whole thing out, didn’t I?
Nurse: You did, but a couple of your responses are less than helpful. You do realize that “Helvetica” is not a blood type, right?
Patient: I took a stab at it.
Nurse: You’re not the only one. It turns out that 43% of adults don’t know their blood type, and 62% don’t know their cholesterol level, according to a recent survey by Quest Diagnostics. The 1,004 respondents were more likely to know their bank account balances (75%) or their wifi passwords (74%).
Patient: Hey, that’s right! Mine is Earwiglover122.
Nurse: Great. And can I assume that you’re one of the 30% or so supposedly Web-savvy millennials (ages 20-37 years) who keep lab results in a filing cabinet at home?
Patient: Actually, I have a pile for stuff like that.
Nurse: Fine. Now about your other answers. When we asked about sex, we were not looking for “just last night.”
A case of emission and injection
In what might win “Most Bizarre Attempt at Home Medicine” of 2019, a 33-year-old Irish man was hospitalized after injecting himself with his own semen … in his arm … multiple times … to reduce back pain. Whew. Does this count as holistic medicine?
This at-home remedy did not cure his back pain, shockingly enough. The patient instead developed a subcutaneous abscess after a year and a half of monthly intramuscular and intravenous injections, during which the semen has leaked into the soft tissues. He reported to a Dublin hospital after suffering severe back pain and a swollen arm, and eventually revealed to doctors his miracle cure.
The doctors did some Googling and found studies where rats and rabbits were injected with semen – possibly the research that inspired this trailblazer. Or, possibly, this was just an extreme case of reduce, reuse, and recycle.
In case you’re concerned, the man was given a course of more traditional medicine, and his back pain improved greatly. The patient chose to discharge himself before doctors could drain the “local collection” – perhaps he was proud of his work.
Down the rabbit hole
Imagine sitting at your computer when suddenly the icons begin to move off the screen and hover directly in front of your eyes. Your first thought might be that someone spiked your morning coffee with acid – and you’re not far off.
This curious occurrence happened to a 54-year-old man who was diagnosed with the rare perceptual disorder Alice in Wonderland syndrome (AIWS). AIWS causes people to develop a misperception of their body or surrounding space, and can be caused by a number of things, including migraine.
In this case, the man’s LSD-like visions were caused by a glioblastoma in the left temporal-occipital region of the brain. Tumors there can interfere with spatial perception, hence the temporary trip down the rabbit hole for this patient. After chemotherapy and radiation, the tumor was defeated, and the patient is back to feeling happier than the Mad Hatter at a tea party.
Must have been some party
On Dec. 25 in the Vietnamese province of Quang Tri, a 48-year-old man was taken to a hospital with a case of alcohol poisoning. Specifically, his body contained more than 1,000 times the recommended limit of methanol.
While the two types of alcohol, ethanol and methanol, are both toxic to the human body to some degree, the liver processes methanol differently and more slowly, making it far more dangerous than ethanol, the key ingredient in commercially available alcoholic beverages. Methanol is found in bootleg liquor and in such products as gasoline, paint, ink, and cleaning products. It can cause blindness, nervous system depression, and death.
However, there is a happy ending to this story. To save their patient’s life, his doctors hit upon an ingenious solution – one that would make Homer Simpson proud.
They administered cans of beer.
When the man was admitted, the doctors immediately gave him 3 cans’ worth, and then transfused an additional 12 at the rate of 1 can per hour. The liver will always prioritize processing ethanol over methanol. By feeding the patient a steady stream of relatively friendly and ethanol-rich beer, the doctors had enough time to perform dialysis and remove the methanol from the man’s system.
So, as Homer himself might declare, here’s to alcohol – truly the cause of, and solution to, all of life’s problems.
A mistake of the bloody type
Nurse: Mr. Smeggins, I need to clear up some of the answers on your new-patient information form.
Patient: I filled the whole thing out, didn’t I?
Nurse: You did, but a couple of your responses are less than helpful. You do realize that “Helvetica” is not a blood type, right?
Patient: I took a stab at it.
Nurse: You’re not the only one. It turns out that 43% of adults don’t know their blood type, and 62% don’t know their cholesterol level, according to a recent survey by Quest Diagnostics. The 1,004 respondents were more likely to know their bank account balances (75%) or their wifi passwords (74%).
Patient: Hey, that’s right! Mine is Earwiglover122.
Nurse: Great. And can I assume that you’re one of the 30% or so supposedly Web-savvy millennials (ages 20-37 years) who keep lab results in a filing cabinet at home?
Patient: Actually, I have a pile for stuff like that.
Nurse: Fine. Now about your other answers. When we asked about sex, we were not looking for “just last night.”
A case of emission and injection
In what might win “Most Bizarre Attempt at Home Medicine” of 2019, a 33-year-old Irish man was hospitalized after injecting himself with his own semen … in his arm … multiple times … to reduce back pain. Whew. Does this count as holistic medicine?
This at-home remedy did not cure his back pain, shockingly enough. The patient instead developed a subcutaneous abscess after a year and a half of monthly intramuscular and intravenous injections, during which the semen has leaked into the soft tissues. He reported to a Dublin hospital after suffering severe back pain and a swollen arm, and eventually revealed to doctors his miracle cure.
The doctors did some Googling and found studies where rats and rabbits were injected with semen – possibly the research that inspired this trailblazer. Or, possibly, this was just an extreme case of reduce, reuse, and recycle.
In case you’re concerned, the man was given a course of more traditional medicine, and his back pain improved greatly. The patient chose to discharge himself before doctors could drain the “local collection” – perhaps he was proud of his work.
Down the rabbit hole
Imagine sitting at your computer when suddenly the icons begin to move off the screen and hover directly in front of your eyes. Your first thought might be that someone spiked your morning coffee with acid – and you’re not far off.
This curious occurrence happened to a 54-year-old man who was diagnosed with the rare perceptual disorder Alice in Wonderland syndrome (AIWS). AIWS causes people to develop a misperception of their body or surrounding space, and can be caused by a number of things, including migraine.
In this case, the man’s LSD-like visions were caused by a glioblastoma in the left temporal-occipital region of the brain. Tumors there can interfere with spatial perception, hence the temporary trip down the rabbit hole for this patient. After chemotherapy and radiation, the tumor was defeated, and the patient is back to feeling happier than the Mad Hatter at a tea party.
Must have been some party
On Dec. 25 in the Vietnamese province of Quang Tri, a 48-year-old man was taken to a hospital with a case of alcohol poisoning. Specifically, his body contained more than 1,000 times the recommended limit of methanol.
While the two types of alcohol, ethanol and methanol, are both toxic to the human body to some degree, the liver processes methanol differently and more slowly, making it far more dangerous than ethanol, the key ingredient in commercially available alcoholic beverages. Methanol is found in bootleg liquor and in such products as gasoline, paint, ink, and cleaning products. It can cause blindness, nervous system depression, and death.
However, there is a happy ending to this story. To save their patient’s life, his doctors hit upon an ingenious solution – one that would make Homer Simpson proud.
They administered cans of beer.
When the man was admitted, the doctors immediately gave him 3 cans’ worth, and then transfused an additional 12 at the rate of 1 can per hour. The liver will always prioritize processing ethanol over methanol. By feeding the patient a steady stream of relatively friendly and ethanol-rich beer, the doctors had enough time to perform dialysis and remove the methanol from the man’s system.
So, as Homer himself might declare, here’s to alcohol – truly the cause of, and solution to, all of life’s problems.
A mistake of the bloody type
Nurse: Mr. Smeggins, I need to clear up some of the answers on your new-patient information form.
Patient: I filled the whole thing out, didn’t I?
Nurse: You did, but a couple of your responses are less than helpful. You do realize that “Helvetica” is not a blood type, right?
Patient: I took a stab at it.
Nurse: You’re not the only one. It turns out that 43% of adults don’t know their blood type, and 62% don’t know their cholesterol level, according to a recent survey by Quest Diagnostics. The 1,004 respondents were more likely to know their bank account balances (75%) or their wifi passwords (74%).
Patient: Hey, that’s right! Mine is Earwiglover122.
Nurse: Great. And can I assume that you’re one of the 30% or so supposedly Web-savvy millennials (ages 20-37 years) who keep lab results in a filing cabinet at home?
Patient: Actually, I have a pile for stuff like that.
Nurse: Fine. Now about your other answers. When we asked about sex, we were not looking for “just last night.”
#Patients looking for #clinicaltrials
I just hung up with a friend I haven’t seen in decades. Her father has advanced cancer, and while she does not have formal medical training, a passerby wouldn’t know it. Her questions are spot on, her resources are peer reviewed and validated, and her questions I’d more likely expect from trainees in a formal oncology training program than from the director of an elementary level tutoring service.
Her father is fortunately doing well, but she’s searching for the next plan for when the standard drugs ultimately fail. We know they will fail. She’s connected to patient advocacy groups, emailing physicians across the country, and looking into clinical trials with their exhaustive lists of exclusion criteria. She sees the logistic difficulties with trials far from home. She’s hit the key issues we face every day in clinical research, and she’s never stepped foot in a medical school lecture hall.
Amazingly her story is not unique. When cancer hits close to home is when these problems become very clear. This same story could easily have been retold as the narrative of former Vice President Joe Biden and his care for his son. Both my friend and Mr. Biden, in fact, asked me the same question: How do we get the cutting-edge science from major research centers out to the rest of the country?
The Cancer Moonshot initiative has done much to promote collaboration, but one major success has been in the Count Me In initiative, a partnership between the Biden Cancer Initiative, Emerson Collective, the Broad Institute, and the Dana-Farber Cancer Institute. Their goal is to gain access to thousands of patients, collect data on treatment and outcomes, and collect biological specimens. They are not alone, the MSK-IMPACT initiative – led by David B. Solit, MD, at my institution – aims to sequence rare cancers. Both programs have heavily leveraged social media to access and engage patients.
There are of course concerns. Coming from hundreds or thousands of different sites will mean the data will likely be heterogeneous in formatting and quality. How do we ensure the security of patient data? Can we rely on patients and family members to report accurately and without bias? We know there are challenges and upside to crowdsourced patient recruitment.
David Ginsburg, MD, Karl Desch, MD, and colleagues enrolled more than 1,000 students from the University of Michigan to participate in a study on blood clotting factors. This led to many important findings on the genetic basis for coagulopathies, but also was instructive in uncovering a worrisome aspect of online patient registration. The group recorded the time taken for registrants to read the consent form – including whether the participant clicked a hyperlink that was embedded. Nearly a quarter of participants accepted the terms of the 2,833-word document in less than 10 seconds, and less than 3% clicked the hyperlink (Ann Intern Med. 2011 Sep 6;155[5]:316-22).
Are these patients, who we are asking for their partnership and trust, really understanding to what they are agreeing?
Surely there is tremendous altruism on the part of these patients. Their hopes of helping the future of cancer care does have a real track record. Crowdsourcing efforts that were less far reaching in scope made substantial impact in discovering the genetic basis for polycythemia vera. The patients, contacted largely through printed newspaper ads, have helped millions of others. What will happen when we add in the power of social media will be exciting to see – and there is something else that comes with great power, but since I can’t seem to remember what that is, I’ll just search online.
Dr. Viny is with the Memorial Sloan-Kettering Cancer Center, N.Y., where he is an assistant attending physician on the leukemia service and is a clinical researcher in the Ross Levine Lab. Follow him on Twitter @TheDoctorIsVin.
I just hung up with a friend I haven’t seen in decades. Her father has advanced cancer, and while she does not have formal medical training, a passerby wouldn’t know it. Her questions are spot on, her resources are peer reviewed and validated, and her questions I’d more likely expect from trainees in a formal oncology training program than from the director of an elementary level tutoring service.
Her father is fortunately doing well, but she’s searching for the next plan for when the standard drugs ultimately fail. We know they will fail. She’s connected to patient advocacy groups, emailing physicians across the country, and looking into clinical trials with their exhaustive lists of exclusion criteria. She sees the logistic difficulties with trials far from home. She’s hit the key issues we face every day in clinical research, and she’s never stepped foot in a medical school lecture hall.
Amazingly her story is not unique. When cancer hits close to home is when these problems become very clear. This same story could easily have been retold as the narrative of former Vice President Joe Biden and his care for his son. Both my friend and Mr. Biden, in fact, asked me the same question: How do we get the cutting-edge science from major research centers out to the rest of the country?
The Cancer Moonshot initiative has done much to promote collaboration, but one major success has been in the Count Me In initiative, a partnership between the Biden Cancer Initiative, Emerson Collective, the Broad Institute, and the Dana-Farber Cancer Institute. Their goal is to gain access to thousands of patients, collect data on treatment and outcomes, and collect biological specimens. They are not alone, the MSK-IMPACT initiative – led by David B. Solit, MD, at my institution – aims to sequence rare cancers. Both programs have heavily leveraged social media to access and engage patients.
There are of course concerns. Coming from hundreds or thousands of different sites will mean the data will likely be heterogeneous in formatting and quality. How do we ensure the security of patient data? Can we rely on patients and family members to report accurately and without bias? We know there are challenges and upside to crowdsourced patient recruitment.
David Ginsburg, MD, Karl Desch, MD, and colleagues enrolled more than 1,000 students from the University of Michigan to participate in a study on blood clotting factors. This led to many important findings on the genetic basis for coagulopathies, but also was instructive in uncovering a worrisome aspect of online patient registration. The group recorded the time taken for registrants to read the consent form – including whether the participant clicked a hyperlink that was embedded. Nearly a quarter of participants accepted the terms of the 2,833-word document in less than 10 seconds, and less than 3% clicked the hyperlink (Ann Intern Med. 2011 Sep 6;155[5]:316-22).
Are these patients, who we are asking for their partnership and trust, really understanding to what they are agreeing?
Surely there is tremendous altruism on the part of these patients. Their hopes of helping the future of cancer care does have a real track record. Crowdsourcing efforts that were less far reaching in scope made substantial impact in discovering the genetic basis for polycythemia vera. The patients, contacted largely through printed newspaper ads, have helped millions of others. What will happen when we add in the power of social media will be exciting to see – and there is something else that comes with great power, but since I can’t seem to remember what that is, I’ll just search online.
Dr. Viny is with the Memorial Sloan-Kettering Cancer Center, N.Y., where he is an assistant attending physician on the leukemia service and is a clinical researcher in the Ross Levine Lab. Follow him on Twitter @TheDoctorIsVin.
I just hung up with a friend I haven’t seen in decades. Her father has advanced cancer, and while she does not have formal medical training, a passerby wouldn’t know it. Her questions are spot on, her resources are peer reviewed and validated, and her questions I’d more likely expect from trainees in a formal oncology training program than from the director of an elementary level tutoring service.
Her father is fortunately doing well, but she’s searching for the next plan for when the standard drugs ultimately fail. We know they will fail. She’s connected to patient advocacy groups, emailing physicians across the country, and looking into clinical trials with their exhaustive lists of exclusion criteria. She sees the logistic difficulties with trials far from home. She’s hit the key issues we face every day in clinical research, and she’s never stepped foot in a medical school lecture hall.
Amazingly her story is not unique. When cancer hits close to home is when these problems become very clear. This same story could easily have been retold as the narrative of former Vice President Joe Biden and his care for his son. Both my friend and Mr. Biden, in fact, asked me the same question: How do we get the cutting-edge science from major research centers out to the rest of the country?
The Cancer Moonshot initiative has done much to promote collaboration, but one major success has been in the Count Me In initiative, a partnership between the Biden Cancer Initiative, Emerson Collective, the Broad Institute, and the Dana-Farber Cancer Institute. Their goal is to gain access to thousands of patients, collect data on treatment and outcomes, and collect biological specimens. They are not alone, the MSK-IMPACT initiative – led by David B. Solit, MD, at my institution – aims to sequence rare cancers. Both programs have heavily leveraged social media to access and engage patients.
There are of course concerns. Coming from hundreds or thousands of different sites will mean the data will likely be heterogeneous in formatting and quality. How do we ensure the security of patient data? Can we rely on patients and family members to report accurately and without bias? We know there are challenges and upside to crowdsourced patient recruitment.
David Ginsburg, MD, Karl Desch, MD, and colleagues enrolled more than 1,000 students from the University of Michigan to participate in a study on blood clotting factors. This led to many important findings on the genetic basis for coagulopathies, but also was instructive in uncovering a worrisome aspect of online patient registration. The group recorded the time taken for registrants to read the consent form – including whether the participant clicked a hyperlink that was embedded. Nearly a quarter of participants accepted the terms of the 2,833-word document in less than 10 seconds, and less than 3% clicked the hyperlink (Ann Intern Med. 2011 Sep 6;155[5]:316-22).
Are these patients, who we are asking for their partnership and trust, really understanding to what they are agreeing?
Surely there is tremendous altruism on the part of these patients. Their hopes of helping the future of cancer care does have a real track record. Crowdsourcing efforts that were less far reaching in scope made substantial impact in discovering the genetic basis for polycythemia vera. The patients, contacted largely through printed newspaper ads, have helped millions of others. What will happen when we add in the power of social media will be exciting to see – and there is something else that comes with great power, but since I can’t seem to remember what that is, I’ll just search online.
Dr. Viny is with the Memorial Sloan-Kettering Cancer Center, N.Y., where he is an assistant attending physician on the leukemia service and is a clinical researcher in the Ross Levine Lab. Follow him on Twitter @TheDoctorIsVin.
Many misunderstand purpose of tumor profiling research
Although most cancer patients and parents of cancer patients understand that genomic tumor profiling research aims to improve care for future patients, many also believe that the process will benefit present treatment, according to a recent survey conducted at four academic treatment centers.
Misunderstandings were most common among less-educated individuals and those with little genetic knowledge, reported lead author Jonathan M. Marron, MD, MPH, of the Dana-Farber Cancer Institute in Boston and his colleagues.
Previous surveys have shown that “up to 60% of research participants demonstrate evidence of therapeutic misconception,” the investigators wrote in JCO Precision Oncology, referring to “the belief that the primary purpose of research is therapeutic in nature rather than acquisition of generalizable knowledge.”
“Although advances in targeted therapeutics generate great excitement, they may also blur the line between research and clinical care,” the investigators wrote. As such therapeutics become more common, so may misconceptions.
To evaluate current views of genomic tumor profiling research, the investigators surveyed 45 cancer patients and parents of cancer patients at four academic treatment centers. All patients were aged 30 years or younger at enrollment and undergoing tumor profiling; parents were asked to respond if patients were younger than 18 years.
The survey was divided into two sections: basic understanding and comprehensive understanding. To achieve basic understanding, a respondent needed to recognize that “the primary purpose was not to improve the patient’s treatment.” To achieve comprehensive understanding, the respondent needed to recognize four facts: “primary purpose was not to improve patient’s treatment,” “primary purpose was to improve treatment of future patients,” “there may not be direct medical benefit,” and “most likely result of participation was not increased likelihood of cure.”
Forty-four out of 45 survey participants responded. Of these, 30 (68%) demonstrated basic understanding, and 24 (55%) had comprehensive understanding. Respondents with higher education were more likely to answer correctly, with 81% showing basic understanding and 73% showing comprehensive understanding; among less-educated respondents, only half (50%) had basic understanding, and about 1 out of 4 (28%) had comprehensive understanding. Similar disparities were observed among respondents with more versus less genetic knowledge. Almost all respondents (93%) who thought that profiling would help present treatment also believed it would benefit future patients.
Taken as a whole, these findings suggest that therapeutic misconception in genomic tumor profiling research is relatively common, which echoes previous findings. The investigators recommended that clinicians anticipate these knowledge gaps and aim to overcome them.
“Interventional work to improve participant understanding of these complexities and nuances is necessary as sequencing moves from the laboratory to the clinic,” the investigators concluded. “Such work can guide pediatric oncologists in how to manage expectations and best counsel patients and families about the meaning and significance of clinical profiling results.”
The study was funded by Hyundai Hope on Wheels, the Friends for Life Foundation, the Gillmore Fund, National Institutes of Health, and others. The investigators reported financial affiliations with Merck, Millennium, Novartis, Roche, Amgen, and others.
SOURCE: Marron et al. JCO Precis Oncol. 2019 Jan 22. doi: 10.1200/PO.18.00176.
Although most cancer patients and parents of cancer patients understand that genomic tumor profiling research aims to improve care for future patients, many also believe that the process will benefit present treatment, according to a recent survey conducted at four academic treatment centers.
Misunderstandings were most common among less-educated individuals and those with little genetic knowledge, reported lead author Jonathan M. Marron, MD, MPH, of the Dana-Farber Cancer Institute in Boston and his colleagues.
Previous surveys have shown that “up to 60% of research participants demonstrate evidence of therapeutic misconception,” the investigators wrote in JCO Precision Oncology, referring to “the belief that the primary purpose of research is therapeutic in nature rather than acquisition of generalizable knowledge.”
“Although advances in targeted therapeutics generate great excitement, they may also blur the line between research and clinical care,” the investigators wrote. As such therapeutics become more common, so may misconceptions.
To evaluate current views of genomic tumor profiling research, the investigators surveyed 45 cancer patients and parents of cancer patients at four academic treatment centers. All patients were aged 30 years or younger at enrollment and undergoing tumor profiling; parents were asked to respond if patients were younger than 18 years.
The survey was divided into two sections: basic understanding and comprehensive understanding. To achieve basic understanding, a respondent needed to recognize that “the primary purpose was not to improve the patient’s treatment.” To achieve comprehensive understanding, the respondent needed to recognize four facts: “primary purpose was not to improve patient’s treatment,” “primary purpose was to improve treatment of future patients,” “there may not be direct medical benefit,” and “most likely result of participation was not increased likelihood of cure.”
Forty-four out of 45 survey participants responded. Of these, 30 (68%) demonstrated basic understanding, and 24 (55%) had comprehensive understanding. Respondents with higher education were more likely to answer correctly, with 81% showing basic understanding and 73% showing comprehensive understanding; among less-educated respondents, only half (50%) had basic understanding, and about 1 out of 4 (28%) had comprehensive understanding. Similar disparities were observed among respondents with more versus less genetic knowledge. Almost all respondents (93%) who thought that profiling would help present treatment also believed it would benefit future patients.
Taken as a whole, these findings suggest that therapeutic misconception in genomic tumor profiling research is relatively common, which echoes previous findings. The investigators recommended that clinicians anticipate these knowledge gaps and aim to overcome them.
“Interventional work to improve participant understanding of these complexities and nuances is necessary as sequencing moves from the laboratory to the clinic,” the investigators concluded. “Such work can guide pediatric oncologists in how to manage expectations and best counsel patients and families about the meaning and significance of clinical profiling results.”
The study was funded by Hyundai Hope on Wheels, the Friends for Life Foundation, the Gillmore Fund, National Institutes of Health, and others. The investigators reported financial affiliations with Merck, Millennium, Novartis, Roche, Amgen, and others.
SOURCE: Marron et al. JCO Precis Oncol. 2019 Jan 22. doi: 10.1200/PO.18.00176.
Although most cancer patients and parents of cancer patients understand that genomic tumor profiling research aims to improve care for future patients, many also believe that the process will benefit present treatment, according to a recent survey conducted at four academic treatment centers.
Misunderstandings were most common among less-educated individuals and those with little genetic knowledge, reported lead author Jonathan M. Marron, MD, MPH, of the Dana-Farber Cancer Institute in Boston and his colleagues.
Previous surveys have shown that “up to 60% of research participants demonstrate evidence of therapeutic misconception,” the investigators wrote in JCO Precision Oncology, referring to “the belief that the primary purpose of research is therapeutic in nature rather than acquisition of generalizable knowledge.”
“Although advances in targeted therapeutics generate great excitement, they may also blur the line between research and clinical care,” the investigators wrote. As such therapeutics become more common, so may misconceptions.
To evaluate current views of genomic tumor profiling research, the investigators surveyed 45 cancer patients and parents of cancer patients at four academic treatment centers. All patients were aged 30 years or younger at enrollment and undergoing tumor profiling; parents were asked to respond if patients were younger than 18 years.
The survey was divided into two sections: basic understanding and comprehensive understanding. To achieve basic understanding, a respondent needed to recognize that “the primary purpose was not to improve the patient’s treatment.” To achieve comprehensive understanding, the respondent needed to recognize four facts: “primary purpose was not to improve patient’s treatment,” “primary purpose was to improve treatment of future patients,” “there may not be direct medical benefit,” and “most likely result of participation was not increased likelihood of cure.”
Forty-four out of 45 survey participants responded. Of these, 30 (68%) demonstrated basic understanding, and 24 (55%) had comprehensive understanding. Respondents with higher education were more likely to answer correctly, with 81% showing basic understanding and 73% showing comprehensive understanding; among less-educated respondents, only half (50%) had basic understanding, and about 1 out of 4 (28%) had comprehensive understanding. Similar disparities were observed among respondents with more versus less genetic knowledge. Almost all respondents (93%) who thought that profiling would help present treatment also believed it would benefit future patients.
Taken as a whole, these findings suggest that therapeutic misconception in genomic tumor profiling research is relatively common, which echoes previous findings. The investigators recommended that clinicians anticipate these knowledge gaps and aim to overcome them.
“Interventional work to improve participant understanding of these complexities and nuances is necessary as sequencing moves from the laboratory to the clinic,” the investigators concluded. “Such work can guide pediatric oncologists in how to manage expectations and best counsel patients and families about the meaning and significance of clinical profiling results.”
The study was funded by Hyundai Hope on Wheels, the Friends for Life Foundation, the Gillmore Fund, National Institutes of Health, and others. The investigators reported financial affiliations with Merck, Millennium, Novartis, Roche, Amgen, and others.
SOURCE: Marron et al. JCO Precis Oncol. 2019 Jan 22. doi: 10.1200/PO.18.00176.
FROM JCO PRECISION ONCOLOGY
Key clinical point: Although most cancer patients and parents of cancer patients understand that genomic tumor profiling research aims to improve care for future patients, many also believe that the process will benefit present treatment.
Major finding: Fifty-five percent of respondents demonstrated comprehensive understanding the purpose of genomic tumor profiling research.
Study details: A survey of 45 cancer patients and parents of cancer patients conducted at four academic treatment centers.
Disclosures: The study was funded by Hyundai Hope on Wheels, the Friends for Life Foundation, the Gillmore Fund, National Institutes of Health, and others. The investigators reported financial affiliations with Merck, Millennium, Novartis, Roche, Amgen, and others.
Source: Marron et al. JCO Precis Oncol. 2019 Jan 22. doi: 10.1200/PO.18.00176.