Device aims to eliminate multiple breast-cancer surgeries

A prototype device created by John Hopkins University grad students can enable a pathologist to inspect excised breast tissue mid-surgery to determine whether a cancerous tumor has been fully removed. The prototype's ability to dramatically reduce the time to inspect breast tissue -- down to as quickly as 20 minutes -- could ultimately decrease, if not flat out eliminate, the need for a second operation on the same tumor, John Hopkins announced this week. One in five women who have surgery to remove cancerous breast tissue have to go back for follow-up surgery because not all the diseased tissue is removed. That amounts to about 60,000 patients annually in the U.S. The four grad students became aware of the problem in 2012 during the school's year-long biomedical engineering master's program, when they were tasked with designing new medical tools to address urgent health care issues. Breast cancer surgeons told the students that they are "desperate" for a tool that enables them to remove an entire tumor the first time around, student and co-inventor Hector Neira said in a school news release. Currently, when tumors are removed from most parts of the body, a pathologist can flash-freeze the tissue, slice off very thin samples, and study it under a microscope. If cancer cells are found near the outer edge of the sample, they know to remove more tissue. In the case of breast tissue, however, the high fat content does not freeze well, so the samples smear and form gaps, making that quick review impossible. So the grad students thought up a device that adds an adhesive film to the breast tissue before it is sliced that holds the fatty but delicate tissue together, resulting in a sample that can withstand the rigors of fine slicing for microscopic inspection within just 20 minutes. Better yet, the set-up is low cost even in prototype form. The students chose a reusable applicator and a proprietary disposable film.

"We're not doing it for the money," said co-inventor Anjana Sinha. "We want to improve health care practices and raise the standard of care for these breast cancer patients. Why can't they get the same type of quick results that people with other types of cancer receive?" Though the device has thus far only tested animal tissue and human breast samples from a tissue bank, it has won more than $40,000 in college prize money and received the People's Choice Award at the university's Design Day event. In fact, even though all the students received their master's degrees in May, two are getting funding from the Wallace H. Coulter Foundation to stay at the school over the next year to further refine the device.

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Hypnosis Eases Pain of Breast Cancer Surgery

TUESDAY, Aug. 28,2012 (HealthDay News) -- Instead of pills and needles, hypnosis may ease the pain of surgery -- both during and after the procedure. According to a new study, women who received hypnosis before breast cancer surgery needed less anesthesia during the procedure, reported less pain afterward, needed less time in the operating room and had reduced costs. "This helps women at a time when they could use help, and it has no side effects. It really only has side benefits," said Guy Montgomery, lead author of the report and associate professor in the department of oncological sciences at Mount Sinai School of Medicine in New York City. Montgomery hopes that the study, published online in the Aug. 28 issue of the Journal of the National Cancer Institute, will promote greater use of hypnosis in medical treatments. Side effects such as pain, nausea and fatigue -- both during and after breast cancer surgery -- are commonplace. Previous research has suggested that hypnosis, a simple and inexpensive procedure, can help ease these problems. One small clinical study indicated that hypnosis was also effective for breast cancer patients about to undergo surgery.

For the new study, 200 women set for breast cancer surgery were randomly assigned to receive either 15 minutes of hypnosis with a psychologist or assigned to a group that simply spoke with a psychologist. During the hypnosis session, the patients received suggestions for relaxation and pleasant imagery as well as advice on how to reduce pain, nausea and fatigue. They also received instructions on how to use hypnosis on their own. The researchers found that women in the hypnosis group required less anesthesia and sedatives than patients in the control group, and also reported less pain, nausea, fatigue, discomfort and emotional upset after the surgery. Those who received hypnosis also spent almost 11 minutes less time in surgery and had their surgical costs reduced by about $773, mainly as a result of the shorter time.

Although people think that hypnosis strips a person of control, it actually does just the opposite, said Dr. David Spiegel, author of an accompanying editorial in the journal and Willson professor and associate chairman of psychiatry and behavioral sciences at Stanford University School of Medicine. "This is something that empowers patients," Spiegel explained. "If you're fighting, you think you're protecting yourself, but, actually, you're losing control, because you're getting into a struggle with your own body. You can teach people to float instead of fighting. You get the body comfortable and think more clearly. The weird thing is it actually works. If thoughts can make the body worse, it follows that thoughts could actually make the body feel better." But will hypnosis catch on with health-care providers? "We have this in-built skepticism of what goes on in the brain and the mind, and the idea is that the only real intervention is a physical one. Yet what supposedly distinguishes us is this huge brain on top of our bodies," Spiegel said. "It seems more scientific and desirable to give drugs than it does to talk to people and have them reorganize the way they're managing their bodies." There are other obstacles. Many doctors find it more expedient to write a prescription than learn to perform hypnosis. Also, there's no industry pushing the technique as there is with drugs, Spiegel said.

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Men Pick Robotic Surgery for Prostate Cancer Despite Risks

Pretty much every medical organization has told men to back off on screening for prostate cancer, because it can lead to unneeded treatment, including surgery that can leave a man incontinent and impotent. But it's hard to resist a robot. Men who have been diagnosed with low-grade prostate cancer increasingly choose expensive newer treatments including robotic surgery and a radiation treatment called intensity-modulated radiotherapy, or IMRT, even though they are not likely to benefit from those treatments, according to a study in JAMA, the journal of the American Medical Association. Use of the newer treatments rose from 32 percent to 44 percent between 2004 and 2009 among men with low PSA test scores or other indications that their prostate cancer was slow-growing and didn't pose a threat Use also increased among men who were older or in poor health and were likely to die of something other than the cancer. Their use of robotic surgery and radiation therapy almost doubled, from 13 percent to 24 percent. Men older than 65 with low-grade prostate cancer have a 20 percent chance of dying of the cancer in the next 20 years, compared to a 60 percent chance of dying from something else, the researchers said. Robotic surgery and radiation treatment are marketed heavily as offering fewer side effects and easier recovery, but as with most new treatments there's little evidence that they are better than established treatments. Earlier this year the nation's gynecologists said women shouldn't have hysterectomies with robotic surgery, because there's no evidence the robots do as good a job as other forms of surgery. The new treatments for prostate cancer are much more expensive than traditional forms of surgery and radiation, and are drawing increasing scrutiny from payers like Medicare. The data for this study came from Medicare records of treatment for more than 83,000 men who had not been diagnosed with other forms of cancer.

So cost is a concern. But more troubling is the idea of men choosing treatments they don't need, robot or no robot, that can have harmful side effects. "For men with low risk, observation would be preferred to intervention, whether with robotic surgery, traditional prostate surgery, or IMRT," says Dr. Timothy Wilt, a researcher for the Veterans Administration who studies treatments for prostate cancer but wasn't involved in this study. Despite that, he notes, "patients are receiving and doctors are recommending treatments that are no more effective, no safer, and much more costly." One way to avoid the lure of new treatments is to screen for prostate cancer less frequently, Wilt tells Shots. "The more we look, the more we find. The more we find, the more we treat. Because we look so hard, we find things that might never cause problems." Last year the U.S. Preventive Services Task Force said that no men should have routine prostate cancer screening with the PSA test, because low-grade prostate cancer is so common, and the risk of being given unnecessary harmful treatments is so high. And last month, the nation's urologists said the prostate-specific antigen test isn't needed for most men, suggesting testing only in men at high risk and those ages 55 to 69. Even those men should get tested no more than every two years, the urologists said, rather than annually. But men who have been tested and found to have low-grade prostate cancer may find it hard to resist the lure of treatment, especially if it's being touted by a physician. Even though most doctors say watchful waiting is a good strategy for low-grade prostate cancer, two-thirds of urologists and radiation oncologists recommend treatments rather than observation, according to a 2012 study. A primary care provider can help sort out the pluses and minuses of prostate cancer treatment versus observation, Wilt says. "They're not selling a procedure," he says He adds: "It's really important that medical care is driven by good science, and that we should be cautious about assuming that something must be better just because it's newer." Tell that to the robot.

Men at low-risk of dying from their prostate cancer increasingly opting for advanced treatment options
ANN ARBOR, Mich. For men with a low risk of dying from their prostate cancer, advanced treatment options may offer little to no benefit, yet more and more patients are opting for these procedures. NEWS-elderypatient.jpg A new study from the University of Michigan Comprehensive Cancer Center examined Medicare data between 2004 and 2009 for men with prostate cancer whose disease was low-risk or those who were at a high risk to die from other causes. The researchers found that these men increasingly underwent advanced treatment options, such as intensity-modulated radiotherapy and robotic prostatectomy. Among men with low-risk disease, the use of advanced treatments increased from 32 percent to 44 percent, the study found. Similarly, in men with a high risk of noncancer mortality, the use of these procedures increased from 36 percent to 57 percent. The results of the study, which were published online Tuesday, June 25, in the Journal of the American Medical Association, suggest that potential overtreatment of prostate cancer is increasing even at a time of greater awareness about the sometimes indolent nature of the disease, says senior author Brent Hollenbeck, M.D., associate professor of urology at U-M. Patients who undergo more aggressive treatments instead of conservative watch-and-wait management are more likely to experience side effects and long-term quality-of-life issues stemming from the treatment, Hollenbeck says. Even during a period of enhanced awareness of overtreatment, it appears that the use of these technologies gained in popularity, Hollenbeck says. Not only do these procedures offer very limited benefits to this group of patients in terms of survival, they also are significantly more expensive than prior treatment options, amplifying the economic implications of potential overtreatment. Hollenbeck says there are several dynamics that might explain the findings. Patients and physicians are sometimes hesitant to embark on an observational treatment plan when an advanced procedure may cure the disease, he says.

Additionally, the stress and anxiety of living with cancer can be overwhelming for some patients. While those concerns are valid, the outcomes of men with low-risk disease who follow an observational management plan as opposed to procedural treatment are well-established, Hollenbeck says. In addition, the financial incentives to do these procedures, through things like fee-for-service reimbursement, may simply be too strong to overcome. More research and policy changes are needed in order to shift the current treatment patterns for men at low risk of dying from their prostate cancer, Hollenbeck says. He points to the Surveillance Therapy Against Radical Treatment, or START, research trial as a valuable tool that will further explore the effectiveness of radiation, surgery and active surveillance for low-risk prostate cancer. Although terminated due to poor accrual, the results from that study arent expected for another five to 10 years. In the interim, Hollenbeck suggests that changes in the delivery system and payment might be effective. We need policy changes that help curtail the excessive use of advanced treatment technologies among patients who are least likely to benefit, he says. For example, value-based insurance design discourages the use of services when their benefits do not outweigh the costs. Things like this can help eliminate the overuse of advanced treatment options when patients stand little to gain

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