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: 3:00 p.m. CT, Tuesday, June 3, 2008)
JAMA NEWS RELEASES
FOR PATIENTS WITH COLON CANCER, FAMILY HISTORY OF COLORECTAL CANCER ASSOCIATED WITH REDUCED RISK OF RECURRENCE AND DEATH
PATIENTS WITH HEART FAILURE OFTEN OVERESTIMATE LIFE EXPECTANCY
MOST ONGOING DIABETES TRIALS DO NOT INCLUDE OUTCOMES IMPORTANT TO PATIENTS
LOW HDL CHOLESTEROL FROM GENE VARIATION NOT ASSOCIATED WITH INCREASED RISK OF ISCHEMIC HEART DISEASE
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
FAMILY HISTORY OF COLORECTAL CANCER MAY IMPROVE CHANCE OF SURVIVAL
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Video News Report is on the impact of family history on cancer recurrence and survival for patients with colon cancer. The report will be fed Tuesday, June 3, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
SAVE THE DATE: JAMA will present new research on HIV/AIDS at a media briefing on Sunday, August 3, at the International AIDS Conference in Mexico City. Program information will be included in a future email. To register, go to www.jamamedia.org and click on the Events tab.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, June 3, 2008
Media Advisory: To contact Jennifer A. Chan, M.D., M.P.H., call Bill Schaller at 617-632-5357. To contact editorial author Boris Pasche, M.D., Ph.D., call Marla Paul at 312-503-8928.
FOR PATIENTS WITH COLON CANCER, FAMILY HISTORY OF COLORECTAL CANCER ASSOCIATED WITH REDUCED RISK OF RECURRENCE AND DEATH
CHICAGO—Among patients with advanced colon cancer receiving treatment that includes chemotherapy, a family history of colorectal cancer is associated with a significant reduction in cancer recurrence and death, with the risk reduced further by having an increasing number of affected first-degree relatives, according to a study in the June 4 issue of JAMA.
“Approximately 16 percent to 20 percent of patients with colorectal cancer have a first-degree relative with colorectal cancer. Beyond rare but highly penetrant hereditary colorectal cancer syndromes, numerous studies have demonstrated that a history of colorectal cancer in a first-degree relative increases the risk of developing the disease by approximately 2-fold. However, the influence of family history on cancer recurrence and survival among patients with established colon cancer remains uncertain,” the authors write.
Jennifer A. Chan, M.D., M.P.H., of the Dana-Farber Cancer Institute, Boston, and colleagues examined the association of family history of colorectal cancer with recurrence and survival of 1,087 patients with stage III colon cancer who were receiving supplemental chemotherapy. Patients provided information on family history of colorectal cancer at the beginning of the study, and were followed up until March 2007 for cancer recurrence and death (median [midpoint] follow-up, 5.6 years).
Among the 1,087 participants, 195 (17.9 percent) reported a family history of colorectal cancer in 1 or more first-degree relatives. The researchers found that a family history of colorectal cancer was associated with a significant reduction in the risk of cancer recurrence or death. Compared with patients without a family history, those with a family history had a 28 percent lower risk for cancer recurrence or death, which occurred in 57 of 195 patients (29 percent) with a family history of colorectal cancer compared with 343 of 892 patients (38 percent) without a family history.
Examining just the risk for cancer recurrence, patients with a family history of colorectal cancer had a 26 percent reduced risk compared with patients without a family history. Cancer recurrence occurred in 27 percent of patients with a family history of colorectal cancer and 35 percent of patients without a family history. The reduced risk of death for patients with a family history of colorectal cancer was 25 percent.
The apparent benefit associated with family history was stronger with an increasing number of affected family members. Compared with participants without a family history of colorectal cancer, participants with two or more affected relatives had a 51 percent lower risk for cancer recurrence or death.
“Beyond rare, well-characterized hereditary colorectal cancer syndromes, our data support the hypothesis that a relatively common though less penetrant genetic predisposition may not only influence colorectal cancer risk but also patient survival. This finding may reflect a distinct underlying molecular and pathogenic mechanism in cancers that develop in the setting of a common (i.e., sporadic) family history,” the researchers write. “Further studies are needed to more fully elucidate potential mechanisms by which a common family history may influence the outcome for patients with colorectal cancer.”
(JAMA. 2008;299[21]:2515-2523. Available pre-embargo to the media 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.
EDITORIAL: FAMILIAL COLORECTAL CANCER—A GENETICS TREASURE TROVE FOR MEDICAL DISCOVERY
In an accompanying editorial, Boris Pasche, M.D., Ph.D., of the Northwestern University Feinberg School of Medicine, Chicago, and Contributing Editor, JAMA, comments on the results of the study by Chan and colleagues.
“If these intriguing findings are validated in other studies, family history may well become a new prognostic factor in colorectal cancer. Should this be the case, genome-wide association studies and tumor gene expression profiling studies will be warranted to identify germline and tumor-specific genetic features associated with a family history of colorectal cancer and favorable outcome following adjuvant chemotherapy.”
“Over the past 2 decades, some of the first major molecular genetics inroads were achieved through careful study of patients with a strong family history of colorectal cancer,” Dr. Pasche writes. “The study by Chan et al suggests that family history of colorectal cancer will lead to the identification of novel genetic features predictive of response to chemotherapy. Familial colorectal cancer may therefore confirm its role as a genetics treasure trove for medical discovery.”
(JAMA. 2008;299[21]:2564-2565. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, June 3, 2008
Media Advisory: To contact Larry A. Allen, M.D., M.H.S., call Michelle Gailiun at 919-660-1306. To contact editorial author Clyde W. Yancy, M.D., call Maria Carpenter at 214-820-4827.
PATIENTS WITH HEART FAILURE OFTEN OVERESTIMATE LIFE EXPECTANCY
CHICAGO—Many patients with heart failure have survival expectations that are significantly greater than clinical predictions, with younger patients and those with more severe disease more likely to overestimate their remaining life span, according to a study in the June 4 issue of JAMA.
Heart failure accounts directly for 55,000 deaths and indirectly for an additional 230,000 deaths in the United States each year. Despite advances in care, the prognosis for patients with symptomatic heart failure remains poor, with median (50 percent of patients still alive) life expectancy of less than 5 years, according to background information in the article. For those with the most advanced disease, 1-year mortality rates approach 90 percent. Prognosis is dependent on various patient characteristics, and a number of prognostic models have been developed to help predict survival in patients with heart failure.
The extent to which patients with heart failure understand their prognosis is not clear. “Patient perception of prognosis is important because it fundamentally influences medical decision making regarding medications, devices, transplantation, and end-of-life care,” the authors write.
Larry A. Allen, M.D., M.H.S., of the Duke Clinical Research Institute, Durham, N.C., and colleagues conducted a study to determine the personal predictions of life expectancy of 122 patients with heart failure (who were not bed-ridden) and compared those with each of their model-estimated life expectancy predictions. The patients (average age 62 years; 47 percent African American; 42 percent New York Heart Association [NYHA] class III or IV [more severe heart failure]) were surveyed regarding their predicted life expectancy. Model-predicted life expectancy was calculated using the Seattle Heart Failure Model (SHFM).
On average, patients overestimated their life expectancy relative to model-predicted life expectancy (median patient-predicted life expectancy, 13.0 years; model-predicted expectancy, 10.0 years). The majority of patients (77 [63 percent]) overestimated their life expectancy when compared with that predicted by the SHFM. The median life expectancy ratio (LER; i.e., ratio of patient-predicted to model-predicted life expectancy) was 1.4, meaning the median overestimation of predicted future survival in the population was 40 percent. There was no association between higher LER and improved survival. Thirty-five patients (29 percent) died over a median follow-up period of 3.1 years.
There was little relationship between patient-predicted and model-predicted life expectancy. Patient predictions of life expectancy were more similar to those predicted by empirically derived actuarial life tables based on age and sex alone, without regard for the presence of heart failure. Patient characteristics that were predictive of overestimation of life expectancy included younger age, more severe disease and less depression.
“The exact reasons for this incongruity are unknown but they may reflect hope or may result from inadequate communication between clinicians and their patients about prognosis. Because differences in expectations about prognosis could affect decision making regarding advanced therapies and end-of-life planning, further research into both the extent and the underlying causes of these differences is warranted. Whether interventions designed to improve communication of prognostic information between clinicians and patients would improve the process of care in heart failure should be tested in appropriately designed clinical trials,” the authors conclude.
(JAMA. 2008;299[21]:2533-2542. Available pre-embargo to the media 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.
EDITORIAL: PREDICTING LIFE EXPECTANCY IN HEART FAILURE
In an accompanying editorial, Clyde W. Yancy, M.D., of the Baylor University Medical Center, Dallas, writes that questions remain regarding the accuracy of clinical prediction models.
“Currently, there is insufficient precision in the prognostication of heart failure, and decision making at the end of life is perhaps the most personalized of all decision making in medicine. Although well-intended and carefully constructed tools and awareness of the natural history of disease are helpful, it is the primacy of the patient-physician interface that must prevail. Until these questions are fully addressed, it is best to avoid adopting an imprecise method, instead continuing to embrace the individualized decision-making process guided by physician judgment that incorporates all patient care considerations.”
(JAMA. 2008;299[21]:2566-2567. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, June 3, 2008
Media Advisory: To contact corresponding author Victor M. Montori, M.D., M.Sc., call John Murphy at 507-284-5005.
MOST ONGOING DIABETES TRIALS DO NOT INCLUDE OUTCOMES IMPORTANT TO PATIENTS
CHICAGO—An analysis of ongoing randomized clinical trials (RCTs) in diabetes finds that only about 20 percent have as primary outcomes results that patients consider important, such as illness, pain, effect on function and death, according to a study in the June 4 issue of JAMA.
Concerns about the safety and efficacy of diabetes interventions continue, in part because RCTs have not measured their effect on patient-important outcomes as quality of life and death, according to background information in the article. “Are future diabetes trials likely to be more informative to patients and clinicians?” the researchers ask.
Gunjan Y. Gandhi, M.D., M.Sc., of Mayo Clinic, Rochester, Minn., and colleagues examined large public clinical trial registries to systematically determine the extent to which ongoing and future registered RCTs plan to measure patient-important outcomes in patients with diabetes. The researchers identified phase 2 through 4 RCTs enrolling patients with diabetes. Of 2,019 RCTs, 1,054 proved eligible, and 50 percent of these (527) were randomly sampled, and 436 trials registered since registration became mandatory in 2004 were selected. Of these, 6 percent (24) had not started enrollment, 25 percent (109) were actively enrolling, and 69 percent (303) had completed enrollment.
Reviewers collected study characteristics and determined the outcomes measured and their type (physiological outcomes [insulin, C-peptide levels], surrogate outcomes thought to reflect an increased risk for patient-important outcomes [such as cholesterol levels, worsening kidney function], and patient-important outcomes [illness, pain, function and death]).
The researchers found that primary outcomes were patient-important outcomes in 18 percent of the RCTs, physiological and laboratory outcomes in 16 percent, and surrogate outcomes in 61 percent of the 436 RCTs. Patient-important outcomes were reported as primary or secondary outcomes in 46 percent of the RCTs.
Independent predictors of patient-important outcomes were larger trial size and longer trial duration while trials of patients with type 2 diabetes were significantly less likely to report patient-important outcomes as a primary outcome. For primary and secondary outcomes, predictors of patient-important outcomes were trial length and trial phase (phase 3 or 4 vs. phase 2), with trials of patients with type 2 diabetes significantly less likely to report patient-important outcomes.
“… the importance of our findings is that (1) without pooling, the individual diabetes trials will largely fail in providing information about the effect of interventions on patient-important outcomes; and (2) trials that are planning to measure patient-important outcomes as secondary end points need to overcome the temptation to selectively report outcomes with statistically significant results as well as to report these findings transparently and carefully. Journals also may need to publish the less-than-interesting results to enable meta-analyses of these results to produce precise enough estimates that can guide practice,” the authors write.
“We believe the time has come for a broad consensus on a standard set of important outcomes for patients in diabetes trials, similar to the Outcome Measures in Rheumatology (OMERACT) initiative. The OMERACT approach allows for the uniform measurement of outcomes in RCTs with emphasis on outcomes that experts—and ultimately patients—thought would better capture the experience of rheumatological conditions.”
(JAMA. 2008;299[21]:2543-2549. Available pre-embargo to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, June 3, 2008
Media Advisory: To contact corresponding author Anne Tybjaerg-Hansen, M.D., D.M.Sc., email: at-h{at}rh.regionh.dk.
LOW HDL CHOLESTEROL FROM GENE VARIATION NOT ASSOCIATED WITH INCREASED RISK OF ISCHEMIC HEART DISEASE
CHICAGO—Lower levels of high-density lipoprotein (HDL) cholesterol due to a gene mutation is not associated with an increased risk of ischemic heart disease, according to a study in the June 4 issue of JAMA.
Numerous studies have indicated that a low plasma level of HDL cholesterol (the “good” cholesterol) is associated with an increased risk of ischemic heart disease (IHD), according to background information in the article. However, whether HDL cholesterol is a primary factor in the development of IHD is not clear, in part because of other factors related to low HDL cholesterol levels, such as plasma triglycerides, which may contribute independently to increases in cardiovascular events. “… studies of genetic disorders that lower HDL cholesterol without increases in plasma triglycerides and remnant lipoproteins provide an ideal system in which to assess the consequences of isolated, lifelong low HDL cholesterol levels,” the authors write.
Ruth Frikke-Schmidt, M.D., Ph.D., of the University of Copenhagen, Denmark, and colleagues examined whether mutations in the gene ABCA1, which genetically reduce HDL cholesterol levels but do not increase plasma triglyceride levels, are associated with an increased risk of IHD. Three studies were used: the Copenhagen City Heart Study (CCHS), a 31-year general population study (n = 9,022; 28 heterozygotes [a person possessing two different forms of a particular gene, one inherited from each parent]); the Copenhagen General Population Study (CGPS), (n = 31,241; 76 heterozygotes); and the Copenhagen Ischemic Heart Disease Study (CIHDS), (n = 16,623; 44 heterozygotes). Certain data in all three studies were collected during the period of January 1976 through July 2007, with researchers analyzing data on HDL cholesterol levels and the association between IHD and HDL cholesterol and genotype.
The researchers found that heterozygotes vs. noncarriers for 4 ABCA1 mutations (P1065S, G1216V, N1800H, R2144X) had HDL cholesterol levels of 41 mg/dL vs. 58 mg/dL, corresponding to a reduction in HDL cholesterol of 17 mg/dL. A 17 mg/dL lower HDL cholesterol level in the CCHS was associated with a 70 percent higher risk for IHD. However, for IHD in heterozygotes vs. noncarriers, the risk was 33 percent lower in the CCHS; 18 percent lower in the CGPS; and 14 percent lower in the CIHDS. When the studies were combined (n = 41,961; 6,666 cases; 109 heterozygotes), there was no association between heterozygotes and a higher risk of IHD.
“The principal finding of this study is that heterozygosity for loss-of-function mutations in ABCA1 associated with substantial, lifelong lowering of plasma levels of HDL cholesterol, but not with corresponding higher levels of plasma triglycerides or atherogenic [capable of producing a type of plaque in arteries] remnant lipoproteins, did not predict an increased risk of IHD,” the authors write.
(JAMA. 2008;299[21]:2524-2532. Available pre-embargo to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
FAMILY HISTORY OF COLORECTAL CANCER MAY IMPROVE CHANCE OF SURVIVAL
INTRO:
The American Cancer Society estimates that there will be about one hundred and fifty thousand new cases of colorectal cancer in 2008. It is widely known that having a family history increases your chance of developing the disease. But now researchers have found that a family history of colorectal cancer may also significantly decrease your chance of dying from the disease. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Woman walks in kitchen
Woman cooks
AUDIO:
SUZANNE LANDRY (Lan-dree) WAS DIAGNOSED WITH COLON CANCER LAST YEAR. SHE HAS A FAMILY HISTORY OF THE DISEASE BUT AT THIRTY-EIGHT AND HAVING ROUTINE COLONOSCOPIES SHE NEVER THOUGHT IT WOULD HAPPEN TO HER.
VIDEO:
SOT/FULL
Super @: 11
Suzanne Landry
Colon Cancer Patient
Runs: 06
AUDIO:
“I had just had a colonoscopy three years ago and there was no polyp and how could it be cancer? Go from nothing to cancer in three years?”
VIDEO:
B-ROLL
Super @:19 to 24
File Video
Doctors looking at image of colon cancer on light board
Dr. Chan walks into office
GRAPHIC:
Colon Cancer Study (title)
1087 Patients
Stage three colon cancer
18% parent or sibling with colorectal cancer
AUDIO:
WHILE A FAMILY HISTORY INCREASES YOUR CHANCE OF DEVELOPING COLON CANCER MEDICAL ONCOLOGIST JENNIFER CHAN WITH DANA-FARBER CANCER INSTITUTE SAYS IT MAY ALSO HELP SAVE YOUR LIFE. SHE LED A GROUP OF RESEARCHERS WHO ANALYZED MORE THAN A THOUSAND PATIENTS WITH STAGE THREE COLON CANCER. EIGHTEEN PERCENT OF THEM HAD A PARENT OR SIBLING DIAGNOSED WITH COLORECTAL CANCER.
VIDEO:
SOT/FULL
Super @: 39
Jennifer Chan, M.D., MPH
Dana-Farber Cancer Institute
Runs: 07
AUDIO:
“The main finding was that patients who had a family member with colon or rectal cancer had improved outcomes.”
VIDEO:
B-ROLL
GRAPHIC:
Patients With Family History (title)
Followed 1999 – 2007
Tumors surgically removed
Received chemotherapy
Decreased chance of death
AUDIO:
PATIENTS IN THE STUDY WERE FOLLOWED FROM 1999 THROUGH 2007. IN ADDITION TO HAVING STAGE THREE COLON CANCER THEY HAD UNDERGONE A COMPLETE SURGICAL RESECTION OF THE TUMOR AND ALSO RECEIVED CHEMOTHERAPY. A FAMILY HISTORY OF THE DISEASE SIGNIFICANTLY DECREASED THEIR CHANCE OF RECURRENCE AND DEATH.
VIDEO:
SOT/FULL
Jennifer Chan, M.D., MPH
Dana-Farber Cancer Institute
Runs: 11
AUDIO:
“So as a group patients with a family history of colon or rectal cancer had an approximately twenty-five percent decrease in the chances of having a cancer recurrence or death.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Super @ 1:21 to 1:26
File video
Inside colon/polyp being removed
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. RESEARCHERS SAY IT APPEARS DIFFERENCES IN THE MOLECULAR MAKE-UP OF THE CANCER INFLUENCE PATIENT SURVIVAL.
VIDEO:
SOT/FULL
Jennifer Chan, M.D., MPH
Dana-Farber Cancer Institute
Runs: 09
AUDIO:
“We suspect that the patients may have a genetic trait…that affects the biological behavior of the disease and the chance for recurrence.”
VIDEO:
B-ROLL
Cancer patient cooking
Patient and son picture
AUDIO:
SUZANNE LANDRY SAYS THE FINDINGS ARE REASSURING BUT SHE STILL WORRIES ESPECIALLY BECAUSE OF HER YOUNG SON.
VIDEO:
SOT/FULL
Suzanne Landry
Colon Cancer Patient
Runs: 04
AUDIO:
“He’s three. He shouldn’t have to worry about what’s going to happen to his parents.”
VIDEO:
B-ROLL
Cancer patient picture with husband and son
AUDIO:
AT THE MOMENT SHE IS CANCER FREE AND HOPEFUL HER FAMILY HISTORY WILL PROTECT HER. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
Researchers found that when patients in the study had two or more affected relatives their chance of recurrence or death decreased even further to about fifty percent. The study only looked at first-degree relatives meaning parents and siblings. Additional studies are needed to fully understand how family history can influence outcomes. For more information about this study you can log on to www.jama.com.
