Chemotherapy effects on brain may be a myth

NEW YORK (Reuters Health) — "Chemofog" — impairments in memory and in thinking, or "cognition," that have been attributed to chemotherapy — was not seen in two studies of women being treated for breast cancer, according to a presentation at the 60th annual meeting of the American Academy of Neurology in Chicago.

In Melbourne, Australia, Dr. David G. Darby of CogState Ltd, where a cognitive assessment test bearing its name was developed, and colleagues, used the test to evaluate the changes in cognitive function in breast cancer patients.

CogState Ltd. is an international, publicly held company that sells diagnostic tools.

The researchers tested 30 women with breast cancer, and 30 "control" subjects matched by age, before each cycle of chemotherapy and 28 days after the last cycle.

Both groups of women also provided a subjective assessment of their cognitive function and feelings of depression and anxiety at each evaluation.

Before chemotherapy was even initiated, cognitive performance and learning ability on the CogState assessment were significantly impaired among patients compared with controls, Darby reported.

After the final cycle of chemotherapy, patient performance using the CogState assessment had declined only on speed of identification of objects.

Three women developed cognitive impairment over the course of chemotherapy. However, the results of the objective assessment did not match the women's subjective reports of depression, anxiety or cognitive performance.

"Prior to chemotherapy, women with breast cancer show subtle but reliable impairment in attention and learning," Darby's team concluded. "Chemotherapy-related cognitive impairment was infrequent and did not correlate with subjective cognitive impairment."

Meanwhile, Dr. Michael J. Boivin of Michigan State University in East Lansing and colleagues presented similar findings for 17 women newly diagnosed with breast cancer prior to chemotherapy or radiation, 21 women with recent benign diagnoses and 20 women who had completed chemotherapy for breast cancer at least one year previously.

These women also completed the CogState battery as well as a quality-of-life questionnaire.

Newly diagnosed women with breast cancer were significantly less accurate on memory tests than the one-year survivors and performed "marginally" poorer than women who had received a benign diagnosis.

"These results suggest that cognitive difficulties experienced by women with a new breast cancer diagnosis may be related to stress as a result of the diagnosis and other quality-of-life factors, and not simply due to the effects of chemotherapy or radiation," Boivin told meeting attendees.

Traditional breast-feeding schedule is best

NEW YORK (Reuters Health) — Following a traditional breast-feeding schedule appears more beneficial for early infant weight gain and is more supportive of continued breast-feeding than a "baby-led" routine, UK researchers report.

The traditional recommendations have been largely replaced by "baby-led" breast-feeding which advises letting infants feed for an unlimited time from the first breast and that both breasts need not be used at each feeding, Dr. C. Anne Walshaw and colleagues note.

"Such advice is not backed up by evidence-based lactation physiology," Walshaw, of Bradford and Airedale Teaching Primary Care Trust, in Bradford, told Reuters Health.

After noticing poor weight gain among breast-fed babies after baby-led breast-feeding became more common, Walshaw and colleagues compared early weight gain in infants who were exclusively breast fed.

Thirty one healthy mother/baby pairs followed the baby-led advice and a similar group of 32 mother/baby pairs followed the traditional breast-feeding advice. The traditional breast-feeding approach involves breast-feeding using both breasts at each feeding for no more than ten minutes per breast.

They found that infants were more likely to be exclusively breast-fed for up to 12 weeks when their mothers followed traditional rather than baby-led breast-feeding practices.

Furthermore, feeding more than ten minutes from the first breast was associated with poor weight gain during the first six to eight weeks of exclusive breast-feeding, the researchers report in the Archives of Disease in Childhood.

Traditional methods take advantage of the physiological mechanisms of breast-feeding, Walshaw said. The regular, short-term use of both breasts at each feeding conditions the let-down reflex.

Moreover, draining milk from both breasts at each feeding inhibits the slowing of milk production in an unused breast, and takes advantage of the higher fat and protein content of early-released milk from each breast.

By contrast, baby-led breast-feeding can decondition the let-down reflex through prolonged suckling at each feed, and can gradually enhance lesser milk production by using only one breast at each feeding.

Walshaw and colleagues conclude that strategies encouraging breast feeding must heed lactation physiology.

New immune drug safely treats psoriasis

WASHINGTON (Reuters) — An experimental new drug that suppresses certain parts of the immune system worked safely to relieve some of the symptoms of psoriasis, researchers in Canada reported.

The drug, called ISA247, is made by Isotechnika Inc., a small company based in Edmonton, Canada.

It mimics some of the effects of the immune suppressing drug cyclosporine, but is designed to avoid some of the dangerous side-effects.

The researchers tested 451 patients aged 18 to 65 years who had plaque psoriasis over at least ten percent of the body.

This unpleasant skin disease is caused by a mistaken immune reaction that causes red, scaly, itchy skin.

They found an almost linear relationship between drug dose and response, suggesting that doctors can figure out an accurate dose that reduces side-effects.

"The highest dose provided the best efficacy," Dr. Kim Papp of Probity Medical Research in Waterloo, Ontario, and colleagues reported in the Lancet medical journal.

There are several monoclonal antibodies that target the immune response and may help against psoriasis, they wrote. But they are expensive and inconvenient to use.

ISA247 did not cause significantly more side-effects than placebo, even at the highest doses, the researchers found. The Phase III trial was a last step before seeking approval to market the drug.