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 of 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 CONTENTS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 20, 2007)
AGE ALONE DOES NOT INCREASE RISK OF DEATH FOLLOWING LIVER TRANSPLANT AMONG SELECTED SEPTUAGENARIANS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 20, 2007)
INCREASED DISTANCE TO PHYSICIAN ASSOCIATED WITH THICKER SKIN CANCER AT DIAGNOSIS
SURVEY REVEALS DISPARITIES IN SKIN CANCER KNOWLEDGE, PROTECTION AMONG HIGH SCHOOL STUDENTS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 20, 2007)
PATIENTS WITH MEDICAID AND THOSE LACKING INSURANCE HAVE HIGHER RISK OF ADVANCED LARYNGEAL CANCER
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 20, 2007
Media Advisory: To contact corresponding author Ronald W. Busuttil, M.D., Ph.D., call Enrique Rivero at 310-794-2273.
AGE ALONE DOES NOT INCREASE RISK OF DEATH FOLLOWING LIVER TRANSPLANT AMONG SELECTED SEPTUAGENARIANS
CHICAGO—Advanced age alone does not appear to be associated with the risk of death following liver transplant, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals.
Life expectancy has increased in recent years, with individuals older than 70 representing a large and fast-growing segment of the general population, according to background information in the article. A healthy 70-year-old adult living in a developed country with a nutritious diet and good medical care can expect to live to age 80 or 90. “As longevity has increased, the burden of liver disease in patients of advancing age has also increased and is associated with a higher mortality than in younger adults,” the authors write. “In the 1980s, the death rate from chronic liver disease was highest in patients 65 to 74 years of age. This had led to more older patients undergoing liver transplantation.”
Gerald S. Lipshutz, M.D., M.S., and colleagues at the David Geffen School of Medicine at UCLA reviewed the records of patients who received their first liver transplant between 1988 and 2005. They compared 62 patients who were age 70 or older (average age 71.9) to 864 patients age age 50 to 59 (average age 54.3). Survival time was measured until death, the last known follow-up date or retransplantation.
Overall, 31 of 62 patients age 70 or older and 345 of 864 patients younger than 70 died during the study period. After one year, 73.3 percent of older patients and 79.4 percent of younger patients survived; after ten years, 39.7 percent of older patients and 45.2 percent of younger patients were still alive. “We found no statistically significant difference in survival in the first 10 years after transplantation for a group of 62 patients 70 years or older when compared with a younger cohort of 864 recipients aged 50 to 59 years with similar characteristics,” the authors write. “The longest-surviving patient was 88 years old at 15 years after transplantation. One-year unadjusted survival of septuagenarians in the most recent surgical period, 2001 to 2005, was 94.4 percent.”
The researchers also analyzed 26 variables related to the recipients, donors and transplant operations to see which predicted patient deaths. Of the 26, four were associated with death rates: preoperative hospitalization, prolonged period of cold storage between liver removal and transplantation, cirrhosis caused by hepatitis C and alcohol and an increasing model for end-stage liver disease (MELD) score, a measure of disease severity. An age of 70 years or older did not independently predict death in transplant patients.
“In conclusion, biological and physiological variables may play a more important role than advanced age in predicting poor survival after liver transplantation. Measures of physiological age and risk of complications should be used in the evaluation process of elderly transplant candidates,” the authors conclude. “Age by itself should not be used to limit liver transplantation.”
(Arch Surg. 2007;142(8):775-784. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 20, 2007
Media Advisory: To contact Karyn B. Stitzenberg, M.D., M.P.H., call Ramona Dubose at 919-966-7467.
INCREASED DISTANCE TO PHYSICIAN ASSOCIATED WITH THICKER SKIN CANCER AT DIAGNOSIS
CHICAGO—The farther patients travel to reach the physician who diagnoses their melanoma, the more likely they are to have thicker skin cancer at diagnosis, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.
“Survival for patients with melanoma is dependent on stage at diagnosis. As Breslow [depth of tumor cells in the skin] thickness increases, overall survival decreases,” according to background information in the article. “Consequently, early diagnosis may substantially improve patient outcomes. Because melanoma can only be definitively diagnosed based on biopsy findings, diagnosis requires detection of the suspicious lesion and biopsy. Some primary care providers perform diagnostic biopsies, but many prefer to refer patients to dermatologists or surgeons.”
Karyn B. Stitzenberg M.D., M.P.H., of the School of Public Health, University of North Carolina at Chapel Hill, and colleagues examined the effect of travel distance—and other factors such as age, sex, poverty rate, living in rural areas and the number of physicians in the area—on access to diagnosing clinicians for 615 patients with melanoma. Patients’ Breslow thickness was also measured.
The median (midpoint) distance to a diagnosing physician was 8 miles. The median Breslow thickness was 0.6 millimeters. For each one-mile increase in distance, average Breslow thickness at diagnosis increased by 0.6 percent. Patients who traveled more than 15 miles had tumors 20 percent thicker than those of patients who traveled 15 miles or less. Patients from rural counties traveled an average 2.4 miles farther to their diagnosing clinician than those from metropolitan counties. Those from counties with at least one dermatologist traveled an average 8.3 miles less than those without a dermatologist in their counties.
Breslow thickness was also associated with age and poverty. “For each 1 percent increase in poverty rate, Breslow thickness increased by 1 percent. Breslow thickness was 19 percent greater for patients aged 51 to 80 years than for those aged 0 to 50 years and was 109 percent greater for patients older than 80 years than for those aged 0 to 50 years,” the authors write. “Sex, rurality and supply of dermatologists were not associated with Breslow thickness.”
“Further work is needed to characterize the determinants of distance to diagnosing provider, as well as the pathways and barriers to melanoma care,” the authors conclude. “Once potential barriers are identified, interventions can be developed to minimize the effect of travel distance and other sociodemographic factors on access to melanoma care.”
(Arch Dermatol. 2007;143(8):991-998. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by a National Research Service Award Postdoctoral Traineeship from the Agency for Healthcare Research and Quality, sponsored by a grant from the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 20, 2007
Media Advisory: To contact corresponding author Robert S. Kirsner, M.D., Ph.D., call Lisa Worley at 305-243-5184. To contact editorialist Ann F. Haas, M.D., call Nancy Turner at 916-454-6570.
SURVEY REVEALS DISPARITIES IN SKIN CANCER KNOWLEDGE, PROTECTION AMONG HIGH SCHOOL STUDENTS
CHICAGO—In a survey of Florida high school students, white Hispanic teens were more likely to use tanning beds and less likely to consider themselves at risk for skin cancer or protect themselves from the sun than white non-Hispanic teens, according to a report in the August issue of Archives of Dermatology, one of the JAMA/Archives journals.
Exposure to the sun’s ultraviolet (UV) rays is a major risk factor for melanoma and non-melanoma skin cancers, and the majority of lifetime exposure occurs by age 18, according to background information in the article. White Hispanics have a lower rate of skin cancer than white non-Hispanics, but are more likely to be diagnosed at a later stage. This suggests that “there are differences in knowledge and behavior related to the prevention of skin cancer in white Hispanic and white non-Hispanic populations; therefore, we hypothesize that these differences may exist in students and may be related to early acquisition of knowledge,” the authors write.
Fangchao Ma, M.D., Ph.D., of the University of Miami Miller School of Medicine, and colleagues surveyed 369 Florida high school students (221 white Hispanics and 148 white non-Hispanics) about their skin cancer knowledge, perceived risk and sun protection behaviors. In addition, students were asked questions related to burning and tanning after sun exposure to determine their skin type.
Compared with white non-Hispanic students, white Hispanic students were:
- More likely to tan deeply (44.2 percent vs. 31 percent)
- 60 percent less likely to have heard of skin self-examination and 70 percent less likely to have been told how to perform it
- About 1.8 times as likely to never or rarely wear sun-protective clothing
- About twice as likely to never or rarely use sunscreen
- Less likely to think they had an average or above-average risk for skin cancer (23.1 percent vs. 39.9 percent)
- 2.5 times as likely to have used a tanning bed in the previous year
“These differences between white Hispanic and white non-Hispanic students remained significant after age, sex, sun sensitivity and family history of skin cancer were controlled for,” the authors write.
“Our survey indicated that a significantly lower proportion of white Hispanics than white non-Hispanics wore sun-protective clothing or used sunscreen with a sun protection factor of 15 or higher, regardless of skin sensitivity to the sun,” they conclude. “Such gaps indicate that there is a need to include white Hispanic students in skin cancer prevention programs targeting young persons.”
(Arch Dermatol. 2007;143(8):983-988. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by the National Institutes of Health through the Redes En Acción program. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: TEEN SKIN-CANCER EDUCATION SHOULD ADDRESS APPEARANCE
Teens tan because they like the effect it has on their appearance, and showing how tanning can damage the skin has been shown to help change sun-related behavior in young people, writes Ann F. Haas, M.D., of the National Coalition for Sun Safety, Sacramento, Calif., in an accompanying editorial.
“The current strategy consists of providing acceptable, healthy alternatives to tanning (highlighting the positive features of the alternatives), emphasizing the negative appearance aspects of tanning and working to change the social norms regarding the ‘tanned-is-healthy-and-attractive’ message,” Dr. Haas writes. “The message should be sex and age appropriate and include a cross section of the adolescent community, including family, school settings, health care providers and the media.”
(Arch Dermatol. 2007;143(8):1058-1061. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 20, 2007
Media Advisory: To contact Amy Y. Chen, M.D., M.P.H., call Becky Steinmark at 404-417-5860.
PATIENTS WITH MEDICAID AND THOSE LACKING INSURANCE HAVE HIGHER RISK OF ADVANCED LARYNGEAL CANCER
CHICAGO—Individuals with advanced-stage laryngeal cancer at diagnosis were more likely to be uninsured or covered by Medicaid than to have private insurance, according to a report in the August issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
“Laryngeal [voice box] cancer is diagnosed in nearly 10,000 men and women in the United States annually and is among the most common cancers in the upper aerodigestive tract,” according to background information in the article. Stage at diagnosis is a key factor influencing prognosis and treatment. “It is plausible that individuals without health insurance or with other barriers to health care access would be less likely to seek medical attention for these symptoms and thus present at a later stage with worse survival and fewer options for treatment.”
Amy Y. Chen, M.D., M.P.H., of Emory University and the American Cancer Society, Atlanta, and colleagues analyzed medical and insurance information from 61,131 patients diagnosed between 1996 and 2003 to examine the relationship between patients’ insurance status and overall stage of cancer and tumor size at diagnosis. Stage at diagnosis was categorized as early (stages I and II) or advanced (stages III and IV) and tumor size (T stage) at diagnosis was categorized as T1, T2, T3 or T4, with T4 being the largest. Patient race, sex, age, U.S. census region of residence, education and ZIP code as well as type of treatment facility were also noted.
“There were 32,665 (53.4 percent) [patients] with early-stage disease and 28,466 (46.6 percent) with advanced-stage disease. The distribution of T stage included 22,693 (37.1 percent) with T1 disease, 15,111 (24.7 percent) with T2 disease, 13,541 (22.2 percent) with T3 disease and 9,786 (16 percent) with T4 disease,” the authors write. “Patients with advanced-stage disease or more advanced T stage were more likely to be uninsured or have Medicaid or other government-funded plans than were those with early-stage disease.”
Patients who were female, black, between ages 18 and 56 or who live in ZIP codes with low proportions of high school graduates or with low median household incomes were more likely to be diagnosed with an advanced stage of the disease and/or larger tumors. Those treated at teaching/research facilities were also more likely to have advanced disease.
“In conclusion, our analyses provide the first assessment, to our knowledge, of the strong association between medical insurance and stage of laryngeal cancer at diagnosis among a large, generalizable cohort. Insurance coverage is a highly modifiable factor that affects not only tumor associated morbidity and mortality but also quality of life and economic costs,” the authors conclude.
(Arch Otolaryngol Head Neck Surg. 2007;133(8):784-790. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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