Although cancer patients are at higher risk for getting influenza and  pneumonia and dying from them due to weakened immune systems, many are not getting the recommended vaccines to prevent the diseases.

According to a study reported at the American Society for Therapeutic Radiology Annual Meeting in Los Angeles on October 28, 2007 a quarter of cancer patients over the age of 50 did not receive an annual flu shot and more than a third over 65 had not been vaccinated against pneumonia.  Patients in the study were being treated for cancer with radiotherapy.

The Centers for Disease Control and Prevention immunization guidelines recommend

• Annual dose of influenza vaccine for adults over 50
• One dose of pneumoccal vaccine for ages 65 and over
• Both influenza and pneumoccal vaccines for patients with a medical condition that suppresses their immune system.

More than 80 percent of those who had not received either vaccine gave one of three reasons

• They didn’t think they needed the vaccines.
• They didn’t know the guidelines.
• Their doctors didn’t recommend them.

Among those patients who did receive vaccines, 44 percent said that their primary care doctor gave them their shot, while on 8 percent received it from their oncologist.

Neha Vapiwala, MD,  study author and a radiation oncologist at the University of Pennsylvania Hospital, said,

People undergoing cancer treatment and their loved ones should ask their oncologists about these vaccines. They are a very simple, yet very effective, way for people living with cancer to extend their lives.

Oncologists have the opportunity to talk to patients about recommended vaccines during their frequent interactions with patients, whether it be before, during, or after cancer therapy. This discussion could result in better cancer care and ultimately save lives.

Dr.Vapiwala, says that communication between primary care physicians and oncologists is critical.  Once a patient is diagnosed with cancer, she points out, primary care doctors may assume that all care is in the hands of the oncologist while the oncologist may assume that routine health care is still the responsibility of the primary care physician.

More information about the study is available on Medscape.

What should you do with leftover prescription drugs?

Flush them down the toilet?  Leave them in the medicine cabinet?  Save them for another time?  Share with a needy friend?

While some narcotic painkillers should be flushed down the toilet, most prescription medicine should be combined with a substance like kitty litter, coffee grounds, or animal waste, put in a closed container, and disposed of in the garbage.

This prevents dangerous medicines  being available to teenagers and others who might abuse them.  At the same time it keeps most of them from entering American waterways where they could harm fish and wildlife. Further, it avoids children or pets from accidentally ingesting them.

The federal Substance Abuse and Mental Health Administration reports than 1 in 5 teenagers abuses someone else’s prescription medications.  Over half say they got the drugs from friends or family for free.

Dr. Irene Ruhoy of the University of Nevada in Las Vegas studied medicines left in the homes of 475 people who died in 2005.  She found 3,600 prescriptions of controlled substances, nearly 8 per person.

Guidelines from the Office of National Drug Control Policy say:

• Take all unused, unneeded or unnecessary drugs out of their original containers and throw them in the trash.
• Mix them with an undesirable substance such as kitty litter or coffee grounds and put them in a sealed bag or can to keep them from being diverted and abused.
• Flush them down the toilet only if the label or accompanying instructions tell you to do so.
• If there is one in your community, take advantage of a pharmaceutical take-back program to bring unused drugs to a central location for proper disposal.

The US Fish and Wildlife Service is working with the American Pharmacists Association (APhA) to encourage the proper disposal of prescription medications.  Their new program SMARXT DISPOSAL will publicize the danger to waterways of flushing all prescription medicines down the toilet.

They suggest that you

DO NOT FLUSH medications unless specifically instructed to by the label or the pharmacist.

Remove all personal identifying information and  labels from containers.

Crush solid medicine or dissolve it in water and add it to kitty litter or another substance that makes it less appealing to children, pets, or a potential abuser.

Check for a community site where medications are collected for safe disposal.

Doctors and pharmacists warn that prescription drugs should be used only by the person for whom they were prescribed.  Never share your prescriptions.

The FDA has a list of drugs that should be flushed down the toilet rather than be put in the trash.

In short:

• When no longer needed, dispose of prescription drugs safely to avoid abuse, accidental ingestion by children or pets, or damage to the environment.
• Don’t store unneeded or expired prescription drugs.
• Don’t share them with others.

People Living with Cancer (PLWC) now has podcasts available on the PLWC site to help with coping with cancer and treatment  Podcasts are adapted from information from PLWC website.  They can be heard over the Internet or downloaded free for listening on a computer or MP3 player.

Some current podcasts include:

• Tips on Caregiving
• Coping with the Fear of Side Effects
• Parenting and Caring for Parents with Cancer
• Strategies for a Better Night’s Sleep

Find a complete list of podcasts here. 

All  PLWC material is reviewed by medical specialists from the American Society.

Before colonoscopy it is critical to completely empty all stool from the colon.  In addition to clear liquid diet, two approaches are used most often

• PEG (polyethylene glycol), a powder that is dissolved in two to four quarts of liquid.  PEG preps include GoLytely®, Nulytely®, Halflytely®, and Miralax®.
• Sodium phosphate which is available as a liquid (Fleet Phospho-Soda®) or pills (Visicol® and OsmoPrep®).

Patient acceptance, side effects, and the ability to complete the prep vary, but most studies show little difference in how completely the colon is cleansed.

However, there has been concern when some patients experienced a rare, but dangerous kidney problem after colonoscopy preparation with sodium phosphate.  In March 2006, the FDA alerted doctors about kidney failure from acute phosphate nephropathy associated with the use of both liquid and pills containing sodium phosphate.  This has worried both doctors and patients as they chose a colonoscopy prep.

However, in a study of patients having colonoscopy in the Henry Ford Health System in Detroit, no difference in the risk of kidney problems with either PEG or sodium phosphate preps was found among patients who didn’t already have pre-existing kidney disease.

7,900 patients had a colonoscopy during the time reviewed, 6,800 of them using a sodium phosphate prep.  In the year before their colonoscopy,1,600 patients had known renal problems.  Another 4000 had no testing in the 12 months before or 6 months after their procedure.

Among the remaining 2,400 people for whom there was information about kidney functioning, 88 had a kidney problem after colonoscopy.  These patients were about equally distributed between the PEG and the sodium phosphate groups.

Risk factors for kidney problems were:

• Age over 65
• African-American race
• low baseline glomerular filtration rate (GFR) which measures potential kidney failure
• hypertension
• use of certain medications including ACE inhibitors, angiotensin-renin blockers, and thiazide diuretics

Stefan Russman MD and his team concluded,

In patients without preexisting renal disease, the risk of renal impairment after colonoscopy appears to be similar between sodium phosphate and PEG users.

However, they warned that

Sodium phosphate use in patients with preexisting renal disease is not recommended, but common in clinical practice. Sodium phosphate should not be used in patients with preexisting serious renal disease, adequate hydration should be assured in all patients, and renal function should be monitored before and after colonoscopy in those at risk of renal dysfunction.

SOURCE:  Russman et al, American Journal of Gastroenterology, Early Online Articles, October 26,2007.

WHAT THIS MEANS FOR PATIENTS

If you are scheduled for a colonoscopy, you need to discuss your medical history and the drugs you are taking with the doctor who will be performing the test.  Tests for adequate kidney function before the colonoscopy are probably important.

If you don’t have kidney or heart problems and are younger than 65, there is probably no difference in safety between large volume PEG gastric lavage colonoscopy preps and lower-volume sodium phosphate liquids or pills.  You can make a choice that meets your personal needs.

Adequate hydration — replacing liquid lost during the copious liquid bowel movements — is critical no matter what prep you use.

C3 has been told that the conference number for NIH is $899.113 million over FY 07. That would mean the funding level is $29.799 billion or 3.1% over FY 2007. With the global AIDS transfer, the NIH level is $29.999 billion.

The numbers are higher than both bills passed in the House and Senate. More details to follow.