By Nancy Lapid
(Reuters) - Hello, Health Rounds readers! Today we report on studies that could lead to a closer look at mammography findings related to clogged arteries. We also discuss a study that could lead to greater use of video visits by health care providers looking to improve the quality of life for patients near the end of life, and a review that takes a fresh look at the risks of treatment with a powerful blood cancer therapy.
Mammogram finding in arteries may indicate heart disease
Calcium buildup in the arteries of the breast, detected by mammography, is usually not a sign of cancer, but it may indicate a higher risk of heart disease, two research teams reported at the Menopause Society's annual meeting in Chicago.
A team followed nearly 400 women for 18 years and found that atherosclerotic cardiovascular disease (clogged arteries that restrict blood flow) was diagnosed in 23% of women with hardened arteries in the chest, compared to 13.9% of women without.
"Previous research has suggested this type of association," study leader Hannah Daley of Drexel University College of Medicine in Pennsylvania said in a statement. "Based on what we found, we believe the presence of calcified breast arteries on mammograms should be routinely reported."
Separately, researchers from Penn State College of Medicine in Pennsylvania looked at data from nine previous studies involving nearly 47,000 women who were followed for an average of almost 12 years. They found that women with calcified breast arteries seen on mammograms had an increased risk of stroke, cardiovascular death, atherosclerotic cardiovascular disease and congestive heart failure.
"I think this study is important for primary care physicians, but also for cardiologists and really for any clinician who is involved in cardiovascular disease risk assessment," study leader Dr. Matthew Nudy said in a statement.
The information from these studies "confirms that risk factors for cardiovascular disease are different in women than in men," Dr. Stephanie Faubion, medical director of the Menopause Society, said in a statement.
Virtual palliative care visits prove useful
A new study finds that cancer patients who don't have access to in-person palliative care can benefit just as much from care via video visits.
Palliative care focuses on relieving pain and other symptoms to improve the quality of life of patients with serious illnesses.
In the United States, 1,250 patients newly diagnosed with advanced lung cancer were randomly assigned to a facility that received early palliative care via video visits or in-person contact at least once every four weeks.
Participants completed surveys at baseline and every 12 weeks thereafter. Quality of life scores improved significantly in both groups and were the same at week 24, according to a study published in JAMA.
Satisfaction with care, anxiety and depression symptoms, use of approach-oriented or avoidance coping strategies, and perception of the primary goal of treatment and the curability of their cancer were also similar between groups.
Caregiver participation in palliative care visits was lower in the video group, but the groups did not differ in caregiver satisfaction with care, quality of life, mood complaints, or prognostic perceptions.
National guidelines in the United States recommend that palliative care be incorporated into a patient's care beginning at the time of diagnosis of advanced cancer, based on numerous clinical trials demonstrating its effectiveness in improving quality of life, symptoms and other outcomes. But, the researchers noted, most patients and their families do not receive such care, in part because of the limited availability of specially trained clinicians.
"Many healthcare institutions now have the capacity to offer video visits," they wrote. "The current study adds critical evidence to support continued access to telehealth services, particularly for vulnerable populations with serious illnesses."
No higher risk of second cancer found with CAR-T cell therapy
A review of previous studies shows that in patients with blood cancer who undergo CAR-T cell therapy, the risk of a second malignant tumor is not higher than after other standard treatments.
CAR T-cell therapy involves modifying a patient's own immune cells to attack cancer cells. These T cells are taken from the blood, genetically modified to fight the individual's cancer, and then reintroduced into the patient.
For the new study, researchers analyzed data from 5,517 participants in 18 clinical trials in the United States and other countries testing six CAR T-cell therapies: Bristol Myers Squibb's Abecma and Breyanzi, Johnson & Johnson's Carvykti, Novartis' Kymriah, or Gilead Science's Tecartus or Yescarta.
After a median follow-up of 21.7 months, 5.8% of patients developed a second primary malignancy.
Among 1,253 participants in four trials comparing CAR T therapy with more traditional treatments, 5% of CAR T recipients and 4.9% of standard-of-care recipients developed new, unrelated cancers. The difference was not statistically significant, according to a report in Clinical Cancer Research.
The outcomes were similar regardless of the type of cancer or the CAR T-cell product used.
Patients who had received at least three other treatments before CAR T had a significantly higher risk of second cancers than patients who had received no more than two prior therapies. This may be due to cumulative tissue damage from the multiple prior therapies, the researchers said.
CAR T-cell therapy is the first in more than 20 years to show an overall survival advantage over standard treatment in the most common type of lymphoma in U.S. patients, study leader Dr. Kai Rejeski, of Memorial Sloan Kettering Cancer Center in New York, said in a statement.
The rate of second cancers was higher in studies with longer follow-up, possibly suggesting that "more patients are developing second primary malignancies because they live long enough to get them," Rejeski said.
Overall, "these data do not suggest that there is an increased risk of second primary malignancies compared to other standard treatments," Rejeski said. "I have a concern that the warning labels may intimidate patients who are getting this therapy, which may not be entirely warranted."
In the United States and Europe, CAR T-cell labels must warn of a possible risk of a new, unrelated cancer developing after treatment, based on cases reported to the U.S. Food and Drug Administration and the European Medicines Agency.
(Reporting by Nancy Lapid; Editing by Will Dunham)
