JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, July 27, 2004)
JAMA NEWS RELEASES
DECISION AIDS CAN HELP WOMEN LEARN ABOUT BREAST CANCER RISK AND TESTING, AND ASSIST IN CHOOSING AMONG TREATMENT OPTIONS
LEG SYMPTOMS AND SEVERITY OF PERIPHERAL ARTERIAL DISEASE PREDICT FUNCTIONAL DECLINE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on decision aids for breast cancer surgery. The release will be fed Tuesday, July 27, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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mediarelations{at}jama-archives.org
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Embargoed for Release: 3 p.m. CT, TUESDAY, July 27, 2004
Media Advisory: To contact Michael J. Green, M.D., M.S., call Valerie Gliem at 814-865-9481.
To contact Michael J. Green, M.D., M.S., call Valerie Gliem at 814-865-9481.
To contact Timothy Whelan, B.M., B.Ch., call Shelly Easton at 905-521-2100 ext. 76731.
To contact editorialist Charis Eng, M.D., Ph.D., call Darrell E. Ward at 614-293-3737.
DECISION AIDS CAN HELP WOMEN LEARN ABOUT BREAST CANCER RISK AND TESTING, AND ASSIST IN CHOOSING AMONG TREATMENT OPTIONS
CHICAGO—An interactive computer program can help educate women about breast cancer risk and genetic testing, and a decision board offering information on treatment options can help breast cancer patients choose between mastectomy and breast-conserving therapy, according to articles in the July 28 issue of JAMA, the Journal of the American Medical Association.
In the first of two studies, Michael J. Green, M.D., M.S., of Penn State College of Medicine, Hershey, Pa., and colleagues compared the effectiveness of an interactive, multimedia CD ROM-based decision aid with standard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing. BRCA1 and BRCA2 are genes that help control normal cell growth. People who inherit specific mutations in one or both of these genes have an increased risk of developing breast cancer. People who carry these mutations and have family members with breast cancer are more likely to develop the disease.
According to background information in the article, genetic testing for inherited cancer predisposition has become widely available. But as the availability of and demand for genetic testing for hereditary cancers increases in primary care and other clinical settings, alternative or adjunct educational methods to traditional genetic counseling will be needed.
The authors conducted a randomized controlled trial at outpatient clinics at six U.S. medical centers from May 2000 to September 2002. Among 211 women with personal or family histories of breast cancer, 105 received standard one-on-one genetic counseling, and 106 received education by a computer program, followed by genetic counseling. Both groups had comparable demographics, prior computer experience, medical literacy, and baseline knowledge of breast cancer and genetic testing. The authors looked at outcome measures that tested factual knowledge, assessed decision making, and measured emotional reactions - such as anxiety, conflict, and satisfaction.
"An interactive computer program was more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation," the authors report.
"However, genetic counseling was more effective than the computer at reducing women's anxiety and facilitating more accurate risk perceptions."
The authors believe their findings support the use of an interactive computer program to educate women about breast cancer risk and genetic testing.
"For those at high risk of hereditary breast cancer, our computer program can effectively supplement standard genetic counseling by providing factual information before genetic counseling sessions," the authors conclude. "For women at low risk, the computer program has the potential to stand alone as an educational method when accompanied by appropriate follow-up with a qualified health care professional."
(JAMA.2004;292:442-452. Available post-embargo at jama.com)
Editor's Note: Dr. Green has received royalty payments from sales of the CD-ROM decision aid. Dr. Green had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
DECISION BOARD HELPS IMPROVE COMMUNICATION AND ENABLES WOMEN TO MAKE CHOICE REGARDING TREATMENT
In an accompanying study, Timothy Whelan, B.M., B.Ch., of McMaster University and the Juravinski Cancer Centre, Hamilton, Ontario, and colleagues evaluated the impact of a decision aid on patient decision making regarding different surgical treatment options. According to background information in the article, long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy (BCT) for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences.
The decision board is an aid that presents written and visual information to patients regarding their treatment options, the acute and long-term adverse effects associated with treatment, and the effects of treatment on a patient's breast, long-term survival, and quality of life. The authors conducted a cluster randomized trial in which general surgeons in central, eastern, and western Ontario were randomly assigned to use the decision board, or not, in surgical consultations.
Twenty surgeons took part in the study, and 201 women with newly diagnosed clinical stage I or II breast cancer agreed to be evaluated. Patients received the decision board, or not, based on which surgeon they saw - 94 were assigned to the decision board, and 107 to usual practice. Immediately following counseling, at six months, and at 12 months, patients were questioned about their choices of therapy, conflict about their decision, satisfaction, anxiety, and depression.
"Patients in the decision board group had higher knowledge scores about their treatment options (66.9 vs. 58.7), had less decisional conflict (1.40 vs. 1.62), and were more satisfied with decision making (4.50 vs. 4.32) following the consultation," the authors write.
"Patients who used the decision board were more likely to choose BCT (94 percent vs. 76 percent)," they report.
"The results of this randomized trial demonstrate that the decision board not only improved patient knowledge about breast cancer and its treatment but also decreased their decisional conflict and increased their satisfaction with decision making following the consultation," the authors write.
"Such instruments should be considered by surgeons when communicating the different surgical options to women with breast cancer," they conclude.
(JAMA. 2004;292:435-441. Available post-embargo at jama.com)
Editor's Note: Dr. Whelan is a Canada Research Chair funded by Health Canada. The Canadian Breast Cancer Research Initiative and the Ontario Ministry of Health and Long-Term Care, Health System-Linked Research Programme provided funding support for the study. The study sponsors did not influence the design or conduct of the study; the collection, analysis, interpretation, or preparation of the data; or the preparation, review, or approval of the manuscript.
EDITORIAL: LONG-TERM CLINICAL UTILITY OR TEMPORARY SOLUTION?
In an accompanying editorial, Charis Eng, M.D., Ph.D., of the Ohio State University, Columbus, Ohio, and the University of Cambridge, Cambridge, England, and Dirk Iglehart, M.D., of Harvard Medical School, Boston, assert that decision aids are useful only if they accurately reflect current and changing information and clinical practice.
"New results and a changing art of practice continue to provide a moving target," they write. "Educational aids are helpful, but an experienced clinician, in touch with changing concepts and data, remains indispensable for integrating and explaining tests and treatments offered to patients."
"Medicine, even 21st century genomic medicine, remains very much an art as well as a science," the authors conclude.
(JAMA. 2004;292:496-498. Available post-embargo at jama.com)
Editor's Note: Dr. Eng is the Dorothy E. Klotz Professor of Cancer Research, is the recipient of a Doris Duke Distinguished Clinical Scientist Award, and is partially supported by the American Cancer Society, Department of Defense U.S. Army Breast and Prostate Research Programs, National Cancer Institute, National Institutes of Health, and V Foundation Jimmy V. Golf Classic Translational Cancer Research Award. Dr. Iglehart is the Anne E. Dyson Professor of Women's Cancer and is supported by a National Cancer Institute SPORE in Breast Cancer at Harvard University and the Breast Cancer Research Foundation.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org (please note new email address).
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Embargoed for Release: 3 p.m. CT, TUESDAY, July 27, 2004
Media Advisory: To contact Mary McGrae McDermott, M.D., call Elizabeth Crown at 312/503-8928.
LEG SYMPTOMS AND SEVERITY OF PERIPHERAL ARTERIAL DISEASE PREDICT FUNCTIONAL DECLINE
CHICAGO—The presence and severity of peripheral arterial disease, as measured by comparing blood pressures in the arm and leg, and the nature of the leg symptoms a patient experiences can be used to identify those at highest risk of decline in walking endurance, according to a study in the July 28 issue of JAMA, the Journal of the American Medical Association.
Peripheral arterial disease (PAD) is a chronic condition that results from narrowing of the vessels that supply oxygen-rich blood to the legs, abdomen, pelvis, arms, or neck. The most commonly affected area is the legs.
According to background information in the article, cross-sectional studies demonstrate that distinct types of leg symptoms reported by patients with PAD in the lower extremities are associated with varying degrees of functional impairment. Severity of PAD, as measured by the ankle brachial index (ABI), is also associated with the degree of functional impairment. However, relationships between ABI, leg symptoms, and functional decline are unknown.
A patient is tested for PAD by measuring blood pressure at the ankle and in the arm while the person is at rest, and then repeating both measurements after five minutes of walking on a treadmill. ABI is calculated by dividing the blood pressures measured in the lower leg by the blood pressure measured in the arm. A normal resting ABI is greater than 1.00 or 1.10, and a decrease in ABI with exercise or a resting ABI of < 0.90 are sensitive indicators that significant PAD is probably present.
Mary McGrae McDermott, M.D., of Northwestern University Feinberg School of Medicine, Chicago, and colleagues conducted a prospective cohort study among 417 people with PAD and 259 without PAD. The participants were age 55 and older, and had baseline functional assessments between October 1, 1998, and January 31, 2000, with follow-up assessments scheduled one and two years afterward. PAD was defined as ABI less than 0.90, and participants with PAD were categorized at baseline into one of five mutually exclusive symptom groups.
The researchers measured annual changes in six-minute walk performance and in usual-paced and fast-paced four-meter walking velocity, adjusted for age, sex, race, prior-year functioning, coexisting diseases, body mass index, cigarette smoking, and patterns of missing data.
"Among 676 men and women age 55 years and older, participants with low ABI levels at baseline had significantly greater decline in walking endurance at two-year follow-up, compared with those with normal baseline ABI levels," the authors write. "Participants with ABIs less than 0.50 at baseline had a nearly 13-fold increased risk of becoming unable to walk for six minutes continuously two years later, relative to participants with ABIs of 1.10 to 1.50."
Baseline leg symptoms among participants with PAD also predicted rates of functional decline. "Participants with PAD having leg pain on exertion and rest experienced greater declines in walking endurance and walking speed than did individuals without PAD," the authors write. "Participants with asymptomatic PAD had significantly greater declines in six-minute walk performance than did participants without PAD."
"Previously reported lack of worsening in claudication symptoms over time in patients with PAD may be more related to declining functional performance than to lack of disease progression," they suggest. Claudication is pain in the legs that is typically felt while walking, and subsides with rest.
"Our findings underscore the importance of using the ABI to identify persons with PAD, since PAD is frequently undiagnosed or asymptomatic," the authors conclude. "Further study is necessary to develop treatments to prevent functional decline in patients with PAD who do not have classic intermittent claudication."
(JAMA. 2004;292:453-461. Available post-embargo at jama.com)
Editor's Note: This study was supported by grants from the National Heart, Lung, and Blood Institute and by a grant from the National Center for Research Resources, National Institutes of Health. Dr. McDermott is the recipient of an Established Investigator Award from the American Heart Association. The organizations funding this study had no role in the design and conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org
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JAMA VIDEO NEWS REPORT
VISUAL AID CALLED 'DECISION BOARD' HELPS WOMEN WITH BREAST CANCER MAKE TREATMENT CHOICES
VIDEO:
NAT SOT UP FULL FOR :03
Doctor using decision board with patient
AUDIO:
"The first option it describes is mastectomy, which is removal of the
breast."
VIDEO:
B-ROLL
Dr. Whelan and Eileen using decision board
Mastectomy graphic on board
Lumpectomy graphic on board
Eileen at decision board
Decision board
AUDIO:
DR. TIMOTHY WHELAN IS USING A VISUAL AID, KNOWN AS A DECISION BOARD, TO
DISCUSS TREATMENT OPTIONS WITH BREAST CANCER PATIENT EILEEN (pronounced
AY-LEEN) BURRIS. ONE CHOICE IS MASTECTOMY, THE OTHER IS LUMPECTOMY
PLUS RADIATION, IN WHICH ONLY THE CANCER IS REMOVED, NOT THE WHOLE
BREAST. EILEEN REMEMBERS HOW SHE FELT LAST YEAR WHEN SHE LEARNED SHE
HAD BREAST CANCER, AND HAD TO MAKE HER TREATMENT DECISION.
VIDEO:
SOT/FULL @ :26
Super: Eileen Burris, Breast Cancer Patient
Runs :03
AUDIO:
"Very difficult, very overwhelming."
VIDEO:
B-ROLL
Dr. Whelan and colleague going over data
Decision board - door opening to reveal info
Eileen nodding her head
Dr. Whelan and Eileen at board
GFX/JAMA COVER
AUDIO:
THAT'S WHY DR. WHELAN AND HIS COLLEAGUES AT MCMASTER UNIVERSITY AND
THREE OTHER CANADIAN INSTITUTIONS DESIGNED THIS DECISION BOARD. THE
BOARD HAS SLIDING DOORS THAT REVEAL INFORMATION SLOWLY WHILE THE SURGEON
TALKS, SO THE PATIENT CAN MORE EASILY PROCESS AND ABSORB WHAT SHE'S
HEARING. THE RESEARCHERS ENROLLED TWENTY SURGEONS IN THEIR STUDY. HALF
GOT DECISION BOARDS TO USE WITH THEIR BREAST CANCER PATIENTS, HALF DID
NOT. SO NINETY-FOUR PATIENTS USED THE DECISION BOARDS WITH THEIR
SURGEONS, AND ONE-HUNDRED SEVEN PATIENTS DIDN'T. DID THE DECISION BOARD
MAKE A DIFFERENCE? THE FINDINGS APPEAR IN THE JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL @ 1:02
Super: Timothy Whelan, B.M., B.Ch., McMaster University
Runs :07
AUDIO:
"Women who used the decision board were more knowledgeable and had an
improved understanding about breast cancer and its treatment."
VIDEO:
B-ROLL
Decision board
AUDIO:
NOT ONLY THAT, BUT THE WOMEN FELT BETTER ABOUT THE TREATMENT THEY CHOSE.
RESEARCHERS ALSO FOUND THAT WOMEN WHO USED THE DECISION BOARD WERE MORE
LIKELY TO CHOOSE THE LUMPECTOMY AND RADIATION THAN THE MASTECTOMY.
VIDEO:
SOT/FULL
Timothy Whelan, B.M., B.Ch., McMaster University
Runs : 14
AUDIO:
"This suggests that perhaps when the board wasn't used, that women
didn't clearly understand that they had two treatment options and that
both were equally the same in terms of survival. But that when decision
board was used, they understood that clearly."
VIDEO:
B-ROLL
Eileen at decision board
Decision board
AUDIO:
EILEEN CHOSE THE LUMPECTOMY AND RADIATION. SHE SAID THE DECISION BOARD
HELPED HER.
VIDEO:
SOT/FULL
Eileen Burris, Breast Cancer Patient
Runs : 08
B-ROLL
Let bite run long
AUDIO:
"It made me feel like I was more in control of what I was doing. It did
help me a lot."
AND TODAY, SHE IS CANCER FREE. THIS IS MAVIS PRALL REPORTING.
