Q)How is complementary and alternative medicine used in multiple sclerosis, and how can I safely recommend it to my patients?

Complementary and alternative medicine (CAM) is a non-mainstream practice used in conjunction with conventional medicine.¹ Its use is prevalent among people with and without chronic illnesses, including those living with multiple sclerosis (MS). Up to 70% of Americans with MS have used some type of CAM therapy, compared with 36% of the general population.^1,2 CAM use is higher in women than in men and is highest among persons ages 35 to 49—two demographics also associated with MS.³

CAM practices include a myriad of therapies from different disciplines (see Table 1).³ Because most people who use CAM do not discuss it with their health care providers, it is important that providers inquire about patient use and are armed with basic safety and efficacy information.

Office visits for MS should include safety and efficacy discussions about all therapeutic treatments (disease modifying, relapse, and symptom management). Some issues—such as adverse effects—are obvious, while others, such as cost, are less so. A patient with MS may pursue an extremely expensive CAM therapy that lacks substantial evidence for the condition. Providers should therefore consider cost as part of the safety equation and be aware that while some CAM therapies have been studied in MS, most have not (or the research has been of poor quality).⁴

For many commonly used therapies, there is insufficient scientific evidence to support their usefulness in MS. These include acupuncture, biofeedback, Chinese medicine, chiropractic care, replacing amalgam dental fillings, equine therapy, hyperbaric oxygen treatment, low-dose naltrexone, massage therapy, tai chi, and yoga. While many of these practices are relatively safe and inexpensive, others may cause financial harm. Conversely, something considered safe and inexpensive (eg, a low-fat diet with omega-3 supplementation) may be found to be ineffective. Although recommending this type of diet for a person with MS is safe, realistic expectations must be discussed regarding its effect (or lack thereof) on the condition.⁴

The effectiveness of medical marijuana for MS is another popular deliberation. While data suggest that several administration methods of oral cannabinoids may be effective for spasticity and pain reduction, there is inadequate evidence to support the use of smoked cannabis. The deleterious effects of cannabis on cognition also need to be considered.⁵

Dietary supplements (eg, vitamins, minerals, botanicals, dietary substances) are often regarded as safe by patients because they are “natural.” As clinicians, we must be direct in asking patients about everything they are taking—many dietary supplements have drug interactions and/or toxic effects and may adversely stimulate the immune system. Vitamin D, for example, is one supplement that has been heavily studied in MS; lower levels of vitamin D have been shown to increase the risk for MS, and higher levels may be associated with lower relapse and disability rates. Therefore, standard of practice is to monitor vitamin D levels and supplement accordingly.

CAM can be safely and effectively recommended to people living with MS with due diligence. A question guide to aid recommendations is listed in Table 2.

Currently, no CAM therapies have been shown to modify MS, and CAM should not be recommended in place of disease-modifying treatment. However, if the proper questions are addressed, many CAM therapies can be safely recommended for common MS symptoms. Insurance coverage varies significantly among policies, but some treatments (eg, acupuncture and chiropractic care) are gaining coverage.

Finally, it is safe and a good standard of care to recommend a healthy anti-inflammatory diet, such as the Mediterranean diet, to people living with MS in order to improve general health. —MW

Megan Weigel, DNP, ARNP-C, MSCN
President of IOMSN
Baptist Neurology, Jacksonville Beach, Florida

Q)How is complementary and alternative medicine used in multiple sclerosis, and how can I safely recommend it to my patients?

Complementary and alternative medicine (CAM) is a non-mainstream practice used in conjunction with conventional medicine.¹ Its use is prevalent among people with and without chronic illnesses, including those living with multiple sclerosis (MS). Up to 70% of Americans with MS have used some type of CAM therapy, compared with 36% of the general population.^1,2 CAM use is higher in women than in men and is highest among persons ages 35 to 49—two demographics also associated with MS.³

CAM practices include a myriad of therapies from different disciplines (see Table 1).³ Because most people who use CAM do not discuss it with their health care providers, it is important that providers inquire about patient use and are armed with basic safety and efficacy information.

Office visits for MS should include safety and efficacy discussions about all therapeutic treatments (disease modifying, relapse, and symptom management). Some issues—such as adverse effects—are obvious, while others, such as cost, are less so. A patient with MS may pursue an extremely expensive CAM therapy that lacks substantial evidence for the condition. Providers should therefore consider cost as part of the safety equation and be aware that while some CAM therapies have been studied in MS, most have not (or the research has been of poor quality).⁴

For many commonly used therapies, there is insufficient scientific evidence to support their usefulness in MS. These include acupuncture, biofeedback, Chinese medicine, chiropractic care, replacing amalgam dental fillings, equine therapy, hyperbaric oxygen treatment, low-dose naltrexone, massage therapy, tai chi, and yoga. While many of these practices are relatively safe and inexpensive, others may cause financial harm. Conversely, something considered safe and inexpensive (eg, a low-fat diet with omega-3 supplementation) may be found to be ineffective. Although recommending this type of diet for a person with MS is safe, realistic expectations must be discussed regarding its effect (or lack thereof) on the condition.⁴

The effectiveness of medical marijuana for MS is another popular deliberation. While data suggest that several administration methods of oral cannabinoids may be effective for spasticity and pain reduction, there is inadequate evidence to support the use of smoked cannabis. The deleterious effects of cannabis on cognition also need to be considered.⁵

Dietary supplements (eg, vitamins, minerals, botanicals, dietary substances) are often regarded as safe by patients because they are “natural.” As clinicians, we must be direct in asking patients about everything they are taking—many dietary supplements have drug interactions and/or toxic effects and may adversely stimulate the immune system. Vitamin D, for example, is one supplement that has been heavily studied in MS; lower levels of vitamin D have been shown to increase the risk for MS, and higher levels may be associated with lower relapse and disability rates. Therefore, standard of practice is to monitor vitamin D levels and supplement accordingly.

CAM can be safely and effectively recommended to people living with MS with due diligence. A question guide to aid recommendations is listed in Table 2.

Currently, no CAM therapies have been shown to modify MS, and CAM should not be recommended in place of disease-modifying treatment. However, if the proper questions are addressed, many CAM therapies can be safely recommended for common MS symptoms. Insurance coverage varies significantly among policies, but some treatments (eg, acupuncture and chiropractic care) are gaining coverage.

Finally, it is safe and a good standard of care to recommend a healthy anti-inflammatory diet, such as the Mediterranean diet, to people living with MS in order to improve general health. —MW

Megan Weigel, DNP, ARNP-C, MSCN
President of IOMSN
Baptist Neurology, Jacksonville Beach, Florida

Q)How is complementary and alternative medicine used in multiple sclerosis, and how can I safely recommend it to my patients?

Complementary and alternative medicine (CAM) is a non-mainstream practice used in conjunction with conventional medicine.¹ Its use is prevalent among people with and without chronic illnesses, including those living with multiple sclerosis (MS). Up to 70% of Americans with MS have used some type of CAM therapy, compared with 36% of the general population.^1,2 CAM use is higher in women than in men and is highest among persons ages 35 to 49—two demographics also associated with MS.³

CAM practices include a myriad of therapies from different disciplines (see Table 1).³ Because most people who use CAM do not discuss it with their health care providers, it is important that providers inquire about patient use and are armed with basic safety and efficacy information.

Office visits for MS should include safety and efficacy discussions about all therapeutic treatments (disease modifying, relapse, and symptom management). Some issues—such as adverse effects—are obvious, while others, such as cost, are less so. A patient with MS may pursue an extremely expensive CAM therapy that lacks substantial evidence for the condition. Providers should therefore consider cost as part of the safety equation and be aware that while some CAM therapies have been studied in MS, most have not (or the research has been of poor quality).⁴

For many commonly used therapies, there is insufficient scientific evidence to support their usefulness in MS. These include acupuncture, biofeedback, Chinese medicine, chiropractic care, replacing amalgam dental fillings, equine therapy, hyperbaric oxygen treatment, low-dose naltrexone, massage therapy, tai chi, and yoga. While many of these practices are relatively safe and inexpensive, others may cause financial harm. Conversely, something considered safe and inexpensive (eg, a low-fat diet with omega-3 supplementation) may be found to be ineffective. Although recommending this type of diet for a person with MS is safe, realistic expectations must be discussed regarding its effect (or lack thereof) on the condition.⁴

The effectiveness of medical marijuana for MS is another popular deliberation. While data suggest that several administration methods of oral cannabinoids may be effective for spasticity and pain reduction, there is inadequate evidence to support the use of smoked cannabis. The deleterious effects of cannabis on cognition also need to be considered.⁵

Dietary supplements (eg, vitamins, minerals, botanicals, dietary substances) are often regarded as safe by patients because they are “natural.” As clinicians, we must be direct in asking patients about everything they are taking—many dietary supplements have drug interactions and/or toxic effects and may adversely stimulate the immune system. Vitamin D, for example, is one supplement that has been heavily studied in MS; lower levels of vitamin D have been shown to increase the risk for MS, and higher levels may be associated with lower relapse and disability rates. Therefore, standard of practice is to monitor vitamin D levels and supplement accordingly.

CAM can be safely and effectively recommended to people living with MS with due diligence. A question guide to aid recommendations is listed in Table 2.

Currently, no CAM therapies have been shown to modify MS, and CAM should not be recommended in place of disease-modifying treatment. However, if the proper questions are addressed, many CAM therapies can be safely recommended for common MS symptoms. Insurance coverage varies significantly among policies, but some treatments (eg, acupuncture and chiropractic care) are gaining coverage.

Finally, it is safe and a good standard of care to recommend a healthy anti-inflammatory diet, such as the Mediterranean diet, to people living with MS in order to improve general health. —MW

Megan Weigel, DNP, ARNP-C, MSCN
President of IOMSN
Baptist Neurology, Jacksonville Beach, Florida

Consumption of dietary fiber at the recommended average intake of 25 g per day was associated with lower risks of developing symptomatic knee osteoarthritis and moderate or severe knee pain over 4-8 years in two separate analyses of Osteoarthritis Initiative participants conducted by investigators at Boston University.

The studies are the first to describe an association between total dietary fiber and lower risk of symptomatic OA and pain worsening in the knee, as well as a lower risk of moderate and severe pain patterns. The lowered risks were partially mediated by body mass index (BMI) but persisted even after adjustment for the variable.

Nic_Ol/Thinkstock

In both studies, the investigators estimated dietary fiber intake by using a validated food frequency questionnaire at baseline that summed the fibers from grains, fruits and vegetables, and nuts and legumes.

Fiber and symptomatic knee OA

At the end of 4 years of follow-up, Dr. Dai and her colleagues identified 152 knees with incident radiographic OA (defined as a knee newly developing a Kellgren and Lawrence grade of 2 or higher), 869 knees with incident symptomatic OA (defined as new onset of both radiographic OA and a painful knee on most days in past month), and 1,964 knees with pain worsening as defined by an increase of at least 14% of the baseline Western Ontario and McMaster Universities (WOMAC) Index pain subscale score at each annual exam. This analysis excluded 540 people who were lost to follow-up and 205 who had invalid caloric intake recordings, leaving 4,051 in the study. The outcomes also excluded people with prevalent radiographic or symptomatic knee OA or knee pain worsening at baseline.

There was a significant trend for lower risk of both symptomatic OA (P less than .002) and pain worsening (P = .005) across four quartiles of daily total dietary fiber intake (mean of 9.1 g, 13 g, 16 g, and 21.9 g in quartiles 1-4). Quartile 4 daily intake was associated with a statistically significant 30% reduction (95% confidence interval, 6%-48%) in the odds of symptomatic knee OA and a 19% reduction (95% CI, 6%-29%) in the odds of pain worsening. Both comparisons were adjusted for age, sex, race, total energy intake, education, smoking status, physical activity, intake of other dietary factors (including polyunsaturated fat and other fats, vitamin C, vitamin D, vitamin E, vitamin K, dairy products, sweets, and soda), and nonsteroidal anti-inflammatory drug use (for the pain-worsening comparison).

Even though approximately 34% of the association between total fiber intake and symptomatic OA and 22% of the association between total fiber intake and pain worsening were mediated through reduced BMI, further adjustment of the comparisons for baseline BMI yielded similarly significant results.

The investigators found no associations between total dietary fiber intake and radiographic knee OA or for other fiber intake with either symptomatic or radiographic knee OA.

“The strongest protection was suggested at the highest quartile, which is in line with the current dietary guidelines for daily fiber intake. For older people [aged 51 years and older], for women it’s 22 g per day and for men it’s 28 g per day,” Dr. Dai said at the meeting.

Fiber and knee pain trajectories

Dr. Dai and her associates identified distinct, relatively homogeneous clusters of WOMAC pain trajectories over the 8-year study course in patients with and without radiographic knee OA at baseline in the Arthritis Care & Research study, and then examined their relationship to participants’ total dietary fiber intake, divided into quartiles (Arthritis Res Care. 2016; Nov 29. doi: 10.1002/acr.23158). The investigators found four pain trajectory patterns, including no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%).

Individuals who consumed the most total fiber also had the highest representation in the no pain pattern (38.1%) and the lowest representation in the severe pain pattern (4.3%). A high total fiber intake was associated with lower risk of having a moderate or severe pain pattern when compared with those in the no pain trajectory (both P for trend less than .01). Intake of fiber in the highest quartile was associated with a 24% lower likelihood (95% CI, 7%-39%) of belonging to the moderate pain pattern and a 44% lower likelihood (95% CI, 2%-59%) of being in the severe pain pattern, compared with individuals in the lowest intake quartile.

The same four pain trajectory patterns existed in individuals with radiographic knee OA at baseline, but the proportions were shifted slightly lower for no pain (26.1%) and higher for severe pain (7.9%). There was an even greater effect magnitude for the association between dietary total fiber and moderate or severe pain pattern among individuals with radiographic knee OA at baseline. Similar results were found for participants without radiographic knee OA at baseline. The relationships between total dietary fiber intake and pain patterns were somewhat attenuated after adjustment for depression scores and BMI at baseline but still remained statistically significant.

In each of the comparisons and sensitivity analyses, the highest quartile of cereal grain fiber intake was also significant on its own in lowering risk for being in the moderate or severe pain trajectory patterns. However, no significant results were found for fiber from fruits and vegetables or from nuts and legumes.

The studies were supported by grants from the National Institutes of Health. None of the authors had conflicts of interest to disclose.

[email protected]

Consumption of dietary fiber at the recommended average intake of 25 g per day was associated with lower risks of developing symptomatic knee osteoarthritis and moderate or severe knee pain over 4-8 years in two separate analyses of Osteoarthritis Initiative participants conducted by investigators at Boston University.

The studies are the first to describe an association between total dietary fiber and lower risk of symptomatic OA and pain worsening in the knee, as well as a lower risk of moderate and severe pain patterns. The lowered risks were partially mediated by body mass index (BMI) but persisted even after adjustment for the variable.

Nic_Ol/Thinkstock

In both studies, the investigators estimated dietary fiber intake by using a validated food frequency questionnaire at baseline that summed the fibers from grains, fruits and vegetables, and nuts and legumes.

Fiber and symptomatic knee OA

At the end of 4 years of follow-up, Dr. Dai and her colleagues identified 152 knees with incident radiographic OA (defined as a knee newly developing a Kellgren and Lawrence grade of 2 or higher), 869 knees with incident symptomatic OA (defined as new onset of both radiographic OA and a painful knee on most days in past month), and 1,964 knees with pain worsening as defined by an increase of at least 14% of the baseline Western Ontario and McMaster Universities (WOMAC) Index pain subscale score at each annual exam. This analysis excluded 540 people who were lost to follow-up and 205 who had invalid caloric intake recordings, leaving 4,051 in the study. The outcomes also excluded people with prevalent radiographic or symptomatic knee OA or knee pain worsening at baseline.

There was a significant trend for lower risk of both symptomatic OA (P less than .002) and pain worsening (P = .005) across four quartiles of daily total dietary fiber intake (mean of 9.1 g, 13 g, 16 g, and 21.9 g in quartiles 1-4). Quartile 4 daily intake was associated with a statistically significant 30% reduction (95% confidence interval, 6%-48%) in the odds of symptomatic knee OA and a 19% reduction (95% CI, 6%-29%) in the odds of pain worsening. Both comparisons were adjusted for age, sex, race, total energy intake, education, smoking status, physical activity, intake of other dietary factors (including polyunsaturated fat and other fats, vitamin C, vitamin D, vitamin E, vitamin K, dairy products, sweets, and soda), and nonsteroidal anti-inflammatory drug use (for the pain-worsening comparison).

Even though approximately 34% of the association between total fiber intake and symptomatic OA and 22% of the association between total fiber intake and pain worsening were mediated through reduced BMI, further adjustment of the comparisons for baseline BMI yielded similarly significant results.

The investigators found no associations between total dietary fiber intake and radiographic knee OA or for other fiber intake with either symptomatic or radiographic knee OA.

“The strongest protection was suggested at the highest quartile, which is in line with the current dietary guidelines for daily fiber intake. For older people [aged 51 years and older], for women it’s 22 g per day and for men it’s 28 g per day,” Dr. Dai said at the meeting.

Fiber and knee pain trajectories

Dr. Dai and her associates identified distinct, relatively homogeneous clusters of WOMAC pain trajectories over the 8-year study course in patients with and without radiographic knee OA at baseline in the Arthritis Care & Research study, and then examined their relationship to participants’ total dietary fiber intake, divided into quartiles (Arthritis Res Care. 2016; Nov 29. doi: 10.1002/acr.23158). The investigators found four pain trajectory patterns, including no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%).

Individuals who consumed the most total fiber also had the highest representation in the no pain pattern (38.1%) and the lowest representation in the severe pain pattern (4.3%). A high total fiber intake was associated with lower risk of having a moderate or severe pain pattern when compared with those in the no pain trajectory (both P for trend less than .01). Intake of fiber in the highest quartile was associated with a 24% lower likelihood (95% CI, 7%-39%) of belonging to the moderate pain pattern and a 44% lower likelihood (95% CI, 2%-59%) of being in the severe pain pattern, compared with individuals in the lowest intake quartile.

The same four pain trajectory patterns existed in individuals with radiographic knee OA at baseline, but the proportions were shifted slightly lower for no pain (26.1%) and higher for severe pain (7.9%). There was an even greater effect magnitude for the association between dietary total fiber and moderate or severe pain pattern among individuals with radiographic knee OA at baseline. Similar results were found for participants without radiographic knee OA at baseline. The relationships between total dietary fiber intake and pain patterns were somewhat attenuated after adjustment for depression scores and BMI at baseline but still remained statistically significant.

In each of the comparisons and sensitivity analyses, the highest quartile of cereal grain fiber intake was also significant on its own in lowering risk for being in the moderate or severe pain trajectory patterns. However, no significant results were found for fiber from fruits and vegetables or from nuts and legumes.

The studies were supported by grants from the National Institutes of Health. None of the authors had conflicts of interest to disclose.

[email protected]

Consumption of dietary fiber at the recommended average intake of 25 g per day was associated with lower risks of developing symptomatic knee osteoarthritis and moderate or severe knee pain over 4-8 years in two separate analyses of Osteoarthritis Initiative participants conducted by investigators at Boston University.

The studies are the first to describe an association between total dietary fiber and lower risk of symptomatic OA and pain worsening in the knee, as well as a lower risk of moderate and severe pain patterns. The lowered risks were partially mediated by body mass index (BMI) but persisted even after adjustment for the variable.

Nic_Ol/Thinkstock

In both studies, the investigators estimated dietary fiber intake by using a validated food frequency questionnaire at baseline that summed the fibers from grains, fruits and vegetables, and nuts and legumes.

Fiber and symptomatic knee OA

At the end of 4 years of follow-up, Dr. Dai and her colleagues identified 152 knees with incident radiographic OA (defined as a knee newly developing a Kellgren and Lawrence grade of 2 or higher), 869 knees with incident symptomatic OA (defined as new onset of both radiographic OA and a painful knee on most days in past month), and 1,964 knees with pain worsening as defined by an increase of at least 14% of the baseline Western Ontario and McMaster Universities (WOMAC) Index pain subscale score at each annual exam. This analysis excluded 540 people who were lost to follow-up and 205 who had invalid caloric intake recordings, leaving 4,051 in the study. The outcomes also excluded people with prevalent radiographic or symptomatic knee OA or knee pain worsening at baseline.

There was a significant trend for lower risk of both symptomatic OA (P less than .002) and pain worsening (P = .005) across four quartiles of daily total dietary fiber intake (mean of 9.1 g, 13 g, 16 g, and 21.9 g in quartiles 1-4). Quartile 4 daily intake was associated with a statistically significant 30% reduction (95% confidence interval, 6%-48%) in the odds of symptomatic knee OA and a 19% reduction (95% CI, 6%-29%) in the odds of pain worsening. Both comparisons were adjusted for age, sex, race, total energy intake, education, smoking status, physical activity, intake of other dietary factors (including polyunsaturated fat and other fats, vitamin C, vitamin D, vitamin E, vitamin K, dairy products, sweets, and soda), and nonsteroidal anti-inflammatory drug use (for the pain-worsening comparison).

Even though approximately 34% of the association between total fiber intake and symptomatic OA and 22% of the association between total fiber intake and pain worsening were mediated through reduced BMI, further adjustment of the comparisons for baseline BMI yielded similarly significant results.

The investigators found no associations between total dietary fiber intake and radiographic knee OA or for other fiber intake with either symptomatic or radiographic knee OA.

“The strongest protection was suggested at the highest quartile, which is in line with the current dietary guidelines for daily fiber intake. For older people [aged 51 years and older], for women it’s 22 g per day and for men it’s 28 g per day,” Dr. Dai said at the meeting.

Fiber and knee pain trajectories

Dr. Dai and her associates identified distinct, relatively homogeneous clusters of WOMAC pain trajectories over the 8-year study course in patients with and without radiographic knee OA at baseline in the Arthritis Care & Research study, and then examined their relationship to participants’ total dietary fiber intake, divided into quartiles (Arthritis Res Care. 2016; Nov 29. doi: 10.1002/acr.23158). The investigators found four pain trajectory patterns, including no pain (34.5%), mild pain (38.1%), moderate pain (21.2%), and severe pain (6.2%).

Individuals who consumed the most total fiber also had the highest representation in the no pain pattern (38.1%) and the lowest representation in the severe pain pattern (4.3%). A high total fiber intake was associated with lower risk of having a moderate or severe pain pattern when compared with those in the no pain trajectory (both P for trend less than .01). Intake of fiber in the highest quartile was associated with a 24% lower likelihood (95% CI, 7%-39%) of belonging to the moderate pain pattern and a 44% lower likelihood (95% CI, 2%-59%) of being in the severe pain pattern, compared with individuals in the lowest intake quartile.

The same four pain trajectory patterns existed in individuals with radiographic knee OA at baseline, but the proportions were shifted slightly lower for no pain (26.1%) and higher for severe pain (7.9%). There was an even greater effect magnitude for the association between dietary total fiber and moderate or severe pain pattern among individuals with radiographic knee OA at baseline. Similar results were found for participants without radiographic knee OA at baseline. The relationships between total dietary fiber intake and pain patterns were somewhat attenuated after adjustment for depression scores and BMI at baseline but still remained statistically significant.

In each of the comparisons and sensitivity analyses, the highest quartile of cereal grain fiber intake was also significant on its own in lowering risk for being in the moderate or severe pain trajectory patterns. However, no significant results were found for fiber from fruits and vegetables or from nuts and legumes.

The studies were supported by grants from the National Institutes of Health. None of the authors had conflicts of interest to disclose.

[email protected]

WASHINGTON – The nation’s political sea-change won’t wash Alzheimer’s disease research funding offtrack, two legislators vowed at a Washington briefing.

Rather than descend into partisan budget-bickering under the new administration, lawmakers should reach across the aisle and pass funding bills to vigorously propel the nation toward its goal of having an effective disease-modifying Alzheimer’s disease therapy by 2025.

“If we make this a high-enough priority, we can meet that goal,” Rep. Paul Tonko (D-NY) said at a briefing sponsored by The Hill newspaper, with support by Eli Lilly. “We should prioritize the work we need to do to achieve it in both the House and Senate, and move forward both aggressively and progressively.”

Michele G. Sullivan/Frontline Medical News

“I am a strong proponent of investing in research. We simply must continue to put research dollars into Alzheimer’s. If we don’t invest, try to find a cure or treatment, Alzheimer’s will become the single largest driver of health care costs on both a federal and state level. We have to recognize this: We could, potentially, not even be able to provide care for all patients we will have, unless we find a treatment or a cure.”

After a decade of struggle, federal dollars for Alzheimer’s research have begun to creep up. Last year, Congress passed a historic $350 million increase in Alzheimer’s research funding at the National Institutes of Health, raising the total spending to $991 million for fiscal year 2016. Then, in June, the Senate Appropriations Committee approved a landmark $400 million funding increase. In July, the House Appropriations Committee approved its own $350 million bump.

In August, the NIH recommended a $414 million increase for fiscal year 2018. If both the fiscal year 2017 increase and fiscal year 2018 request are ultimately passed, funding levels would be very close to the $2 billion/year federal commitment that researchers and Alzheimer’s policy mavens say is necessary to achieve the 2025 goal, set forth in the National Plan to Address Alzheimer’s Disease.

“There’s no such thing as too much research funding,” Sen. Tillis said during the briefing. But, he added, that federal generosity must be wisely husbanded.

“There must also be a sense of discipline along with the funding. Money like that should be targeted in terms of which diseases we go after – they should be areas that have the broadest impact. In a world of scarce resources, we can’t afford to simply throw money around.”

Alzheimer’s research is a perfect example of this careful resource management, he said. The NIH has prepared its second “bypass budget,” a funding proposal that passes the normal legislative channels and goes directly to the President.

Based on the consensus of scientists involved in search for a disease-modifying therapy, this budget proposal estimates the additional money needed to meet the 2025 goal, above the NIH’s baseline Alzheimer’s funding.

Only two other areas of medicine have such a budget: cancer and HIV-AIDS, said Robert J. Egge, chief public policy officer of the Alzheimer’s Association.

“This budget goes right from the scientists to Congress with no filter by the Office of Management and Budget, and lands directly on the President’s desk,” he said in an interview. “It tells legislators what scientists need in order to accomplish that 2025 goal.”

The $2 billion/year figure, Mr. Egge noted, is a ground-floor suggestion. “That’s what we need right now to stay on track. We think the best way to figure out where we need to be in the long-term is to let the scientists at NIH tell us what they need, and we need Congress and the Administration to follow this year to year.”

Like Sen. Tillis and Rep. Tonko, Mr. Egge was upbeat in anticipating steady funding progress.

“The champions of Alzheimer’s funding who have made such a difference for us are all back and in their same positions,” with unstinting commitment to the cause.

Those legislators include:

• Rep. Tom Cole (R-OK), chairman of the House Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, which funds the NIH. In 2015, Rep. Cole shepherded through a $300 million appropriation for Alzheimer’s research, and the pending $350 million appropriation for fiscal year 2017.

• Sen. Roy Blunt (R-MO), who, as chairman of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, secured June’s $400 million and a $350 million bump in 2015.

• Ranking member Sen. Patty Murray (D-WA), who cosponsored the Alzheimer’s Breakthrough Act of 2009, and who worked with Sen. Blunt to secure the recent Alzheimer’s funding increases.

Mr. Egge is not overly troubled about the antiscience rhetoric bandied about by some potential members of President-elect Trump’s administration. He predicted those rumblings will settle down and not negatively affect Alzheimer’s funding.

“I think all the talk of not believing in the science of biomedical research was premature,” he said. “I think it’s completely appropriate to say ‘We are going to watch closely and form opinions,’ but I have never been overly alarmed by this. As an Alzheimer’s advocate for strong science, I am waiting to see what the next steps are. President-elect Trump has said on the campaign trail that Alzheimer’s would be a top priority. Our champions from both parties are fully committed to this fight and recognize that science is the fundamental path to do so. I share this optimism. It’s not complacent optimism – it’s vigilant optimism that we will continue with the momentum we need to finally, squarely and effectively, address this disease.”

[email protected]
On Twitter @alz_gal

WASHINGTON – The nation’s political sea-change won’t wash Alzheimer’s disease research funding offtrack, two legislators vowed at a Washington briefing.

Rather than descend into partisan budget-bickering under the new administration, lawmakers should reach across the aisle and pass funding bills to vigorously propel the nation toward its goal of having an effective disease-modifying Alzheimer’s disease therapy by 2025.

“If we make this a high-enough priority, we can meet that goal,” Rep. Paul Tonko (D-NY) said at a briefing sponsored by The Hill newspaper, with support by Eli Lilly. “We should prioritize the work we need to do to achieve it in both the House and Senate, and move forward both aggressively and progressively.”

Michele G. Sullivan/Frontline Medical News

“I am a strong proponent of investing in research. We simply must continue to put research dollars into Alzheimer’s. If we don’t invest, try to find a cure or treatment, Alzheimer’s will become the single largest driver of health care costs on both a federal and state level. We have to recognize this: We could, potentially, not even be able to provide care for all patients we will have, unless we find a treatment or a cure.”

After a decade of struggle, federal dollars for Alzheimer’s research have begun to creep up. Last year, Congress passed a historic $350 million increase in Alzheimer’s research funding at the National Institutes of Health, raising the total spending to $991 million for fiscal year 2016. Then, in June, the Senate Appropriations Committee approved a landmark $400 million funding increase. In July, the House Appropriations Committee approved its own $350 million bump.

In August, the NIH recommended a $414 million increase for fiscal year 2018. If both the fiscal year 2017 increase and fiscal year 2018 request are ultimately passed, funding levels would be very close to the $2 billion/year federal commitment that researchers and Alzheimer’s policy mavens say is necessary to achieve the 2025 goal, set forth in the National Plan to Address Alzheimer’s Disease.

“There’s no such thing as too much research funding,” Sen. Tillis said during the briefing. But, he added, that federal generosity must be wisely husbanded.

“There must also be a sense of discipline along with the funding. Money like that should be targeted in terms of which diseases we go after – they should be areas that have the broadest impact. In a world of scarce resources, we can’t afford to simply throw money around.”

Alzheimer’s research is a perfect example of this careful resource management, he said. The NIH has prepared its second “bypass budget,” a funding proposal that passes the normal legislative channels and goes directly to the President.

Based on the consensus of scientists involved in search for a disease-modifying therapy, this budget proposal estimates the additional money needed to meet the 2025 goal, above the NIH’s baseline Alzheimer’s funding.

Only two other areas of medicine have such a budget: cancer and HIV-AIDS, said Robert J. Egge, chief public policy officer of the Alzheimer’s Association.

“This budget goes right from the scientists to Congress with no filter by the Office of Management and Budget, and lands directly on the President’s desk,” he said in an interview. “It tells legislators what scientists need in order to accomplish that 2025 goal.”

The $2 billion/year figure, Mr. Egge noted, is a ground-floor suggestion. “That’s what we need right now to stay on track. We think the best way to figure out where we need to be in the long-term is to let the scientists at NIH tell us what they need, and we need Congress and the Administration to follow this year to year.”

Like Sen. Tillis and Rep. Tonko, Mr. Egge was upbeat in anticipating steady funding progress.

“The champions of Alzheimer’s funding who have made such a difference for us are all back and in their same positions,” with unstinting commitment to the cause.

Those legislators include:

• Rep. Tom Cole (R-OK), chairman of the House Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, which funds the NIH. In 2015, Rep. Cole shepherded through a $300 million appropriation for Alzheimer’s research, and the pending $350 million appropriation for fiscal year 2017.

• Sen. Roy Blunt (R-MO), who, as chairman of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, secured June’s $400 million and a $350 million bump in 2015.

• Ranking member Sen. Patty Murray (D-WA), who cosponsored the Alzheimer’s Breakthrough Act of 2009, and who worked with Sen. Blunt to secure the recent Alzheimer’s funding increases.

Mr. Egge is not overly troubled about the antiscience rhetoric bandied about by some potential members of President-elect Trump’s administration. He predicted those rumblings will settle down and not negatively affect Alzheimer’s funding.

“I think all the talk of not believing in the science of biomedical research was premature,” he said. “I think it’s completely appropriate to say ‘We are going to watch closely and form opinions,’ but I have never been overly alarmed by this. As an Alzheimer’s advocate for strong science, I am waiting to see what the next steps are. President-elect Trump has said on the campaign trail that Alzheimer’s would be a top priority. Our champions from both parties are fully committed to this fight and recognize that science is the fundamental path to do so. I share this optimism. It’s not complacent optimism – it’s vigilant optimism that we will continue with the momentum we need to finally, squarely and effectively, address this disease.”

[email protected]
On Twitter @alz_gal

WASHINGTON – The nation’s political sea-change won’t wash Alzheimer’s disease research funding offtrack, two legislators vowed at a Washington briefing.

Rather than descend into partisan budget-bickering under the new administration, lawmakers should reach across the aisle and pass funding bills to vigorously propel the nation toward its goal of having an effective disease-modifying Alzheimer’s disease therapy by 2025.

“If we make this a high-enough priority, we can meet that goal,” Rep. Paul Tonko (D-NY) said at a briefing sponsored by The Hill newspaper, with support by Eli Lilly. “We should prioritize the work we need to do to achieve it in both the House and Senate, and move forward both aggressively and progressively.”

Michele G. Sullivan/Frontline Medical News

“I am a strong proponent of investing in research. We simply must continue to put research dollars into Alzheimer’s. If we don’t invest, try to find a cure or treatment, Alzheimer’s will become the single largest driver of health care costs on both a federal and state level. We have to recognize this: We could, potentially, not even be able to provide care for all patients we will have, unless we find a treatment or a cure.”

After a decade of struggle, federal dollars for Alzheimer’s research have begun to creep up. Last year, Congress passed a historic $350 million increase in Alzheimer’s research funding at the National Institutes of Health, raising the total spending to $991 million for fiscal year 2016. Then, in June, the Senate Appropriations Committee approved a landmark $400 million funding increase. In July, the House Appropriations Committee approved its own $350 million bump.

In August, the NIH recommended a $414 million increase for fiscal year 2018. If both the fiscal year 2017 increase and fiscal year 2018 request are ultimately passed, funding levels would be very close to the $2 billion/year federal commitment that researchers and Alzheimer’s policy mavens say is necessary to achieve the 2025 goal, set forth in the National Plan to Address Alzheimer’s Disease.

“There’s no such thing as too much research funding,” Sen. Tillis said during the briefing. But, he added, that federal generosity must be wisely husbanded.

“There must also be a sense of discipline along with the funding. Money like that should be targeted in terms of which diseases we go after – they should be areas that have the broadest impact. In a world of scarce resources, we can’t afford to simply throw money around.”

Alzheimer’s research is a perfect example of this careful resource management, he said. The NIH has prepared its second “bypass budget,” a funding proposal that passes the normal legislative channels and goes directly to the President.

Based on the consensus of scientists involved in search for a disease-modifying therapy, this budget proposal estimates the additional money needed to meet the 2025 goal, above the NIH’s baseline Alzheimer’s funding.

Only two other areas of medicine have such a budget: cancer and HIV-AIDS, said Robert J. Egge, chief public policy officer of the Alzheimer’s Association.

“This budget goes right from the scientists to Congress with no filter by the Office of Management and Budget, and lands directly on the President’s desk,” he said in an interview. “It tells legislators what scientists need in order to accomplish that 2025 goal.”

The $2 billion/year figure, Mr. Egge noted, is a ground-floor suggestion. “That’s what we need right now to stay on track. We think the best way to figure out where we need to be in the long-term is to let the scientists at NIH tell us what they need, and we need Congress and the Administration to follow this year to year.”

Like Sen. Tillis and Rep. Tonko, Mr. Egge was upbeat in anticipating steady funding progress.

“The champions of Alzheimer’s funding who have made such a difference for us are all back and in their same positions,” with unstinting commitment to the cause.

Those legislators include:

• Rep. Tom Cole (R-OK), chairman of the House Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, which funds the NIH. In 2015, Rep. Cole shepherded through a $300 million appropriation for Alzheimer’s research, and the pending $350 million appropriation for fiscal year 2017.

• Sen. Roy Blunt (R-MO), who, as chairman of the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services, Education and Related Agencies, secured June’s $400 million and a $350 million bump in 2015.

• Ranking member Sen. Patty Murray (D-WA), who cosponsored the Alzheimer’s Breakthrough Act of 2009, and who worked with Sen. Blunt to secure the recent Alzheimer’s funding increases.

Mr. Egge is not overly troubled about the antiscience rhetoric bandied about by some potential members of President-elect Trump’s administration. He predicted those rumblings will settle down and not negatively affect Alzheimer’s funding.

“I think all the talk of not believing in the science of biomedical research was premature,” he said. “I think it’s completely appropriate to say ‘We are going to watch closely and form opinions,’ but I have never been overly alarmed by this. As an Alzheimer’s advocate for strong science, I am waiting to see what the next steps are. President-elect Trump has said on the campaign trail that Alzheimer’s would be a top priority. Our champions from both parties are fully committed to this fight and recognize that science is the fundamental path to do so. I share this optimism. It’s not complacent optimism – it’s vigilant optimism that we will continue with the momentum we need to finally, squarely and effectively, address this disease.”

[email protected]
On Twitter @alz_gal

ATLANTA – Research into vaccine hesitancy in the United States tends to focus on overall trends among native-born Americans or immigrants who have mostly assimilated into American culture. But the nation is dotted with tight-knit ethnic communities which have immigrated to the United States, including refugee communities that retain much of the culture and practices of their home country.

Developing interventions to address vaccine hesitancy in these communities may require a significantly different approach than it would in fully assimilated groups, with a need to start by learning about the culture, fears, values and priorities of that particular community.

Fibonacci Blue [CC BY 2.0

ATLANTA – Research into vaccine hesitancy in the United States tends to focus on overall trends among native-born Americans or immigrants who have mostly assimilated into American culture. But the nation is dotted with tight-knit ethnic communities which have immigrated to the United States, including refugee communities that retain much of the culture and practices of their home country.

Developing interventions to address vaccine hesitancy in these communities may require a significantly different approach than it would in fully assimilated groups, with a need to start by learning about the culture, fears, values and priorities of that particular community.

Fibonacci Blue [CC BY 2.0

ATLANTA – Research into vaccine hesitancy in the United States tends to focus on overall trends among native-born Americans or immigrants who have mostly assimilated into American culture. But the nation is dotted with tight-knit ethnic communities which have immigrated to the United States, including refugee communities that retain much of the culture and practices of their home country.

Developing interventions to address vaccine hesitancy in these communities may require a significantly different approach than it would in fully assimilated groups, with a need to start by learning about the culture, fears, values and priorities of that particular community.

Fibonacci Blue [CC BY 2.0

ATLANTA – A multifaceted comprehensive intervention significantly improved human papillomavirus (HPV) vaccination rates in a Florida pediatric health care group practice.

Alix G. Casler, MD, chief of pediatrics at Orlando Health Physician Associates, described how her practice put into place practices to improve the overall HPV vaccination rate of their clients.

National Cancer Institute

ATLANTA – A multifaceted comprehensive intervention significantly improved human papillomavirus (HPV) vaccination rates in a Florida pediatric health care group practice.

Alix G. Casler, MD, chief of pediatrics at Orlando Health Physician Associates, described how her practice put into place practices to improve the overall HPV vaccination rate of their clients.

National Cancer Institute

ATLANTA – A multifaceted comprehensive intervention significantly improved human papillomavirus (HPV) vaccination rates in a Florida pediatric health care group practice.

Alix G. Casler, MD, chief of pediatrics at Orlando Health Physician Associates, described how her practice put into place practices to improve the overall HPV vaccination rate of their clients.

National Cancer Institute

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has uncoupled spirometry results from the ABCD treatment algorithm; this move marks the organization’s first announcing of major COPD guidance since 2011.

Spirometry now stands apart from GOLD’s ABCD symptom/exacerbation risk score with its own grade, with possibilities ranging from 1 to 4. A forced expiratory volume in 1 second (FEV₁) of 80% or more of the predicted value rates a 1; the score degrades to 4 with an FEV₁ below 30%.

[email protected]

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has uncoupled spirometry results from the ABCD treatment algorithm; this move marks the organization’s first announcing of major COPD guidance since 2011.

Spirometry now stands apart from GOLD’s ABCD symptom/exacerbation risk score with its own grade, with possibilities ranging from 1 to 4. A forced expiratory volume in 1 second (FEV₁) of 80% or more of the predicted value rates a 1; the score degrades to 4 with an FEV₁ below 30%.

[email protected]

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has uncoupled spirometry results from the ABCD treatment algorithm; this move marks the organization’s first announcing of major COPD guidance since 2011.

Spirometry now stands apart from GOLD’s ABCD symptom/exacerbation risk score with its own grade, with possibilities ranging from 1 to 4. A forced expiratory volume in 1 second (FEV₁) of 80% or more of the predicted value rates a 1; the score degrades to 4 with an FEV₁ below 30%.

[email protected]

The American Diabetes Association has updated its guidance for those treating and researching hypoglycemia , joining with the European Association for the Study of Diabetes to specify that a level of less than 3 mmol/L (54 mg/dL) should be considered “clinically important hypoglycemia.”

“A single glucose level should be agreed to that has serious clinical and health-economic consequences,” the ADA and EASD stated in the new guidelines. “This would enable the diabetes and regulatory communities to compare the effectiveness of interventions in reducing hypoglycemia, be they pharmacological, technological, or educational. It would also permit the use of meta-analysis as a statistical tool to increase power when comparing interventions.”

An international, multidisciplinary group – the International Hypoglycemia Study Group – was formed to create distinct definitions of the various levels of severity that hypoglycemia can have. The new guidelines contain three levels, which should be used by clinicians to determine what amounts of blood glucose are significant enough to be clinically reported.

[email protected]
 

The American Diabetes Association has updated its guidance for those treating and researching hypoglycemia , joining with the European Association for the Study of Diabetes to specify that a level of less than 3 mmol/L (54 mg/dL) should be considered “clinically important hypoglycemia.”

“A single glucose level should be agreed to that has serious clinical and health-economic consequences,” the ADA and EASD stated in the new guidelines. “This would enable the diabetes and regulatory communities to compare the effectiveness of interventions in reducing hypoglycemia, be they pharmacological, technological, or educational. It would also permit the use of meta-analysis as a statistical tool to increase power when comparing interventions.”

An international, multidisciplinary group – the International Hypoglycemia Study Group – was formed to create distinct definitions of the various levels of severity that hypoglycemia can have. The new guidelines contain three levels, which should be used by clinicians to determine what amounts of blood glucose are significant enough to be clinically reported.

[email protected]
 

The American Diabetes Association has updated its guidance for those treating and researching hypoglycemia , joining with the European Association for the Study of Diabetes to specify that a level of less than 3 mmol/L (54 mg/dL) should be considered “clinically important hypoglycemia.”

“A single glucose level should be agreed to that has serious clinical and health-economic consequences,” the ADA and EASD stated in the new guidelines. “This would enable the diabetes and regulatory communities to compare the effectiveness of interventions in reducing hypoglycemia, be they pharmacological, technological, or educational. It would also permit the use of meta-analysis as a statistical tool to increase power when comparing interventions.”

An international, multidisciplinary group – the International Hypoglycemia Study Group – was formed to create distinct definitions of the various levels of severity that hypoglycemia can have. The new guidelines contain three levels, which should be used by clinicians to determine what amounts of blood glucose are significant enough to be clinically reported.

[email protected]
 

NEW ORLEANS – The latest revision of U.S. guidelines for diagnosing and managing lower-extremity peripheral artery disease is seen by several experts as primarily a renewed call to action by American physicians to more diligently identify at-risk people in their practices, diagnose the disease with ankle-brachial index measurement, and appropriately treat patients who have the disease.

The new lower-extremity peripheral artery disease (PAD) guidelines “give us a platform to get something done,” said Heather L. Gornik, MD, vice chair of the guidelines panel and medical director of the noninvasive vascular lab at the Cleveland Clinic. Improved PAD identification and care “starts with the fundamentals of recognizing who is at risk for PAD and then doing some clinical investigation to find it, because it’s there. You just need to ask patients if they have leg symptoms, have them take off their socks and examine their feet,” Dr. Gornik said in an interview following a program devoted to the revised guidelines at the American Heart Association scientific sessions.

The new guidelines are “a clarion call to action,” commented Alan T. Hirsch, MD, professor of medicine, epidemiology, and community health and director of the vascular medicine program at the University of Minnesota in Minneapolis. PAD “is the single most morbid and fatal of all cardiovascular diseases, so why in 2016 are we challenged to have every cardiologist trained in basic PAD competency?” asked Dr. Hirsch, who chaired the 2005 guidelines panel.

Mitchel L. Zoler/Frontline Medical News

[email protected]

On Twitter @mitchelzoler

NEW ORLEANS – The latest revision of U.S. guidelines for diagnosing and managing lower-extremity peripheral artery disease is seen by several experts as primarily a renewed call to action by American physicians to more diligently identify at-risk people in their practices, diagnose the disease with ankle-brachial index measurement, and appropriately treat patients who have the disease.

The new lower-extremity peripheral artery disease (PAD) guidelines “give us a platform to get something done,” said Heather L. Gornik, MD, vice chair of the guidelines panel and medical director of the noninvasive vascular lab at the Cleveland Clinic. Improved PAD identification and care “starts with the fundamentals of recognizing who is at risk for PAD and then doing some clinical investigation to find it, because it’s there. You just need to ask patients if they have leg symptoms, have them take off their socks and examine their feet,” Dr. Gornik said in an interview following a program devoted to the revised guidelines at the American Heart Association scientific sessions.

The new guidelines are “a clarion call to action,” commented Alan T. Hirsch, MD, professor of medicine, epidemiology, and community health and director of the vascular medicine program at the University of Minnesota in Minneapolis. PAD “is the single most morbid and fatal of all cardiovascular diseases, so why in 2016 are we challenged to have every cardiologist trained in basic PAD competency?” asked Dr. Hirsch, who chaired the 2005 guidelines panel.

Mitchel L. Zoler/Frontline Medical News

[email protected]

On Twitter @mitchelzoler

NEW ORLEANS – The latest revision of U.S. guidelines for diagnosing and managing lower-extremity peripheral artery disease is seen by several experts as primarily a renewed call to action by American physicians to more diligently identify at-risk people in their practices, diagnose the disease with ankle-brachial index measurement, and appropriately treat patients who have the disease.

The new lower-extremity peripheral artery disease (PAD) guidelines “give us a platform to get something done,” said Heather L. Gornik, MD, vice chair of the guidelines panel and medical director of the noninvasive vascular lab at the Cleveland Clinic. Improved PAD identification and care “starts with the fundamentals of recognizing who is at risk for PAD and then doing some clinical investigation to find it, because it’s there. You just need to ask patients if they have leg symptoms, have them take off their socks and examine their feet,” Dr. Gornik said in an interview following a program devoted to the revised guidelines at the American Heart Association scientific sessions.

The new guidelines are “a clarion call to action,” commented Alan T. Hirsch, MD, professor of medicine, epidemiology, and community health and director of the vascular medicine program at the University of Minnesota in Minneapolis. PAD “is the single most morbid and fatal of all cardiovascular diseases, so why in 2016 are we challenged to have every cardiologist trained in basic PAD competency?” asked Dr. Hirsch, who chaired the 2005 guidelines panel.

Mitchel L. Zoler/Frontline Medical News

[email protected]

On Twitter @mitchelzoler

A newly devised risk score may help identify which patients with acute venous thromboembolism (VTE) are most likely to have occult cancer and where they are likely to have it, according to a report published online in CHEST.

Although VTE is known to occur before an occult cancer becomes symptomatic in a minority of patients, clinicians don’t agree on which patients with VTE should be screened for occult cancer or on how extensive that screening should be. Some favor a basic screening with only a clinical history, physical exam, simple lab tests, and a chest X-ray, while others advocate a more thorough work-up to improve the patient’s chance for a cure. “The potential benefits and harms of such screening are controversial, partly because there is little evidence” concerning which patients are at highest risk and which cancer types/sites should be assessed, said Luis Jara-Palomares, MD, PhD, of the medical surgical unit of respiratory diseases, Virgen del Rocio Hospital, Seville, Spain, and his associates.

Dr. Jara-Palomares and his associates devised a prognostic score by assigning points to the variables they found to be most significantly associated with occult cancer. For example, male sex was accorded 1 point, chronic lung disease or a high platelet count was accorded 1 point, age over 70 years or anemia was accorded 2 points, and postoperative or prior VTE was accorded negative 2 points. The incidence of occult cancer was significantly lower among patients whose total score was 2 points or less (5.8%) than among those whose total score was 3 points or higher (12%).

The mean age of these study participants was 63 years, and approximately half were women. A total of 444 (7.6%) were diagnosed as having cancer at 1-24 months after presenting with VTE. Most of these cancers were discovered within 6 months of the VTE.

Patients who had occult cancer were significantly more likely than those who did not to be male and older than 70 years of age; to have chronic lung disease, an elevated platelet count, and/or anemia; and to have a history of recent surgery and/or prior VTE.

The percentage of VTE patients who had occult cancer increased with advancing age, from 2%-3% in the youngest age group (younger than 50 years) to 8%-12% in the oldest age group (older than 70 years). Among men with occult cancer, the most frequently affected sites were the lung (26%), prostate (17%), and colon/rectum (10%). Among women, the most frequent types of cancer were colorectal (19%), breast (12%), uterine (9.1%), hematologic (8.6%), pancreatic (7.6%), and stomach (6.6%).

Overall, more than half of the men who had occult cancer had cancer affecting the lung, prostate, or colon/rectum, while two-thirds of the women who had occult cancer had cancer affecting the colon/rectum, breast, or abdomen. “This is important because [cancer] screening is not necessary in all VTE patients, but any information suggesting [which] patients are at increased risk and [which] sites are more common may be of help to decide the most appropriate work-up for each patient,” the investigators noted.

To determine which patients are most likely to have occult cancer and which cancer types are most likely to develop, the investigators analyzed data from RIETE (the Computerized Registry of Patients With Venous Thromboembolism), an international registry of more than 50,000 consecutive patients with confirmed acute VTE. They focused on 5,863 patients who presented with pulmonary embolism (34%), deep vein thrombosis (48%), or both disorders (18%) and were followed for at least 2 years for the development of cancer.

The accuracy of this risk scoring system must be tested further in a large validation cohort before it can be widely adopted. If it proves to be accurate, then patients with low total risk scores could forgo the expense, discomfort, and psychological stress of extensive cancer screening, Dr. Jara-Palomares and his associates said.

Men whose total score is 3 points or more could benefit from a rectal exam and fecal occult blood test to rule out colorectal cancer, a rectal exam and prostate-specific antigen test to rule out prostate cancer, and a chest CT to rule out lung cancer. Women whose total score is 3 points or higher could benefit from a fecal occult blood test to rule out colorectal cancer, a mammogram to rule out breast cancer, and abdominopelvic CT to rule out uterine, pancreatic, and stomach cancer, they noted.

The RIETE Registry is supported by an unrestricted educational grant from Sanofi Spain and by Bayer Pharma AG. Dr. Jara-Palomares reported having no relevant financial disclosures; his associates reported ties to Sanofi, Bayer, and LEO Pharma.

A newly devised risk score may help identify which patients with acute venous thromboembolism (VTE) are most likely to have occult cancer and where they are likely to have it, according to a report published online in CHEST.

Although VTE is known to occur before an occult cancer becomes symptomatic in a minority of patients, clinicians don’t agree on which patients with VTE should be screened for occult cancer or on how extensive that screening should be. Some favor a basic screening with only a clinical history, physical exam, simple lab tests, and a chest X-ray, while others advocate a more thorough work-up to improve the patient’s chance for a cure. “The potential benefits and harms of such screening are controversial, partly because there is little evidence” concerning which patients are at highest risk and which cancer types/sites should be assessed, said Luis Jara-Palomares, MD, PhD, of the medical surgical unit of respiratory diseases, Virgen del Rocio Hospital, Seville, Spain, and his associates.

Dr. Jara-Palomares and his associates devised a prognostic score by assigning points to the variables they found to be most significantly associated with occult cancer. For example, male sex was accorded 1 point, chronic lung disease or a high platelet count was accorded 1 point, age over 70 years or anemia was accorded 2 points, and postoperative or prior VTE was accorded negative 2 points. The incidence of occult cancer was significantly lower among patients whose total score was 2 points or less (5.8%) than among those whose total score was 3 points or higher (12%).

The mean age of these study participants was 63 years, and approximately half were women. A total of 444 (7.6%) were diagnosed as having cancer at 1-24 months after presenting with VTE. Most of these cancers were discovered within 6 months of the VTE.

Patients who had occult cancer were significantly more likely than those who did not to be male and older than 70 years of age; to have chronic lung disease, an elevated platelet count, and/or anemia; and to have a history of recent surgery and/or prior VTE.

The percentage of VTE patients who had occult cancer increased with advancing age, from 2%-3% in the youngest age group (younger than 50 years) to 8%-12% in the oldest age group (older than 70 years). Among men with occult cancer, the most frequently affected sites were the lung (26%), prostate (17%), and colon/rectum (10%). Among women, the most frequent types of cancer were colorectal (19%), breast (12%), uterine (9.1%), hematologic (8.6%), pancreatic (7.6%), and stomach (6.6%).

Overall, more than half of the men who had occult cancer had cancer affecting the lung, prostate, or colon/rectum, while two-thirds of the women who had occult cancer had cancer affecting the colon/rectum, breast, or abdomen. “This is important because [cancer] screening is not necessary in all VTE patients, but any information suggesting [which] patients are at increased risk and [which] sites are more common may be of help to decide the most appropriate work-up for each patient,” the investigators noted.

To determine which patients are most likely to have occult cancer and which cancer types are most likely to develop, the investigators analyzed data from RIETE (the Computerized Registry of Patients With Venous Thromboembolism), an international registry of more than 50,000 consecutive patients with confirmed acute VTE. They focused on 5,863 patients who presented with pulmonary embolism (34%), deep vein thrombosis (48%), or both disorders (18%) and were followed for at least 2 years for the development of cancer.

The accuracy of this risk scoring system must be tested further in a large validation cohort before it can be widely adopted. If it proves to be accurate, then patients with low total risk scores could forgo the expense, discomfort, and psychological stress of extensive cancer screening, Dr. Jara-Palomares and his associates said.

Men whose total score is 3 points or more could benefit from a rectal exam and fecal occult blood test to rule out colorectal cancer, a rectal exam and prostate-specific antigen test to rule out prostate cancer, and a chest CT to rule out lung cancer. Women whose total score is 3 points or higher could benefit from a fecal occult blood test to rule out colorectal cancer, a mammogram to rule out breast cancer, and abdominopelvic CT to rule out uterine, pancreatic, and stomach cancer, they noted.

The RIETE Registry is supported by an unrestricted educational grant from Sanofi Spain and by Bayer Pharma AG. Dr. Jara-Palomares reported having no relevant financial disclosures; his associates reported ties to Sanofi, Bayer, and LEO Pharma.

A newly devised risk score may help identify which patients with acute venous thromboembolism (VTE) are most likely to have occult cancer and where they are likely to have it, according to a report published online in CHEST.

Although VTE is known to occur before an occult cancer becomes symptomatic in a minority of patients, clinicians don’t agree on which patients with VTE should be screened for occult cancer or on how extensive that screening should be. Some favor a basic screening with only a clinical history, physical exam, simple lab tests, and a chest X-ray, while others advocate a more thorough work-up to improve the patient’s chance for a cure. “The potential benefits and harms of such screening are controversial, partly because there is little evidence” concerning which patients are at highest risk and which cancer types/sites should be assessed, said Luis Jara-Palomares, MD, PhD, of the medical surgical unit of respiratory diseases, Virgen del Rocio Hospital, Seville, Spain, and his associates.

Dr. Jara-Palomares and his associates devised a prognostic score by assigning points to the variables they found to be most significantly associated with occult cancer. For example, male sex was accorded 1 point, chronic lung disease or a high platelet count was accorded 1 point, age over 70 years or anemia was accorded 2 points, and postoperative or prior VTE was accorded negative 2 points. The incidence of occult cancer was significantly lower among patients whose total score was 2 points or less (5.8%) than among those whose total score was 3 points or higher (12%).

The mean age of these study participants was 63 years, and approximately half were women. A total of 444 (7.6%) were diagnosed as having cancer at 1-24 months after presenting with VTE. Most of these cancers were discovered within 6 months of the VTE.

Patients who had occult cancer were significantly more likely than those who did not to be male and older than 70 years of age; to have chronic lung disease, an elevated platelet count, and/or anemia; and to have a history of recent surgery and/or prior VTE.

The percentage of VTE patients who had occult cancer increased with advancing age, from 2%-3% in the youngest age group (younger than 50 years) to 8%-12% in the oldest age group (older than 70 years). Among men with occult cancer, the most frequently affected sites were the lung (26%), prostate (17%), and colon/rectum (10%). Among women, the most frequent types of cancer were colorectal (19%), breast (12%), uterine (9.1%), hematologic (8.6%), pancreatic (7.6%), and stomach (6.6%).

Overall, more than half of the men who had occult cancer had cancer affecting the lung, prostate, or colon/rectum, while two-thirds of the women who had occult cancer had cancer affecting the colon/rectum, breast, or abdomen. “This is important because [cancer] screening is not necessary in all VTE patients, but any information suggesting [which] patients are at increased risk and [which] sites are more common may be of help to decide the most appropriate work-up for each patient,” the investigators noted.

To determine which patients are most likely to have occult cancer and which cancer types are most likely to develop, the investigators analyzed data from RIETE (the Computerized Registry of Patients With Venous Thromboembolism), an international registry of more than 50,000 consecutive patients with confirmed acute VTE. They focused on 5,863 patients who presented with pulmonary embolism (34%), deep vein thrombosis (48%), or both disorders (18%) and were followed for at least 2 years for the development of cancer.

The accuracy of this risk scoring system must be tested further in a large validation cohort before it can be widely adopted. If it proves to be accurate, then patients with low total risk scores could forgo the expense, discomfort, and psychological stress of extensive cancer screening, Dr. Jara-Palomares and his associates said.

Men whose total score is 3 points or more could benefit from a rectal exam and fecal occult blood test to rule out colorectal cancer, a rectal exam and prostate-specific antigen test to rule out prostate cancer, and a chest CT to rule out lung cancer. Women whose total score is 3 points or higher could benefit from a fecal occult blood test to rule out colorectal cancer, a mammogram to rule out breast cancer, and abdominopelvic CT to rule out uterine, pancreatic, and stomach cancer, they noted.

The RIETE Registry is supported by an unrestricted educational grant from Sanofi Spain and by Bayer Pharma AG. Dr. Jara-Palomares reported having no relevant financial disclosures; his associates reported ties to Sanofi, Bayer, and LEO Pharma.