Palliative chemotherapy is treatment designed for terminal cancer patients to prolong survival and ease symptoms but not cure disease. Now, researchers have found that the therapy comes with certain harms, which they say need to be addressed.
The researchers, from the Weill Cornell Medical College, Dana-Farber Cancer Institute and Harvard Medical School, have published their results in the BMJ.
They say their findings uncover a discrepancy between what type of care cancer patients want and what they actually receive.
Overall, the team found that terminal cancer patients who receive chemotherapy during the last months of their lives are less likely to die where they wish and are more likely to undergo invasive medical procedures - including CPR and mechanical ventilation - than patients who did not receive the therapy.
Dr. Holly Prigerson, of Weill Cornell Medical College, says that the reasons for the link are complicated, but they may originate in misunderstanding of the purpose and consequences of palliative chemotherapy.
For the study, investigators assessed data from 386 patients in a federally funded study, called Coping with Cancer.
This 6-year study followed terminally ill people and their caregivers until the patients died, and the researchers looked at how psychosocial factors influenced patient care.
After asking the caregivers to rate their patient's care, quality of life and where the patient would have wanted to die, the researchers reviewed patient medical charts to determine the type of care they actually received during their last week.
The researchers found that patients receiving palliative chemotherapy were less likely to talk to their oncologists about the type of care they wanted to receive, to complete Do-Not-Resuscitate orders or to even acknowledge they were terminally ill.
The findings reveal that 68% of patients receiving palliative chemotherapy died where they wanted, compared with 80% of those not receiving the therapy.
In detail, 47% of patients who received the therapy died at home, compared with 66% of patients who did not receive the palliative care. Additionally, 11% of patients receiving the chemotherapy died in an intensive care unit, versus only 2% of patients not receiving the therapy.
"It's hard to see in these data much of a silver lining to palliative chemotherapy for patients in the terminal stage of their cancer. Until now, there hasn't been evidence of harmful effects of palliative chemotherapy in the last few months of life."
"This study is a first step in proving evidence that specifically demonstrates what negative outcomes may result," she adds.
The team also found that patients receiving palliative chemotherapy were more likely to be referred to hospice care much later than those not receiving the therapy.
Hospice care is a place that provides comfort and emotional support for terminal patients, and 54% of the patients receiving chemotherapy were referred to hospice late, compared with 37% of the patients not receiving the drugs.
The team notes that 56% of the patients from the study were receiving palliative chemotherapy in their final months, and they say this majority of use emphasizes the potential need for changes in oncology practice at academic medical centers.
"We often wait until patients stop chemotherapy before asking them about where and how they want to die, but this study shows we need to ask patients about their preferences while they are receiving chemotherapy to ensure they receive the kind of care they want near death."
But Dr. Wright adds that their findings should not be interpreted that patients should be denied or not offered palliative chemotherapy:
"The vast majority of patients in this study wanted palliative chemotherapy if it might increase their survival by as little as a week. This study is a step towards understanding some of the human costs and benefits of palliative chemotherapy."
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Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study, Holly G Prigerson, et al., BMJ, DOI:10.1136/bmj.g1219, published 4 March 2014.
Ellis, Marie. "Palliative chemotherapy: harms and benefits weighed in new study." Medical News Today. MediLexicon, Intl., 5 Mar. 2014. Web.
Ellis, M. (2014, March 5). "Palliative chemotherapy: harms and benefits weighed in new study." Medical News Today. Retrieved from
Over-the-counter dietary supplements and therapies sold to improve male sexual health may be ineffective and even unsafe, says a report published in the Journal of Sexual Medicine.
To avoid paying for prescription drugs, or the embarrassment of discussing such matters with their physicians, many turn to over-the-counter (OTC) products.
Sales of dietary supplements doubled in the US from 1999-2007, and around 50% of Americans use them for a variety of conditions.
The dazzling array of products, from horny goat weed to ginseng, costs from $0.83 to $5.77 per day. But lack of regulation on dosage, purity or ingredients, and limited information regarding health effects confuses patients and medical practitioners alike.
Researchers from Wake Forest Baptist Medical Center in Winston-Salem, NC, reviewed the scientific evidence for the effectiveness and safety of the most common ingredients in top-selling men's health products.
They wanted to provide urologists with a guide for counseling patients who present with sexual health problems and who are taking such supplements.
There was no scientific evidence to support claims that many products positively impact erectile function, libido and sexual performance, and some were likely to be unsafe.
Some products advertised as "natural" contain traces of phosphodiesterase-5-inhibitors (PDE5Is), the same class of medication that includes prescription drugs such as Viagra, which is used to treat erectile dysfunction. PDE5Is cannot be legally sold over the counter in the US, because using them without a physician's supervision could be risky.
Patients with advanced heart disease or who take nitrates, such as nitroglycerin, should not use PDE5Is, as it may cause an unsafe drop in blood pressure.
PDE5Is should also be avoided by men with severe liver impairment or end-stage kidney disease. Those with enlarged prostates who take medications such as Flomax (tamsulosin), terazosin or doxazosin should only take it with supervision, as interactions may cause dizziness, leading to falls and fractures.
DHEA is a hormone naturally made by the human body and produced in laboratories from chemicals found in wild yam and soy. While findings do not suggest a benefit, it appears to be relatively safe, as the impact on hormone levels is not significant
Fenugreek features in 1 in 3 top-selling men's health supplements. It may improve sexual arousal and orgasm, muscle strength, energy and well-being. There was no evidence of adverse effects
Ginkgo biloba is taken for numerous conditions, but data does not support its use in erectile dysfunction. It can cause headache, seizures and significant bleeding, especially if taken alongside Coumadin
Ginseng is the most common ingredient in top-selling men's health supplements; it can cause headache, upset stomach, constipation, rash and insomnia. It can also lower blood sugar, risky in cases of diabetes
Horny Goat Weed is generally safe with rare reports of toxicity leading to fast heart rate and hypomania; it has no apparent benefit for sexual function
L-arginine is the top amino acid in men's health supplements, featuring in 1 in 3 best sellers. It may improve erectile function in some patients and seems relatively safe. It has been associated with a drop in blood pressure but without significantly changing the heart rate
Maca is the most common vegetable among top-selling men's health supplements. Maca has been associated with increased sexual behavior in animals but not in humans. Rare cases of toxicity and a mild increase in liver enzymes and blood pressure have been reported.
Tribulus promises to treat a range of conditions, but evidence is lacking to prove its effectiveness; two young men suffered liver and kidney toxicity after taking high doses. Yohimbine is a well-established product that may improve male sexual function, but it can also cause hypertension, headache, agitation, insomnia and sweating. Zinc appears to be safe but not beneficial.
Purity is a concern. Because dietary supplements are currently classified as foods rather than drugs, the manufacturers themselves are largely responsible for ensuring the safety, purity and efficacy of the products.
Four major retailers have recently been targeted by the New York attorney general for selling misleading or adulterated dietary supplements.
"While certain natural supplements we reviewed show promise for improving mild sexual dysfunction, they lack robust human evidence."
Dr. Terkecki adds that his team is unlikely to recommend the products to patients due to concerns that they are impure or ineffective.
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A urologist's guide to ingredients found in top-selling nutraceuticals for men's sexual health, Tao Cui et al., Journal of Sexual Medicine, DOI: http://dx.doi.org/10.1111/jsm.13013, published 11 January 2016.
Brazier, Yvette. "Men's sexual health: are the supplements safe?." Medical News Today. MediLexicon, Intl., 16 Jan. 2016. Web.
Brazier, Y. (2016, January 16). "Men's sexual health: are the supplements safe?." Medical News Today. Retrieved from
Prions cause neurodegenerative diseases in humans and animals like cows, sheep, or deer. In most cases, humans or animals get sick sporadically, when, for unknown reasons, normal proteins in the brain called PrPc change to harmful prions (called PrPSc).
The PrPSc proteins then cause severe degeneration of the brain that kills the victims within a matter of months. There are no cures or therapies for prion diseases. The most common human prion disease is sporadic Creutzfeld-Jacob Disease, or sCJD. Scientists still understand little about why and how in some cases normal proteins change to prions and destroy the brain.
All patients die, most of them within a few months, but there are differences between individual cases. The hope is that understanding the differences between individual cases might eventually provide some insight into the causes of the disease and suggest ways to treat it.
To catalogue and examine those differences, it is important to come up with standard assays that allow meaningful comparisons. Markus Glatzel (Hamburg University) and colleagues have developed such an assay.
Applying it to 50 postmortem samples from patients with sCJD reveals substantial differences in molecular pathology, suggesting that this approach could indeed help to understand this mysterious and devastating disease.
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