Public Release: 

Embargoed news from Annals of Internal Medicine

Annals of Internal Medicine tip sheet for April 6, 2010, issue

American College of Physicians

1. Survivors of Childhood Cancer Face Shortened Life Expectancy in Adulthood

Due to advances in treatment, five-year survival rates for childhood cancer have risen to approximately 80 percent. As the population of long-term survivors continues to grow, health care providers will need to understand the late effects of cancer and its treatments on survivor's long-term health. Researchers developed a computer model to estimate the cumulative effect of disease- and treatment-related mortality risk for persons aged 15 years who had survived at least 5 years after receiving treatment for childhood cancer. The researchers found that survivors of childhood cancers face health risks that shorten their life span by about 10 years on average. The loss in life expectancy varied for different types of cancer. Survivors of kidney cancer died about 4 years earlier, whereas survivors of bone and brain cancer died about 18 years earlier than the general population. The researchers suggest that use of treatment agents with late toxicities used in previous decades could be to blame. The authors of an accompanying editorial conclude that physicians should consider the complexity of past treatments and their long-term and late effects when caring for these patients. "The important role of prevention and health promotion in this patient population should not be underestimated. Caring for the whole patient is essential, including the psychological needs that arise with the burden of living with a chronic disease," they write.

2. Early, Lifelong Surveillance for Breast Cancer Recommended for Young Women Treated with Chest Radiation

Studies consistently show that chest radiation is associated with an excess risk for breast cancer. Researchers reviewed available data to summarize breast cancer risk and breast cancer surveillance in women after chest radiation for pediatric or young adult cancer. They found that women in this population have a substantially elevated risk for breast cancer at a young age, which does not seem to plateau. Since breast cancer outcomes after diagnosis are similar to those in the general population, early detection is beneficial. However, women in this patient population have fewer treatment options for breast cancer because of treatment exposures used to cure their first cancer. The evidence suggests that MRI plus mammography beginning at age 25 may be the best way to screen these women for breast cancer, but more research is needed to weigh the potential benefits and harms of the additional radiation exposure. Estimates of benefits and risks may change over time given use of lower radiation doses in contemporary treatments.

3. Your Social Network May Affect Your Drinking Habits

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According to a study published today in Annals of Internal Medicine, the flagship journal of the American College of Physicians, the drinking habits of the people in your extended social group play a major role in determining your own rate of alcohol consumption.

Researchers used data from the landmark Framingham Heart Study which followed 12,067 people for more than 30 years and helped to define the patterns in social networks of other health issues such as obesity, smoking, and sexually transmitted diseases. In this analysis, the researchers sought to explore patterns of alcohol use in a large social network.

"We've found that the influence of your friends and people you have connections with can affect your health just as much as your family history or your genetic background," said Nicholas Christakis, MD, PhD, Professor of Medicine at Harvard University and lead author of the study. "With regard to alcohol consumption, your social network may have both positive and negative health consequences, depending on the circumstances."

In the study, self-reported alcohol intake over time followed changes in the alcohol intake of the respondents' social contacts. The researchers found that a person was 50 percent more likely to drink heavily if a person they are directly connected with also drinks heavily and 36 percent more likely to drink heavily if a friend of a friend drinks heavily. The impact extended up to three degrees of separation. The researchers suggest this social phenomena could have other implications for clinical and health interventions. Social networks could be used to exploit positive health behaviors and further support group interventions.

"Our findings reinforce the idea that drinking is a public health and clinical problem that involves groups of interconnected people who evince shared behaviors," said Christakis. "In treating individuals for problematic drinking, we need to look at their social networks to identify and eliminate obstacles to abstaining."

4. Elderly Patients on Antipsychotic Drugs at Increased Risk for Community-acquired Pneumonia

Both atypical and typical antipsychotic drugs are widely used to treat geriatric psychiatric disorders, including dementia. However, experts have questioned the safety profile of these drugs as increased mortality (mostly due to pneumonia) has been reported in elderly dementia patients who were treated with antipsychotics. Dutch researchers conducted a nested case-control study of elderly, community-dwelling patients who received a prescription for an antipsychotic drug between 1996 and 2006. Compared with past use, current use of either atypical or typical antipsychotic drugs was associated with a dose-dependent increase in risk for fatal or nonfatal community-acquired pneumonia. The highest risk period was the first week of treatment. Researchers recommend that physicians closely monitor patients, particularly at the beginning of therapy, and if patients are on a high dose.


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