Chemotherapy for Elderly Prostate Cancer patients with Advanced prostate cancer

Chemotherapy has been shown to unequivocally improve prognosis of advanced prostate cancer patients.

The survival was found to be improved by an average of 10 months with addition of chemotherapy to long term hormone therapy in a large clinical trial.

Prognosis without chemotherapy was 71 months and prognosis with chemotherapy was 81 months.

But this extra benefit from chemotherapy comes at a cost.

Chemotherapy can be toxic with occasional life threatening side effects. Some elderly patients are frail and others may have diseases affecting heart, lung and brain.

So some patients after carefully weighing up benefits and risks might decline chemotherapy.

This need to weigh up risks and benefits is sometimes very difficult for both patients and doctors before a decision is reached whether to opt for chemotherapy or not.

Express your views at the BMJ rapid response section.

References

Access the BMJ article at: http://bmj.com/cgi/content/full/bmj.m519

Toll-free link:
http://bmj.com/cgi/content/full/bmj.m519?ijkey=Nj2sM5GVE36Yq8G&keytype=ref

Do omega 3 supplements provide protection from Stroke and Heart diseases?

It is a common belief that omega 3 fatty acids provide protection from strokes and heart attacks, and improve overall health.

A review from the esteemed Cochrane collaboration pours cold water on this belief.

The review concludes that omega 3 provides ” little or no meaningful effect on the risk of death from any cause”.

They conclude that “omega 3 supplements probably makes little or no difference to risk of cardiovascular events, coronary heart deaths, coronary heart disease events, stroke or heart irregularities”.

The review did find “moderate evidence that ALA, found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation”.

However, the effect was very small. They estimated that “143 people would need to increase their ALA intake to prevent one person developing arrhythmia”.

They also estimated that “One thousand people would need to increase their ALA intake to prevent one person dying of coronary heart disease or experiencing a cardiovascular event”.

Overall the review finds that overall “omega 3 provides little if any benefit at all”.

References

New Cochrane health evidence challenges belief that omega 3 supplements reduce risk of heart disease, stroke or death.

Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD003177. https://www.cochrane.org/CD003177/VASC_omega-3-intake-cardiovascular-disease

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Walking is good exercise

New year. January. First month of a New year – it’s the time of year many people take a look at their lifestyle and vow to eat better, exercise better and live better.

Many people consider Gym or Health Club membership.

But Exercise doesn’t need to cost a lot. Being active, doesn’t need to be regimented.

Simply walking anywhere is good compared to no exercise at all. Walking in the Park or Quiet streets has lot of benefits.

Good article in BBC on the benefits of walking.

A word of caution though !

Avoid Walking or Jogging near busy roads so that the benefits of walking are not negated by pollution.

Reference

1. BBC. 8 reasons why we should all walk more. BBC.

2. Guardian. Traffic fumes in city streets ‘largely wipe out exercise benefits for over-60s’.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Exciting new immunotherapy treatment !

Test tube lab

The holy grail of cancer treatment is design a drug that is highly lethal to cancerous tissue but completely spares the normal tissues.

Scientists at Cardiff University have discovered immune cells which could provide such a clever treatment.

It is still early days. The principle has been proven in lab. But to be a useful treatment that can be used in cancer patients, it is still far off.

This particular novel form of immunotherapy using T cells is still in early stages and so many hurdles have to be overcome before this discovery could be employed in cancer treatment.

Nevertheless, it has certainly excited many researchers in the field of cancer and the paper has been published by a premier scientific journal.

 

References:

Original scientific paper. Genome-wide CRISPR–Cas9 screening reveals ubiquitous T cell cancer targeting via the monomorphic MHC class I-related protein MR1

BBC news. Immune discovery ‘may treat all cancer’. By James Gallagher. Health and science correspondent

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Do the morning people have it all ?

Picture of morning bird against rising sun

There is definitely truth in idiom that “The early bird catches the worm”.

Are there any other life advantages for the early risers compared to those who hate early mornings?

A paper in BMJ says the women with “morning preference” have less risk of breast cancer compared to the evening people.

So there are advantages for those who can jump out of their bed easily in the morning but it is a different question whether the late risers can train themselves to be early risers !

Reference

Investigating causal relations between sleep traits and risk of breast cancer in women: mendelian randomisation study

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2327 (Published 26 June 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Does alcohol increase of breast cancer?

Yes, Alcohol does substantially increase the risk of Breast cancer.

Very few people seem to be aware of the risks.

Previously it was thought that heavy drinking is responsible for harmful cancer effects.

But studies from U.K and U.S.A have subsequently shown that even light to moderate drinking can increase the risk of breast cancer.

A very large study involving more than 1,250,000 middle-aged women in the United Kingdom ( enrolled in the Million Women Study) showed that “Low to moderate alcohol consumption” in women increases the risk of breast cancer and certain other cancers.

In a study involving more than 88,000 women from United States, also showed that light to moderate drinking increases the risk of breast cancer.

So keep counting the alcohol units during the festive time.

References

1. U.K. Study: Moderate alcohol intake and cancer incidence in women.

2. U.S.A study. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4238 (Published 18 August 2015). Cite this as: BMJ.2015;351:h4238

3. Telegraph. Drinking alcohol raises risk of cancer by snapping DNA, scientists find.

4. Telegraph U.K. Just one in five women at risk of breast cancer know alcohol increases the danger.

Is whole milk harmful ?

In years gone by , many viewed milk as a wholesome healthy food. Government encouraged consumption of milk by providing free milk.

But in recent years, milk is viewed with suspicion.

Vegans shun milk and diary products.

Perhaps the Vegans got it right all along at least as far as whole milk is concerned.

A very large study involving 168 153 women and 49 602 men was published recently in British Medical Journal. The study found that whole milk intake is associated with increased risk of death from heart problems and from some cancers such as lung cancer, ovarian cancer, and prostate cancer.

Interestingly “Cheese and yogurt intake was NOT associated with increased risk of death”.

The risk was also less with “skimmed or low fat milk”.

References

1. Government Cheap Milk Scheme. Br Med J 1940; 2 doi: https://doi.org/10.1136/bmj.2.4170.806-b (Published 07 December 1940)

2. Vegetarian diets. BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2507 (Published 08 July 2009)

3. Associations of dairy intake with risk of mortality in women and men: three prospective cohort studies. BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6204 (Published 27 November 2019). Cite this as: BMJ 2019;367:l6204

Futile antibiotic treatments

Infections are normally highly treatable with antibiotics.

But when someone is dying , the body’s immune system gets weaker. Hence infections quite often occur as part of the dying process.

Treating these infections are often futile. But human nature is inclined to “fight and survive” by all means. So quite often powerful antibiotics are used to treat these infections in dying patients.

There is an ethical argument against futile treatments.

There is also the risk of antibiotic resistance in general population if antibiotics are used inappropriately.

Submit your views at BMJ journal website (rapid response section).

References

Access the article at: http://bmj.com/cgi/content/full/bmj.l6706

Toll-free link:

http://bmj.com/cgi/content/full/bmj.l6706?ijkey=ZXN1zz6QXpPz8np&keytype=ref

Can long working hours kill you?

Yes, it can.

It has been well established by systemic review that working long hours can lead to excessive heart attacks. ( ref 1).

A recent French study indicates that working long hours can lead to increased risk of stroke ( Long hours defined as more than 10 hours on at least 50 days per year in this study) (ref 2).

So look after yourself and don’t push yourself too hard !

References

1. Long Working Hours and Coronary Heart Disease: A Systematic Review and Meta-Analysis .

2. Long working hours ‘linked to stroke risk’ BBC News.

Can complementary therapies do harm ?

Yes,

Very interesting program on BBC “Vitamins and Green Tea” broadcast by BBC . ( BBC iPlayer).

Another Good article on BBC website: Complementary cancer therapies ‘do more harm than good’

So everything in moderation if necessary and take only that’s appropriate for your individual circumstances!!!

 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Are some people fat because of their “gut bacteria mix” is of the wrong sort?

Some people are able to eat everything they like and do not gain much weight (as long as they don’t go over the top).

But others have to just smell a chocolate or a cake and they put on weight (even though this comment is made jokingly some people are so exasperated with their weight gain in-spite of all diets !!!).

Could this discrepancy be related to the having “wrong cocktail of Bacteria in their gut”.

Some scientists seem to think so. An intriguing proof of concept study has been published in Nature Medicine which is a very esteemed science journal.

Read this thoroughly interesting and balanced article on The Atlantic website.

References

The Fundamental Link Between Body Weight and the Immune System

JAMES HAMBLIN

AUG 2, 2019

Inflammation plays a critical role in determining how we digest food, and it’s only now starting to reveal itself.

Can stress cause infection?

Yes, stress can increase risk of serious infections.

Based on personal experience, anecdotally many people would vouch for the fact that stressful events makes them more prone to illness. But strong scientific evidence has been spare.

A recent Swedish study published in British Medical Journal confirms that stress related disorders significantly increase risk of life threatening infections later in life.

Reference

Stress related disorders and subsequent risk of life threatening infections: population based sibling controlled cohort study

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5784 (Published 23 October 2019)

Cite this as: BMJ 2019;367:l5784

Can weather affect joint pain?

Yes, weather can affect joint pain.

A study involving 2500 people conducted by University of Manchester study showed that “people with arthritis feel more pain on humid days”

The study reports that “Damp and windy days with low pressure can increase risk of experiencing more pain than normal”

Cold, damp days also made pain worse but interestingly pain was not made by temperature alone”.

Other studies in the past have also found a “significant correlation between humidity and pain“.

References

BBC News. People ‘more likely to feel pain on humid days’.

Does rheumatoid arthritis disease activity correlate with weather conditions?

The Influence of Weather Conditions on Joint Pain in Older People with Osteoarthritis: Results from the European Project on OSteoArthritis.

Gastric bypass surgery for severe obesity

Severely obese are sometimes offered Stomach (gastric) bypass surgery.

A recent study published in New England Journal of Medicine confirms that benefits are real and are sustained over long term .

Stomach bypass , technically called Bariatric surgery, leads to weight loss and health improvements in both adults and adolescents.

Although it benefits both Adolescents and Adults, Adolescents who underwent gastric bypass seems to have benefited more !

Reference

Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

“Think Positive “ and live longer !

People with sunny disposition seems to live longer.

Having a positive outlook on life seems to protect heart.

Is it a case of “chicken vs egg” in that what came first. Do healthy people have a optimistic outlook and pessimistic people have lot of social, personal and health problems. Do life problems make people pessimistic or being optimistic makes one do better?

Researchers have adjusted the data for confounding factors. Evidence so far is very intriguing.

And the next question is – can one learn to be optimistic, change personality and have beneficial health effects. We don’t know at present.

References

1. Guardian. Optimists have lower risk of heart problems and early death.

2. Guardian. Optimism may hold secret to longer life, study suggests.

3. The association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA)

4. JAMA. Association of Optimism With Cardiovascular Events and All-Cause Mortality

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Does exercise protect you from dementia?

It would be common senses to think that exercise would lead to better physical health and this in turn would protect you from dementia.

But a recent study in BMJ suggests that exercise does NOT have a significant protective effect on developing Alzheimer’s dementia .

Reference

Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1495

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Crowdfunding expensive stem cell therapies

Crowd fund metaphor

If you have come across a desperate request to crowdfund an expensive stem cell therapy, read this well researched BBC article before you contribute.

Hope is a powerful driver particularly when someone is facing immense difficulties in life. Human beings have a natural inclination to fight against all odds and it seems to be inbuilt in our DNA and psyche.

But not all promising treatments do help desperate people searching for a cure.

Reference.

BBC news. The unwarranted hype of stem cell therapies. By Jules Montague. 21 August 2019

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Dietary advice: take it with a pinch of salt

Official dietary advice as well as various “Diets” promoted by various celebrities tend to be very prescriptive. They often give the impression that the evidence behind everything they promote is very clear cut.

But truth is far more murkier ( I might say more “mish mash “).

A new study analysis of old data comes to a different conclusion about “red meat”. This is in fact not surprising as the evidence for various Dietary guidelines and “Diets” are not usually robust and watertight and involves lot of assumptions.

What is the take home message:

Eat “everything you like” in moderation and try to make it as balanced as possible with substitutes for things you avoid !!

Avoid processed food as much as possible and eat fresh.

Don’t be surprised if the next two studies on this topic reach three different conclusions.

References

1. BBC news. Is red meat back on the menu?

2. New York Times. Eat Less Red Meat, Scientists Said. Now Some Believe That Was Bad Advice.

3. The original study article from Annals of Internal Medicine. Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium.

4. Daily Mail. You DON’T need to cut out red meat: Scientists say official advice on eating less beef, pork and lamb is based on bad evidence and having it four times a week poses ‘NO cancer risk’ 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Is processed red meat bad for health?

Yes, red meat especially processed red is bad for health.

In a study published in BMJ, red meat was implicated in causing more deaths.

The authors from Harvard, advocate replacing red meat with equivalent amounts of other protein sources, such as nuts, poultry, fish, dairy, eggs, and legumes, and whole grains and vegetables.

Reference

Association of changes in red meat consumption with total and cause specific mortality among US women and men: two prospective cohort studies. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2110 (Published 12 June 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Olaparib: exciting results in treatment of prostate cancer harbouring certain genetic alterations

https://www.esmo.org/Oncology-News/Olaparib-Outperforms-Enzalutamide-or-Abiraterone-Acetate-in-Men-with-mCRPC-and-HRR-Alterations

Olaparib is set to become a standard treatment option for advanced prostate cancer patients whose tumours harbour certain genetic alterations.

Study results presented at ESMO congress in Barcelona shows good response to olaparib compared to other hormonal agents in this sub-group of patients.

References

1. ESMO European Society of Medical Oncology Annual Conference 2019. Barcelona. Olaparib Outperforms Enzalutamide or Abiraterone Acetate in Men with mCRPC and HRR Alterations.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Acknowledgement: Copyright of Slides: Authors and ESMO

Prostate Bed Radiation can be avoided or delayed in many prostate patients following surgery

A large UK trial shows that lot of men undergoing surgery for prostate do not need Immediate follow-on radiation straightaway.

Trial data was presented at ESMO conference in Barcelona.

Radiation can be entirely avoided in many patients at high risk of relapse and it can be safely delayed until there is definite evidence of relapse in selected patients for months and years.

Waiting and watching is certainly prudent in some patients rather than rushing in with radiation so as to avoid side effects.

Combined data analysis using study data from France as well as Australian and New Zealand trials confirm these findings.

References

1. ESMO 2019 Barcelona. Men with Prostate Cancer can be Spared Radiotherapy after Surgery [ESMO 2019 Press Release].

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Veliparib : Another new drug for treatment of Ovarian Cancer

Veliparib trial data has certainly brought more options to the table in treatment of advanced Ovarian cancer.

Trial data presented at ESMO congress at Barcelona shows that first line therapy with Veliparib is beneficial.

Acknowledgement: Copyright of Slides: Authors and ESMO

References

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

New drug combination for Ovarian Cancer (Olaparib and Bevacizumab)

New trial data presented at the ESMO cancer Congress 2019 in Barcelona, Spain, show excellent results for the combination of Olaparib and Bevacizumab. The combination looks likely to become standard of care in at-least a subgroup of patients.

The expert discussing the trial data did raise the possibility that most benefit seems to come from Olaparib in patients with BRCA mutations and whether Olaparib alone instead combination is enough for this group. More data is awaited.

References

1. ESMO 2019 congress press release. Ovarian Cancer: More Women Benefit from Maintenance Combined Targeted Therapy [ESMO 2019 Press Release]

Acknowledgement: Copyright of Slides: Authors and ESMO

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Niraparib : New treatment for new diagnosed Ovarian Cancer

A landmark study presented at ESMO congress at Barcelona shows significant benefits for maintenance treatment with the drug Niraparib.

Niraparib is likely to become a standard treatment in a much more widely group of advanced ovarian cancer patients.

Many clinicians will be weighing up Niraparib Vs Olaparib in Some patients and Niraparib vs Bevacizumab in other groups of patients.

Reference

1. Niraparib Prolongs PFS in Patients with Newly Diagnosed Advanced Ovarian Cancer. ESMO press release.

Acknowledgement: Copyright of Slides: Authors and ESMO

Melanoma Skin cancers: significant improvement in life expectancy with immunotherapy

Advanced melanoma skin cancers used to carry a dismal prognosis.

Data presented at Barcelona European Cancer Congress ( ESMO) shows the prognosis has improved remarkably in the recent years.

Fifty percent of patients are now alive for at-least five years. It is quite a remarkable achievement for immunotherapy.

References

1. ESMO press release. One in Two Patients with Metastatic Melanoma Alive after Five Years with Combination Immunotherapy [ESMO 2019 Press Release].

2.BBC News. Skin cancer: Half of people surviving advanced melanoma. By James Gallagher. Health and science correspondent, BBC News

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Exercise: Anything is better than nothing

Many people put off exercise thinking it needs to be a planned activity with time allocated for it.

A paper published in British Medical Journal ( BMJ) reports that any exercise is good and contributes to good health compared to no exercise

The recent UK guidelines also advises to “clock up few minutes at a time” whenever and wherever you can. (UK Chief Medical Officer).

You don’t need to run a marathon or join a running group. Just taking the stairs rather the lift would be good.

References

1. Guardian. Even a few minutes’ exercise is good for you, new guidelines state.

2. BMJ. British Medical Journal. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4570 (Published 21 August 2019)

Cite this as: BMJ 2019;366:l4570

3. Daily Telegraph. No such thing as too little exercise, says Chief Medical Officer, as ten minute minimum is scrapped.

4. BBC news. Strengthen muscles as well as heart to stay fit and healthy, say top doctors

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Celery Juice: Super Juice ?

Why Celery Juice is popular now?

Every year some type of food or fruit trends on the social media after being hyped by celebrities and Influencers.

Unfortunately, it seems Celery Juice is trending now.

Just because something is endorsed with good intentions by well meaning people doesn’t mean you have to blindly believe them.

Read the BBC news article for a balanced account .

Reference

1. Celery Juice: The big problem with a viral Instagram ‘cure. BBC news.

Single dose prostate radiation : Can a single shot of radiation cure prostate cancer?

Yes, say the authors of a recent study from United Kingdom. The study was presented at the European society of radiotherpy ( ESTRO) meeting in Milan.

The study looked at treatment results in patients with localized, low-risk prostate cancer. The short term results are very good. These promising are yet to be fully accepted by everyone as standard of care

This is because patients in this study were followed up only for about 2 years ( to be precise a median follow up of only 26 months) . More long term follow up is needed before firm conclusions could be drawn.

References

1. Daily Mail newspaper article. Single ten-minute shot of radiation can save prostate cancer patients misery of weeks of gruelling treatment, study finds . 29 Apr 2019.

2. ASCO post. ESTRO 38: High–Dose Rate Brachytherapy in Localized Prostate Cancer. 5/3/2019 2:28:54 PM.

3. ESTRO ( 2019 Milan). Session type:Award Lecture. Presentation number:OC-0633. Abstract title: Single dose high dose-rate (HDR) brachytherapy as monotherapy for localised prostate cancer. H. Tharmalingam , Y.M. Tsang, P. Hoskin Mount Vernon Cancer Centre and The Christie NHS Foundation Trust, Clinical Oncology, London, United Kingdom.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Is Vegan diet the most healthy ? Are there any risks from Vegetarian diet?

Life would be very simple if we can have clear cut answers with regards to the best diet for everyone’s health.

A recent study published in BMJ indicates that while Vegan diet reduces risk of heart problems it can increase the risk of strokes.

The results might seem confusing and scientists would be certainly seeking more answers. But don’t be surprised if another study from some other research group comes up with a contradictory result. That’s normal in science.

What’s most important is to realise that there are no easy scientific answers to most scientific questions. Research quite often shows unexpected results. What is a logical scientific question quite often throws up unexpected answers.

Overall, the message is “have a well balanced diet” without omitting essential nutrients.

References

1. BBC news. Plant-based diets ‘linked to higher stroke risk‘ Vegan and vegetarian diets ‘link to higher stroke risk’ Sept 2019.

2. BMJ. British Medical Journal.

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4897 (Published 04 September 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Low Carb Diet

High carbohydrate diet can make a person put on weight.

The extra weight can put a strain on the knees and logic dictates that over time this can cause knee problems due to excessive “wear and tear”.

So would a Low-Carbohydrate and Low-Fat Diet help to relieve Pain in Individuals with Knee Osteoarthritis.

Yes, low carb diet can indeed have positive effect on Knee pain.

A study testing the efficacy of two dietary interventions found that low carb diet can reduce pain intensity .

Reference

Pain Med. 2019 Mar 13. pii: pnz022. doi: 10.1093/pm/pnz022.

The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis.

Strath LJ1, Jones CD1, Philip George A1, Lukens SL1, Morrison SA2, Soleymani T3, Locher JL4, Gower BA5, Sorge RE1.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Are health benefits of Alcohol a myth?

Moderate alcohol consumption has been touted as protective and that alcohol in moderation may be good for health.

You often hear people saying that “Very few things in life that are good for health are also pleasurable” . Alcohol was thought to be an exception to this this rule.

But a recent study bursts the myth that alcohol may have health benefits.

The Chinese study in collaboration with University of Oxford found that ” even a small drink a day increases risk of stroke”.

Another study last year also indicated that there is no safe level of drinking.

So the message is that if you do drink ( and don’t want to stop altogether) cut it down as much as possible and have at least a few alcohol free days !!!

References

1. BBC news. 5 April 2019. Even one drink a day increases stroke risk, study finds

2. BBC. 24 August 2018
No alcohol safe to drink, global study confirms

3. The Lancet ( medical journal ) Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

GBD 2016 Alcohol Collaborators
Open AccessPublished:August 23, 2018

4. The Lancet ( medical journal )

Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China

VOLUME 393, ISSUE 10183, P1831-1842, MAY 04, 2019

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

What news can you trust as a cancer patient?

A Cancer diagnosis is terrifying and upsets all the carefully crafted life’s plans.

Many cancer patients would like to have in-depth information about cancer. It is quite natural and logical to expect “black and white” information cancers. But cancer is always associated with uncertainty.

Well meaning but ill informed people sometimes inadvertently bombard cancer patients with fake news. Even worse, there are charlatans who would try to sell unproven treatments to vulnerable cancer patients.

There is a good article in Observer about this “cancer fake news”.

If you are not sure about information you have read on the net, ask your doctor to clarify.

If you prefer a independent person , ring the helpline of independent charities such as Cancer Research UK or Macmillan.

Reference

1. How to survive the fake news about cancer. Observer.

Can fruit juices increase risk of cancer?

Instinctively, many people would think of fruit juices as healthy. Many would not associate fruit juices with cancer.

A recent study in British Medical Journal says that “the consumption of 100% fruit juice was significantly associated with the risk of overall cancer”.

The conclusion – sugar is bad from cancer point of view.

References

Sugary drink consumption and risk of cancer: results from NutriNet-Santé prospective cohort

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2408 (Published 10 July 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Too much of a good thing

Sometimes it is better to leave things alone if they are working well.

Trying to refine things does not always make it lot better.

A case in point is the Troponin blood test used for diagnosis of heart attacks.

The conventional troponin blood test used to work reasonably well. I suppose it is human nature to try and make existing things better.

The high sensitivity troponin tests were developed to diagnose more heart attacks.

Yes, it is a good thing to diagnose more heart attacks quicker.

But the problem is these new blood tests can also generate false positives. It’s like a super sensitive fire alarm which is triggered by impurities rather than by fire. It’s not only annoying, but affects people’s response to alarms.

The high sensitivity troponin test can sound the false alarm for heart attack in lot of hospital patients admitted for something else.

Just because a test is highly sensitive doesn’t make it super useful!

But it looks like the genie is out of the bottle and the high sensitivity troponin tests are here to stay ….

Share your thoughts at the BMJ website through the rapid response option.

References

1. High sensitivity troponin assays: too much of a good thing.

Toll-free link: http://bmj.com/cgi/content/full/bmj.l1640?ijkey=63W6oWyB18vrXHn&keytype=ref

2. True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study.

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l729 (Published 13 March 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Taking up Exercise in middle age: is it worthwhile?

You could have been a ‘couch potato‘ all your life.

Is it worthwhile starting exercise now?

Yes, says the paper published in British Medical Journal.

The study involving nearly 15,000 people found that irrespective of your past, taking up physical activity in middle and old age is beneficial.

The study concludes “Middle aged and older adults, including those with cardiovascular disease and cancer, can gain substantial longevity benefits by becoming more physically active, irrespective of past physical activity levels and established risk factors.”

So get going !!!!!

Reference

Physical activity trajectories and mortality: population based cohort study. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2323 (Published 26 June 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can some advanced cancer kidney cancer patients be safely watched closely (without going for chemotherapy treatment straightaway).

A Canadian team presented data on this topic at the American Society of Clinical Oncology meeting at Chicago.

The team says it can be safely done in select group of patients without compromising the survival.

Delayed treatment without putting patients through nasty side effects is certainly a welcome option for some patients.

Reference

1. ASCO 2019: Abstract number 4516.

Session: Genitourinary (Nonprostate) Cancer. Type: Poster Discussion Session

Time: Monday June 3, 4:30 PM to 6:00 PM

Location: Hall D2

Active surveillance in metastatic renal cell carcinoma (mRCC): Results from the Canadian Kidney Cancer information system (CKCis). 2019 ASCO Annual Meeting J Clin Oncol 37, 2019 (suppl; abstr 4516)

Robotic or Laparoscopic versus Open surgery for Cancer of Cervix

For early cervical cancer, surgical removal of the uterus is the primary treatment which provides a very good chance of cure.

Open Surgery can cause complications and so surgeons set about using the latest Robotic Surgery or Laparoscopic surgery to perform minimally invasive surgery.

Unfortunately, newer techniques led to more recurrences of cancer.

A Swedish study abstract published at the American Society of Clinical Oncology meeting at Chicago confirms the findings from a previous study which was widely reported in mass media including in New York Times

References

1. NEJM paper. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer.

2. NEJM paper. Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

3. European Society of Gynaecological Oncology – statement

4. Sweden Study: Recurrence rates in cervical cancer patients treated with abdominal versus minimally invasive radical hysterectomy: A multi-institutional analysis of 700 cases.

5. British Gynaecological Cancer Society (BGCS) statement.

6. New York Times. Studies Warn Against Minimally Invasive Surgery for Cervical Cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can Vitamin D make cancer patients live longer ?

Taking high doses of multi-vitamins is usually not a good idea for someone having a well balanced diet and hence multivitamins are not medically advocated.

Vitamin D is often an exception. Lot of prostate and breast cancer patients are often advised to make sure they have adequate vitamin D ( sunlight exposure , but D rich diet or Vit D supplements) for preservation bone health.

An intriguing study presented at the American Society of Clinical Oncology annual meeting on June 3, 2019 suggests Vitamin D supplements can help cancer patients live longer.

Vitamin D was associated with significant reduction of cancer-related deaths in patients who have been diagnosed with cancer in the past.

On the other hand , in healthy people with no prior history of cancer, Vitamin D did not have any cancer prevention properties.

Reference

ASCO. 2019. Annual Meeting abstracts. Role of vitamin D supplementation for primary prevention of cancer: Meta-analysis of randomized controlled trials.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Darolutamide : a new prostate cancer drug

Darolutamide is a new drug developed to treat prostate cancer that has come back after failure of hormone injections .

Dr Fizazi from France presented the study at the American Society of Clinical Oncology meeting at Chicago.

The drug was found to be highly effective at controlling the cancer and had a significant impact on the ability of prostate cancer to spread.

Reference

Impact of darolutamide (DARO) on pain and quality of life (QoL) in patients (Pts) with nonmetastatic castrate-resistant prostate cancer (nmCRPC).

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Apalutamide : Another new drug for Advanced prostate cancer

Apalutamide, a new hormonal tablet, has been found to improve survival of patients with metastatic, castration-sensitive prostate cancer .

The study was presented at the ASCO (American Society of Clinical Oncology) meeting at Chicago .

It is wonderful to have so many treatment options to treat advanced prostate cancer.

Reference

Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Enzalutamide versus Docetaxel in advanced prostate cancers ( tablets vs injections )

Data presented just now at the American Society of Clinical Oncology meeting at Chicago shows that the Enzalutamide ( Xtandi) tablets improve survival in advanced prostate cancer patients.

So in addition to starting hormone injections to suppress production of testosterone hormones , additional treatment with Enzalutamide ( Xtandi) helps in controlling cancer much more longer.

What’s the downside: The tablets do have physical side effects such as fatigue and it needs to be taken continuously. Since it is a oral medication, in some countries patients do end up paying a lot ( co-pays).

Furthermore, the benefits of Enzalutamide ( Xtandi) is limited to patients who didn’t receive intravenous docetaxel chemotherapy.

Having six doses of chemotherapy over 18 weeks seems to provide the same benefits as 36+ months of Enzalutamide ( Xtandi) .

Other agents are also available in this setting.

So patients need a detailed discussion with their oncologists !!!

Reference

Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

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Thank you for reading my blogs!

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Perceptions matter

People’s perception and expectations do affect their health care.

Palliative care physicians, at least in UK, are mainly based or linked to hospices.

In UK , hospices often provide terminal care to cancer patients. The hospice team provide a invaluable service in terms of minimising the patient’s suffering as the cancer takes its toll.

Palliative care physicians are an integral part of terminal care team. But they are often able to offer more than terminal care. Their significant expertise can be of immense help to patients in “early” part of cancer journey.

But the perception that a referral to palliative care team at hospice is bad news hinders some patients….

One option to overcome the stigma would be relocation of palliative care departments to cancer centres at hospitals so that the referral to palliative care team doesn’t have a negative connotation .

Please provide your thoughts at the BMJ site through rapid response link.

Reference

“Palliative care: relocation rather than rebranding is needed” published online by BMJ.

Access the article at: http://bmj.com/cgi/content/full/bmj.l1641

Toll-free link:

http://bmj.com/cgi/content/full/bmj.l1641?ijkey=gPzXvpIHI1jQwYi&keytype=ref

Can dietary supplements make you live longer?

A recent study published in Annals in Internal Medicine looked at the effects of dietary supplements on overall mortality risk.

“Use of dietary supplements was NOT associated with mortality benefits among U.S. adults.”

In fact, there was a suggestion of increased risk of cancer deaths from calcium supplements.

Reference: Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study. Ann Intern Med. [Epub ahead of print 9 April 2019] doi: 10.7326/M18-2478.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

What’s in a name?

awareness cancer design pink Photo by Miguel on Pexels.com

The word cancer is a dreaded one. Not without a good reason. Cancer is the number one killer. Even when someone has a good outcome, the cancer journey is torture. Emotional turmoil is immeasurably horrendous.

But many people would be surprised to hear that there exists a category of low risk cancers. “Low-risk Cancers are cancers which usually don’t kill; These Cancers are found either incidentally on scans performed for some other reasons or found as part of routine cancer screening.”

Because they are not deadly, Should the patients diagnosed with low-risk cancers be spared the dreaded label of cancer?

Should low-risk cancers be labelled something else and the word cancer used only for the “serious” high-risk cancers ?

Personally, I do not agree with renaming of the low risk cancers..Others disagree

Joint the debate at the BMJ.

Submit your views through rapid response

Reference: 
Should we rename low risk cancers? BMJ

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Is it a bad idea to use alternative therapy instead of conventional treatment for Cancer?

bamboo bamboo whisk board bowls

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Generally speaking Yes, it is a very bad idea.

Patients using alternative therapy exclusively  such as mistletoe therapy, vitamin therapy quite often come to harm.

For example, a well known Chinese actress shunned conventional chemotherapy for her lymphoma. Instead, Ms Xu Ting – a previously fit and well 26 year old – opted for traditional Chinese medicine methods for her lymphoma.

She underwent alternative therapies such as cupping, acupuncture, back stretching and a method called gua sha. Unfortunately traditional treatments didn’t help and she died from a potentially curable cancer. (1-3).

The misconceptions are certainly NOT confined to East. One of the prominent examples in the West is the fate of Dutch actress Sylvia Millecam.

She refused conventional treatment for her Breast Cancer and instead tried a wide range of so called alternative treatments – such as faith healing, salt therapy and magnetic field therapy. She unfortunately died of a potentially curable cancer. (4-6).

In addition to these well known anecdotal evidence, Studies have shown that alternative therapies can affect survival. Utilization of alternative therapies for curable cancer without any conventional therapy was associated with greater risk of death. (7-11).

However convincing the material you read on social media and wider internet, do NOT abandon conventional tretments. Always ask professional opinion about various things you have read and if not satisfied, ask second or third opinion.

 

How else cancer patients use complementary/ alternative therapy?

Although scientifically not universally validated, complementary medicine may help some cancer patients to cope better with their symptoms. Many patients do use acupuncture, hypnotherapy, massage, aromotherapy and group art therapy to deal with physical and psychological symptoms and side effetcs from conventional treatments.

two yellow sunflowers with clear glass bottle with cork lid

Photo by Mareefe on Pexels.com

Links

Chinese actress

1. https://www.independent.co.uk/news/people/xu-ting-death-cancer-actor-chose-alternative-medicine-over-chemotherapy-a7310786.html

2. https://www.bbc.co.uk/news/world-asia-china-37370201

3. https://www.theguardian.com/world/2016/sep/16/chinese-actor-xu-ting-dies-after-choosing-traditional-medicine-over-chemotherapy

Dutch actress

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1910656/

5. https://en.wikipedia.org/wiki/Sylvia_Millecam

6. https://www.theguardian.com/society/2004/mar/23/lifeandhealth.cancercare

Survival Risk

7. Cancer patients who use alternative medicine more than twice as likely to die.The Independent, August 15 2017

8. Cancer patients who rely on herbs, homeopathy or energy crystals over conventional treatment are two-and-a-half times more likely to die within five years of diagnosis.Mail Online, August 15 2017

9. Cancer patients who shun chemo for alternative therapies ‘are TWICE as likely to die’.The Sun, August 15 2017

10. Johnson SB, Park HS, Gross CP, Yu JB. Use of Alternative Medicine for Cancer and Its Impact on Survival.Journal of the National Cancer Institute. Published online August 10 2017

11. https://www.nhs.uk/news/cancer/alternative-cancer-therapies-may-increase-your-risk-death/

 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Surprising Number of Americans Believe Alternative Therapies Can Cure Cancer

woman holding white laptop between women

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A recent National Cancer Opinion Survey found that a significant Number of Americans Believe Alternative Therapies Can Cure Cancer.

Nearly four in 10 Americans (39%) believe cancer can be cured solely through alternative therapies such as enzyme and oxygen therapy, diet, vitamins, and minerals.

Even many of the respondents with direct cancer experience—people who have or had cancer and family caregivers—believe cancer can be cured solely through alternative medicine.(22% and 38%, respectively).

The American survey also found that younger people are the group most likely to hold these views: 47% of people ages 18 to 37 and 44% of people ages 38 to 53.

It is counterintuitive that the generation with access to vast online information at the swipe of a finger holds such unscientific views. One wonders whether the social media is inadvertently promoting misinformation.

References

1.American Society of Clinical Oncology : Second National Cancer Opinion Survey.

 

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Can Turmeric control cancer ?

Turmeric powder

 

Turmeric is an orange coloured spice widely used in Indian dishes.

Turmeric has been used in Indian traditional medicine (Siddha and Ayurveda).

Turmeric has anti-inflammatory and anti-Cancer properties when tested in laboratories.

Remember – a potential to be beneficial (based on lab studies) is not the same as being proven to work in humans. Lot of substances which are promising in the laboratory eventually turn out to be useless in humans.

If you search PUBMED database- which is an online database of scientific papers- you will find hundreds of papers pertaining to medicinal use of turmeric and its key ingredients such as curcumin. But unfortunately among the many hundreds of published papers, there are very few human trials which have explored turmeric as a anti-cancer treatment.

Inspite of the positive anectodal reports on various internet sites, the available scientific evidence for use of turmeric as an anti-cancer treatment is very spare. ( references below).

Hence it is not worthwhile using turmeric as a cancer treatment.

If you do like Indian dishes, use turmeric as a spice in your normal diet.

But do stay away from the supplements which are sold with health claims.

 

ginger and turmeric powder

Photo by Pixabay on Pexels.com

References

The EssentialMedicinal Chemistry of Curcumin.Nelson KM, Dahlin JL, Bisson J, Graham J, Pauli GF, Walters MA. J Med Chem. 2017 Mar 9;60(5):1620-1637.

Phase I clinical trial of oralcurcumin: biomarkers of systemic activity and compliance.Sharma RA, Euden SA, Platton SL, Cooke DN, Shafayat A, Hewitt HR, Marczylo TH, Morgan B, Hemingway D, Plummer SM, Pirmohamed M, Gescher AJ, Steward WP. Clin Cancer Res. 2004 Oct 15;10(20):6847-54.

A Placebo-Controlled Double-Blinded Randomized Pilot Study of Combination Phytotherapy in Biochemically Recurrent Prostate Cancer.van Die MD, Williams SG, Emery J, Bone KM, Taylor JM, Lusk E, Pirotta MV. Prostate. 2017 May;77(7):765-775.

Efficacy and Safety of Curcumin in Treatment of Intestinal Adenomas in Patients With Familial Adenomatous Polyposis.Cruz-Correa M, Hylind LM, Marrero JH, Zahurak ML, Murray-Stewart T, Casero RA Jr, Montgomery EA, Iacobuzio-Donahue C, Brosens LA, Offerhaus GJ, Umar A, Rodriguez LM, Giardiello FM. Gastroenterology. 2018 Sep;155(3):668-673.

Effect on prostatic specific antigen by a short time treatment with a Curcuma extract: A real life experience and implications for prostate biopsy.Fabiani A, Morosetti C, Filosa A, Principi E, Lepri L, Maurelli V, Fioretti F, Servi L. Arch Ital Urol Androl. 2018 Jun 30;90(2):107-111.

Pharmacodynamic and pharmacokinetic study of oral Curcuma extract in patients with colorectal cancer.Sharma RA, McLelland HR, Hill KA, Ireson CR, Euden SA, Manson MM, Pirmohamed M, Marnett LJ, Gescher AJ, Steward WP. Clin Cancer Res. 2001 Jul;7(7):1894.

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A double-blind, placebo-controlled randomised trial evaluating the effect of a polyphenol-rich whole food supplement on PSA progression in men with prostate cancer–the U.K. NCRN Pomi-T study.Thomas R, Williams M, Sharma H, Chaudry A, Bellamy P. Prostate Cancer Prostatic Dis. 2014 Jun;17(2):180-6

Consumption of the putative chemopreventive agent curcumin by cancer patients: assessment of curcumin levels in the colorectum and their pharmacodynamic consequences.Garcea G, Berry DP, Jones DJ, Singh R, Dennison AR, Farmer PB, Sharma RA, Steward WP, Gescher AJ. Cancer Epidemiol Biomarkers Prev. 2005 Jan;14(1):120-5.

A phase I/II study of gemcitabine-based chemotherapy plus curcumin for patients with gemcitabine-resistant pancreatic cancer.Kanai M, Yoshimura K, Asada M, Imaizumi A, Suzuki C, Matsumoto S, Nishimura T, Mori Y, Masui T, Kawaguchi Y, Yanagihara K, Yazumi S, Chiba T, Guha S, Aggarwal BB. Cancer Chemother Pharmacol. 2011 Jul;68(1):157.

Phytosome complex of curcumin as complementary therapy of advanced pancreatic cancer improves safety and efficacy of gemcitabine: Results of a prospective phase II trial.Pastorelli D, Fabricio ASC, Giovanis P, D’Ippolito S, Fiduccia P, Soldà C, Buda A, Sperti C, Bardini R, Da Dalt G, Rainato G, Gion M, Ursini F. Pharmacol Res. 2018 Jun;132:72-79.

Monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, and curcumin: a randomized, double-blind placebo-controlled cross-over 4g study and an open-label 8g extension study.Golombick T, Diamond TH, Manoharan A, Ramakrishna R. Am J Hematol. 2012 May;87(5):455-60.

 

Image credit: Simon A. Eugster. Turmeric (Curcuma longa):fresh rhizome and powder.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Does Cranberry juice relieve bladder symptoms due to radiation cystitis?

bowl of red round fruits

Many people do look for natural remedies to help with their symptoms.

Anectodally, many patients undergoing radiotherapy have reported that Cranberry Juice has eased their radiation cystitis symptoms.

What is the scientific evidence behind it ?

Should all patients having cystitis symptoms during radiotherapy take cranberry juice?

There is certainly scientific basis to expect benefit from Cranberry Juice.(1).

A lab study and a volunteer study (with volunteers from Japan, Hungary, Spain and France) has shown that certain chemicals in Cranberry can make bacteria ‘less sticky‘ to urinary tract walls and hence potentially reduces virulence of the bacteria.(1). But subsequent large studies have NOT confirmed any large benefit from Cranberry in terms of treating or preventing urinary tract infections. (2)(3).

But Radiation Cystitis is not due to bacterial infections although infections can co-exist sometimes. Hence the use of Cranberry has been studied separately in patients undergoing radiation therapy.

A New Zealand study involved 41 men undergoing radiotherapy for prostate cancer. Taking Cranberry (one capsule a day at breakfast) was found to reduce symptoms of pain and burning. (4).

On the other hand, in a study from Canada involving 112 patients , consumption of Cranberry juice compared with apple juice had no effect on radiation cystitis symptoms. (5).

Another study from United Kingdom was inconclusive because of poor patient recruitment and poor compliance. (6).

So the scientific evidence is inconclusive at present.(7).

Practically, if someone is keen to try it – the best course of action – ( for someone not intolerant of cranberry juice) – is to try it and see whether it offers any symptomatic benefit .

Disclaimer: Please note- This is NOT medical advice. This blog is purely for information only. See your own doctor to discuss options.

There are prescription medications available to help with radiation cystitis symptoms.

References:

1.Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010 Apr 14;10:94.

2. BBC News. Does Cranberry juice stop cystitis. By Claudia Hammond. (Accessed 1st Jan 2019).

3. BBC News. Ditch cranberry juice for urine infection . (Accessed 1st Jan 2019).

4.Standardized cranberry capsules for radiation cystitis in prostate cancer patients in New Zealand: a randomized double blinded, placebo controlled pilot study. Support Care Cancer (2015) 23: 95.

5. A Randomised Trial of Cranberry Versus Apple Juice in the Management of Urinary Symptoms During External Beam Radiation Therapy for Prostate Cancer. G.Campbell et al. Clin Oncol (R Coll Radiol). 2003 Sep;15(6):322-8.

6. A Randomised Double-blind Placebo-controlled Trial to Determine the Effect of Cranberry Juice on Decreasing the Incidence of Urinary Symptoms and Urinary Tract Infections in Patients Undergoing Radiotherapy for Cancer of the Bladder or Cervix. Cowan CC, et al. Clin Oncol (R Coll Radiol). 2012.

7.Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges. BJU Int. 2013 Nov;112(7):885-97.

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