Resources

Cancer patients like Jobs face risks from treatment

Patients with the rare form of cancer suffered by Apple Inc’s Steve Jobs face a tougher battle if the disease recurs, because of the methods used in fighting it.

Jobs said on Wednesday that he could no longer be chief executive of the company he co-founded. He had gone on medical leave in January for an undisclosed condition after years of fighting a rare type of pancreatic cancer and other health issues.

He gave no new details on his health in his latest announcement.

The type of pancreatic cancer is caused by an islet cell neuroendocrine tumor.

Jobs was reported to have undergone a liver transplant in 2009 to fight off the spread of the neuroendocrine tumor. The procedure is experimental and is fraught with complications.

Jobs has never publicly stated the reason for his liver transplant.

Dr. Simon Lo, director of pancreatic and biliary diseases at Cedars-Sinai Medical Center in Los Angeles said the most likely serious complication after Jobs’ liver transplant would have been further spread of the cancer, which could have forced Jobs to leave his position permanently. Lo has not treated Jobs.

As many as 80 percent of patients who get liver transplants to treat this type of cancer live for at least five years, according to the University of California San Francisco.

Lo said a recent study showed about three-quarters of patients who got a liver transplant because of cancer saw their cancer return within two to five years. The cancer can return to the liver or spread to other organs in the body.

The immunosuppressant drugs necessary for a liver transplant also make it harder for the body to fight the return of the disease.

Jobs may be “confronting both the liver transplant related specific problems, as well as the cancer itself,” Lo said. “Whenever you put patients on immunosuppressant medications, there’s always a risk that it could take away natural resistance, so the cancer could grow faster.”

Although this cancer is broadly lumped in with pancreatic cancer, neuroendocrine tumors have a different nature from most pancreatic tumors, which are highly lethal and which kill 95 percent of patients within five years.

Neuroendocrine tumors are more easily treated and less aggressive. According to the National Cancer Institute, there are only 200 to 1,000 new cases a year.

Jobs had a neuroendocrine tumor removed in 2004 and said afterward all the cancer was gone, and that he did not require chemotherapy or radiation treatment.

But he remained noticeably thin, even gaunt, and took time off in 2009 to deal with what he initially termed a hormone imbalance, again giving few details.

Islet-cell tumors can cause over-secretion of hormones, including insulin, into the bloodstream, wreaking havoc on digestion and leading to drastic weight loss. They are usually easily removed surgically, but recur in roughly half of patients, doctors say, possibly spreading to other organs. source: www.reuters.com/article/

Vaccines largely safe, U.S. expert panel finds

Vaccines

After a close review of more than 1,000 research studies, a federal panel of experts has concluded that vaccines cause very few side effects, and found no evidence that vaccines cause autism or type 1 diabetes.

The report, issued on Thursday by the Institute of Medicine, part of the National Academies of Sciences, is the first comprehensive report on vaccine side effects since 1994.

Fears that vaccines might cause autism or other health problems have led some parents to skip vaccinating their children, despite repeated reassurances from health authorities. The concerns have also forced costly reformulations of many vaccines.

“We looked at more than 1,000 articles evaluating the epidemiological and biological evidence about whether vaccines cause side effects,” said committee chair Ellen Wright Clayton, professor of pediatrics and law, and director of the Center for Biomedical Ethics and Society at Vanderbilt University in Nashville.

“The big take-home message is that we found only a few cases in which vaccines can cause adverse side effects, and the vast majority of those are short-term and self-limiting,” she said in a telephone interview.

The report was commissioned by the U.S. Department of Health and Human Services to help guide the Vaccine Injury Compensation Program, which provides a pool of money to take care of children who experience side effects from vaccines.

The panel looked at eight common vaccines: the combination measles-mumps-rubella (MMR), the diphtheria-tetanus-acellular pertussis (DTaP), varicella for chickenpox, influenza, hepatitis B, meningococcal, tetanus-containing vaccines, and the human papillomavirus (HPV) vaccine.

These vaccines protect against a host of diseases, including measles, mumps, whooping cough, hepatitis, diphtheria, tetanus, chickenpox, meningitis and pneumococcal disease and cervical cancer.

SIDE EFFECTS ARE GENERALLY MILD

Once again, the IOM found that the MMR vaccine does not cause autism, nor does it cause type 1 diabetes, Clayton said.

“The DTaP vaccine, which is the pertussis vaccine, does not cause type 1 diabetes, and the killed flu vaccine does not cause Bell’s palsy (temporary facial paralysis) and it doesn’t make your asthma get worse,” Clayton said.

“The evidence was really quite strong that vaccines don’t cause these side effects,” she said.

Among the side effects vaccines can cause, Clayton said most are short-lived. The panel found that the MMR vaccine can cause seizures in people who develop high fevers after getting the vaccine, but these pass quickly.

“They are scary to be sure, but they do not cause any long-term harm and they are not a sign the child will get epilepsy,” Clayton said.

MMR can also cause a rare form of brain inflammation in some people with severe immune system deficiencies.

With the varicella vaccine against chickenpox, some people can develop brain swelling, pneumonia, hepatitis, meningitis or shingles, but this occurs most often in people with compromised immune systems.

Six vaccines — MMR, varicella, influenza, hepatitis B, meningococcal, and the tetanus-containing vaccines — also can trigger anaphylaxis, an allergic reaction that appears shortly after injection.

But Clayton said this can be addressed with the requirement by doctors to have patients remain in the waiting room for 15 minutes after their shot to make sure they do not have an allergic reaction.

She said the report should help people who are seeking to file claims for vaccine side effects, but it should also reassure many people that vaccines are largely safe.source: www.reuters.com/article/

Childhood pets linked to lower allergy risk

Good news for families that would love to have a furry dog or cat but hesitate for fear the kids might become allergic: Fido or Kitty might actually be good for children’s health, scientists say.

They found that children who were exposed to animals at a young age had lower rates of nasal allergies as adolescents.

“Family pets, in particular dogs…need not be removed to prevent allergies, and in fact may protect against them,” Melanie Matheson of the University of Melbourne, lead author of the study, told Reuters Health in an email.

Looking at survey responses from nearly 8,500 adults from Europe and Australia, Matheson and colleagues focused on those who grew up around house pets or farm animals, and those who had the troublesome runny noses, itchy eyes, and sore throats that plague nasal allergy sufferers.

Growing up with pets has already been linked to a lower risk of other types of allergies. A 2010 study from the University of Cincinnati showed than owning a dog may decrease the risk of childhood eczema, a skin condition (see Reuters Health story of October 13, 2010). Similarly, a 2011 study from Henry Ford Hospital in Detroit found that growing up with pets cut kids’ risk of developing pet allergies by half.

In the new study, published in the Journal of Allergy and Clinical Immunology, more than one in four respondents said they had nasal allergies. In most cases, people said their allergies started when they were adolescents.

A number of factors were linked to a higher risk of nasal allergies in the study. Some, like a family history of allergies and the mother smoking while pregnant, are well documented risk factors.

But the research team also found that small children who had lots of exposure to other little kids – because they had young siblings, for instance, or attended day care – had lower risks of nasal allergy. And the more siblings a child had, the lower the odds that the child would have nasal allergies later in life.

The scientists saw a similar pattern among people who grew up on a farm or had pets before age five. Compared to rates in people who didn’t have those experiences in early childhood, the odds of having nasal allergies in adolescence were 30 percent lower in people who grew up on a farm, while having a dog and cat were each associated with a 15 percent reduction.

Furthermore, people who’d had siblings and animal exposure had lower rates of nasal allergies compared to those who’d had only one or the other experience.

These results were consistent in the 13 countries surveyed, “despite the differences in pet ownership and farming between countries,” Matheson told Reuters Health in an email.

Since nasal allergies can put people at risk for asthma and other allergic diseases, the authors wrote, exposure to pets could potentially reduce the child’s risk of developing asthma in the future.

The study design cannot prove that exposure to pets or other children are the cause of the lower risk of nasal allergies. Although the authors accounted for several factors, including education and family history of allergies, there may be another cause of the reduced nasal allergy risk that is associated with pets and siblings.

Also, the researchers only had information on exposure to animals before age five, so they don’t know whether being around animals at an older age would have any effect on allergy risk.

While the results of the study are promising, it would be premature to suggest that parents buy pets or have more children, said Dr. Jonathan Bernstein, professor of medicine of University of Cincinnati College of Medicine and a co-author of an earlier report on the same topic.

Still, the results provide further evidence that avoiding exposures may not be the best way to protect children against allergies, Bernstein said. source: reuters.com/article/helath