Many With Terminal Cancer Still Getting Routine Screens

Many patients with incurable cancer are still being screened for common cancers, although these tests are unlikely to provide any benefit, researchers from Memorial Sloan-Kettering Cancer Center in New York City have found. Specifically, many patients diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer are still undergoing the ordeal of routine breast, prostate and colon cancer screening, said the researchers. Not only might these patients suffer from invasive procedures like colonoscopies near the end of life, the researchers said, but they face the unnecessary risk of additional tests, biopsies and psychological distress resulting from the detection of new malignancies.

"For patients living with advanced cancer, cancer screening should not be a routine procedure," said lead researcher Dr. Camelia S. Sima, an assistant attending biostatistician. "Patients living with advanced malignancies and their doctors should engage in a realistic conversation about the risks and benefits associated with cancer screening in face of a severely limited life expectancy," she added. The report is published in the Oct. 13 issue of the Journal of the American Medical Association. For the study, Sima's team collected data on 87,736 Medicare patients aged 65 years or older with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer, whose data was reported in the Surveillance, Epidemiology, and End Results (SEER) tumor registries.

These patients were followed from their diagnosis, between 1998 and 2005, until they died or to the end of 2007. To compare the findings to a control group, the researchers also collected data on 87,307 similar Medicare patients without cancer, who were matched with the other individuals for age, race, sex and SEER data. In both patient groups, Sima's team looked at the rates of mammograms for breast cancer, Pap tests for cervical cancer, prostate-specific antigen (PSA) tests for prostate cancer and endoscopy for colon cancer. The investigators found that among women with advanced cancer, 8.9 percent had a mammogram, compared with 22 percent of those without cancer; and 5.8 percent of the cancer patients had a Pap test, compared with 12.5 percent of those without cancer.

Placebo Pill Gives Boost to Some Women's Sex Drive

About one-third of women given a placebo pill to treat a low libido reported improvements in their sex lives, a finding researchers say is evidence of the powerful and somewhat mysterious mind-body connection surrounding arousal and desire. After drugs like Viagra and Cialis revolutionized the treatment of male sexual dysfunction in the late 1990s, a flurry of clinical trials were conducted in women in the hopes that the drugs could do the same to revive a woman's flagging sex drive. The drugs flopped in women. But recently, researchers went back and looked at the old data on Cialis and found that not only did about 35 percent of women given the placebo pill experience significant improvement in psychological aspects of sex such as desire, many reported improvements in the physical aspects of arousal, including better lubrication, more frequent orgasms or more easily attainable orgasms, according to the study.

"Everything across the board improved in some women," said study author Andrea Bradford, a post-doctoral fellow at the Baylor College of Medicine in Houston. The study is published in the current issue of the Journal of Sexual Medicine. In the original study, 50 women aged 35 to 55 who were diagnosed with female sexual arousal disorder were given either Cialis or a placebo for 12 weeks. The women, most of whom were married, were asked to have sex at least three times a month. "Many went above and beyond," Bradford noted. Women also had to keep a diary of how often they had sex and how satisfying it was. Bradford suspects the improvements were due to several aspects of the study the hope that the pill might be working plus speaking with medical professionals about sex, thinking about sex and trying to have better sex.

"I think just the act of attending to their sex lives was very therapeutic for some women," Bradford said. Over time, the frequency with which women had sex dropped some, but they continued to report better sex lives overall. "It was quality over quantity," she said. When sex is no longer satisfying, women tend to avoid it, noted Aline Zolbrod, a Boston-area clinical psychologist and sex therapist. Without at least giving it a try, there's little hope sex will get better. "I love this study," Zolbrod said. "It does what we'd like to get our patients to do, which is to start having sex again. Instead of getting into bed and sighing, 'Oh, this is never going to work,' instead they are getting into bed and thinking, 'Let's see what happens.' When you have that attitude and you have sex almost once a week, for some women it really did the trick."