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Cancer Centers Rate Best

April 12, 1999|THOMAS H. MAUGH II

If you have cancer, you are much better off going to a specialized cancer center than to your local hospital or your family doctor, according to a report issued Wednesday. Most physicians who do not routinely treat cancer are not up to date on the latest research findings and so often provide inferior care, according to the Institute of Medicine report, commissioned by the National Cancer Institute, the American Cancer Society, the Centers for Disease Control and Prevention, and two pharmaceutical companies.

For some types of cancer, the report said, the risk of dying is two to four times higher if a patient does not go to a specialized cancer center.

Efficacy of treatment for a variety of diseases varies widely, with experience playing a major role. You are more likely to survive heart surgery, for example, if it is performed at a center that does 200 operations a year than at a center that does only one or two. But the differences are even greater with cancer, according to the report.

"One of the things we were struck with was evidence that standard cancer care is erratically applied," Dr. Robert Young of the Fox Chase Cancer Center in Philadelphia said at a news conference. Many doctors are simply not knowledgeable about the most recent treatment developments, he said.

Research shows, for example, that Tamoxifen is the best treatment for post-menopausal women with breast cancer that has spread to lymph nodes, but only 60% of such women receive the drug, he noted.

Adderall Tests Well Against Ritalin

The first head-to-head trial of the drug Adderall against Ritalin, the most commonly used drug for treatment of attention deficit hyperactivity syndrome, showed that the new drug is as effective as Ritalin, and that its effects last longer.

Ritalin is destroyed in two or three hours in the bloodstream and thus must be given three times a day. For school-age children, that means they must get at least one dose at school. Children often do not receive that dose, and their behavior is not properly controlled.

The new results, reported in the April issue of Pediatrics, show that Adderall is as effective as Ritalin, even when given in only two doses a day. Children can thus receive the drug only at home without the stigma of taking it at school. The trial, conducted by psychologist William R. Pelham of the State University of New York at Buffalo, enrolled 25 children who participated in a summer day camp. Adderall, like Ritalin, is an amphetamine derivative.

Cancer Drug May Be Useful for Heart Disease

A highly touted drug that has been claimed to cure cancer--at least in mice--may also be useful in preventing heart disease, according to new data reported in Tuesday's edition of Circulation: Journal of the American Heart Assn. The drug is endostatin, which was discovered by Dr. Judah Folkman of Children's Hospital in Boston.

Endostatin is a so-called angiogenesis inhibitor: It blocks the formation of the new blood vessels a tumor requires for growth. But researchers have shown that the plaque that blocks coronary arteries in atherosclerosis also has a network of tiny blood vessels.

Folkman and his colleagues gave endostatin to mice that already had plaque in their arteries. The researchers found that the drug blocked further growth of the plaque by as much as 85%, compared with animals that received no treatment. Mice fed another angiogenesis inhibitor called TNP-470 showed a 70% reduction in further plaque growth.

Study Tracks Girls With Birth Defects

Females born with birth defects have lower long-term survival rates than other females, and if they have children themselves, the children have a higher risk of developing birth defects, according to the first long-term study of children born with birth defects. Few studies have looked at such children beyond the first year of life.

A team from the University of Bergen in Norway and the U.S. National Institute of Environmental Health Sciences studied records of 8,192 females with birth defects and 451,241 others born in Norway between 1967 and 1982. They found that only 80% of the girls with birth defects survived to age 15, compared with 98% of other girls.

The affected girls were a third less likely than other girls to have a child by the age of 30. Overall, children of the affected women were 60% more likely to have a birth defect than children of the unaffected women, but the risk varied with the defect. Women with a cleft palate, for example, were 82 times more likely to have a child with a cleft palate, the highest risk observed, than other women.

Experts noted, however, that the overall risks were still small, and that 96% of the affected women gave birth to healthy children.

Young Smokers May Face Genetic Damage

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