publication date: Sep. 27, 2019

Clinical Roundup

Breast cancer patients who exercise pre-diagnosis are at lower risk for heart disease

Older patients with breast cancer who exercised before diagnosis may be at a lower risk for cardiovascular disease compared to those who did not, according to a study in JACC: CardioOncology.

Researchers examined 4,015 patients with a confirmed diagnosis of primary breast cancer enrolled in the Women’s Health Initiative, which included postmenopausal women age 50-79. Women with cardiovascular disease, a history of any other malignancy prior to enrollment or a body mass index less than or equal to 18.5kg/m2 were excluded.

In the WHI, exercise history at baseline and follow-up were assessed with a questionnaire where patients reported the frequency, duration and intensity of leisure-time physical activity. Researchers examined exercise data that were collected at the visit closest to breast cancer diagnosis and that was between five years and one month prior to diagnosis.

Metabolic equivalent task values were assigned for levels of physical activity per week and exercise was categorized in quartiles: less than 2.5 MET-hours/week (994 patients); 2.50 to greater than 8.625 (1,008 patients); 8.625 to less than 18 (1,011 patients); and greater than or equal to 18 (1,002 patients).

During the study, 324 cardiovascular events occurred. Researchers found that exercising prior to a breast cancer diagnosis was associated with a 20-37% reduction in the risk of first cardiovascular events. The risk of heart attack and heart failure were not impacted, suggesting that exercise may be associated with a greater risk reduction in other cardiovascular events such as angina, coronary revascularization, peripheral artery disease or stroke. Individuals who met current physical activity recommendations (9 MET-hours/week), prior to diagnosis had a 46% lower risk of coronary heart disease death compared to those who exercised less than recommended.

“This study is the first to show the exposure to exercise prior to a cancer diagnosis may potentially protect against or mitigate the established adverse cardiovascular consequences observed in breast cancer patients,” lead author Tochi M. Okwuosa, director of the cardio-oncology program at Rush University Medical Center, said in a statement.


One in five young adults regularly uses e-cigarettes and believes they are harmless, not addictive

Roughly one in five young adults uses e-cigarettes daily or recreationally, and nearly one in four believes the products are harmless and not addictive, according to findings from the American Society of Clinical Oncology third annual National Cancer Opinion Survey.

This comes after the Centers for Disease Control and Prevention (CDC) issued the results from its National Youth Tobacco Survey earlier this month, reporting that e-cigarette use among pre-teens and teens is on the rise. It is also despite warnings from the U.S. Surgeon General that e-cigarettes (also known as vapes) contain addictive and harmful or potentially harmful ingredients, including nicotine; lead and other heavy metals; and flavorants such as diacetyl, a chemical linked to serious lung disease.

Amid public debate over banning flavored e-cigarettes, the ASCO survey also found that nearly three in 10 young adults think flavored e-cigarettes are less damaging to a person’s health than non-flavored ones. In addition, nearly seven in 10 Americans support raising the legal age to purchase e-cigarettes from 18 to 21.

The National Cancer Opinion Survey is a large, nationally representative survey of the general public conducted online by The Harris Poll on behalf of ASCO.

“We should do everything in our power to prevent a generation of young people from becoming addicted to nicotine, regardless of how it is delivered,” said ASCO President Howard A. “Skip” Burris III. “As an organization of cancer doctors, we’re also concerned about the potential for e-cigarettes to become a gateway for youth to use cancer-causing tobacco products and the serious side effects that are beginning to emerge.”

FDA and CDC began investigating deaths from severe respiratory illness associated with e-cigarette use Aug. 17. Since then, the Trump Administration has announced it plans to ban the sale of most flavored e-cigarettes; at the state level, both New York and Michigan are also enacting bans on flavored vaping products. 

The National Cancer Opinion Survey, commissioned by ASCO, was conducted from July 9 – Aug. 10, 2019, among 4,001 U.S. adults ages 18 and over. Of these adults, 195 have or have had cancer. A broader set of survey findings will be released on October 30, 2019. 

Troubling Misperceptions about E-Cigarettes Among Young Adults

Among Generation Z (ages 18-22) and Millennials (ages 23-38), the survey found:

  • 20% of Generation Z and 24% of Millennials believe e-cigarettes are harmless

  • 22% of Generation Z and 24% of Millennials believe you cannot get addicted to e-cigarettes

  • 27% of Generation Z and 29% of Millennials think flavored e-cigarettes are less damaging to your health than non-flavored e-cigarettes

Older adults are less likely to hold these misperceptions.

“These beliefs among young adults about e-cigarettes parallel early misperceptions about tobacco products,” Burris said. “Education is crucial to correcting misinformation and preventing what could become a public health crisis.”

Young People Report Greater Use of E-Cigarettes Than Older Adults

More than one in five Millennials (21%) report being a regular (daily or recreational) user of e-cigarettes, compared to 18% of Generation Z and 15% of Generation X (ages 39-54). In contrast, only 5% of Baby Boomers (ages 55-72) and 1% of the Silent Generation (ages 73 and older) say they use e-cigarettes regularly. 

One in six parents (17%) with children ages 9-17 say their children have tried e-cigarettes, with 7% of parents of 9-17-year-olds saying their child uses the products regularly. In addition, 73% of parents with children of those ages say they have talked with their child(ren) about the dangers of e-cigarettes. Children under the age of 18 were not surveyed as part of this research.

Overall, one in eight Americans (13%) report using e-cigarettes regularly. Of them, a majority (80%) currently smoke or have smoked traditional cigarettes in the past.

The majority of this group says they have used e-cigarettes to decrease their use of traditional cigarettes (44%) or to quit smoking them altogether (41%).

“There is no doubt that quitting smoking is one of the best things you can do for your health. If you are trying to quit, we recommend talking to your doctor about methods that are proven to work,” said ASCO Chief Medical Officer Richard L. Schilsky, MD, FACP, FSCT, FASCO. “No e-cigarette products are currently approved by the FDA as cessation aids, and more research to understand these products, the substances in them, and the acute and long-term effects of their use is urgently needed.”

Americans Support Policy Changes to Address E-Cigarette Use

Amid growing public concern over the dangers of e-cigarettes, even before the recent deaths and investigations linked to e-cigarettes, Americans indicated support for policy change. For example, as of August 10:

  1. 71% support FDA regulation of e-cigarettes

  2. 68% support raising the legal age for purchasing e-cigarettes from 18 to 21, roughly the same percentage who support raising the legal age for purchasing tobacco products from 18 to 21 (69%)

  3. Slightly less than half of Americans (46%) support banning the sale of flavored e-cigarettes, and four in 10 (41%) support banning the sale of all e-cigarettes

“There are so many unanswered questions about e-cigarettes,” ASCO Chief Medical Officer Richard L. Schilsky said in a statement. “We need more research about these products so we can begin to answer these questions and protect the health and safety of the American public through education and, where necessary, regulation.”

In a 2015 policy statement, ASCO and the American Association for Cancer Research called for a number of steps to be taken in the interest of public health, including requiring e-cigarette packaging to carry safety labels with a warning about nicotine addiction, prohibiting youth-oriented advertising, and banning the sale of e-cigarettes containing candy or youth-oriented flavors unless there is evidence demonstrating these products do not encourage use of e-cigarettes by youth.


Univ. of Arizona researchers look to treat neuropathic pain caused by chemotherapy without using opioids.

A research team at the University of Arizona College of Medicine are developing potent and selective T-type calcium channel antagonists as potential novel pain medicines to treat chemotherapy-induced peripheral neuropathy.

Chemotherapy-induced peripheral neuropathy is detected in 64% of cancer patients during all phases of cancer, but no effective treatment exists, said Rajesh Khanna, professor of pharmacology at the University of Arizona College of Medicine. Khanna is the principal investigator on the study.

The research team’s goal is to provide pain relief to cancer patients, increase their compliance of chemotherapy and improve their well-being, he said.

Khanna also is scientific co-founder of Regulonix, LLC., a UA Health Sciences start-up company that received a $341,528 grant from NIH as part of the “Helping to End Addiction Long-Term Initiative” (NIH HEAL Initiative), launched in 2018 to improve prevention and treatment strategies for opioid misuse and addiction and to enhance pain management.

Khanna said the study represents the first step in developing non-opioid pain treatments for chemotherapy-induced peripheral neuropathy. Jun Wang, assistant professor in the department of pharmacology and toxicology in the UA College of Pharmacy and a member of the UA BIO5 Institute, is a key collaborator on this study and created the original compounds that led to development of the compound being tested, called “UAWJ111.”

Although initial results in rodent models have been promising, the research is in its very early stages, Khanna cautioned, adding the team also seeks to determine if the new compound has significant side effects and potential for abuse – and whether it also might be effective for other types of pain.

“It’s clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain and provide more flexible and effective options for treating addiction to opioids,” said NIH Director Francis S. Collins, who launched the initiative in early 2018. “This unprecedented investment in the NIH HEAL Initiative demonstrates the commitment to reversing this devastating crisis.”

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