STUDY: Women with early-stage ovarian cancer may do better if they receive chemotherapy immediately after undergoing surgery.

JOURNAL: Journal of the National Cancer Institute 2003;95:94-95,113-132

AUTHORS: Dr. Mahesh Parmar

ABSTRACT: Two large, newly released European studies suggest that women with early-stage ovarian cancer may do better if they receive chemotherapy immediately after undergoing surgery.

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COMMENTARY: Both studies found chemotherapy reduced the risk of a cancer recurrence. One found the treatment increased survival, but the other did not.

However, the studies are not the final word on the benefits of chemotherapy following surgery, said Dr. Debbie Saslow, of the American Cancer Society, who was not involved in either study.

"Women still need to discuss their particular situations with their doctors and decide about which course of treatment may be best for them."

Currently, women diagnosed with early-stage ovarian cancer tend to have surgery and if the cancer comes back, additional surgery and chemotherapy are recommended, according to Saslow, director of breast and gynecologic cancer at the American Cancer Society. In about 50% of cases, women with early-stage cancer experience a relapse after surgery.

Previous studies have shown that some women with early-stage ovarian cancer can be cured by surgery alone and therefore can avoid the devastating side effects of chemotherapy.

One important factor is to determine how far the disease has progressed so an informed decision can be made, Slaslow explained.

In the first study, the International Collaborative Ovarian Neoplasm Collaborators led by Dr. Mahesh Parmar of the Medical Research Council Clinical Trials Unit in London, England looked at 477 women who either had chemotherapy after surgery or had surgery alone.

After five years, women who received chemotherapy had a 9% greater overall survival (79% versus 70%) and an 11% greater chance of not having a recurrence of their cancer (73% versus 62%), according to the report published in the January 15th issue of the Journal of the National Cancer Institute.

In the second study, 448 women with early-stage ovarian cancer had either chemotherapy and surgery or had surgery alone.

In this study, after 5.5 years no difference in overall survival was detected between the two groups of women. However, women who got chemotherapy were less likely to have their cancer come back, according to the study's lead author, Dr. J. Baptist Trimbos of Leiden University Medical Center in The Netherlands and colleagues.

Overall, 76% of patients treated with chemotherapy were recurrence-free compared with 68% of patients not treated with chemotherapy.

The trials included a mix of patients, some with a poor prognosis and others with a better prognosis, based on the types of tumors they had. The studies do not help determine which women can be spared chemotherapy.

More research needs to be conducted to better identify women "who do not require additional therapy, while also seeking to improve therapy in patients who do."

STUDY: Losing just over two pounds is associated with a 1% reduction in cholesterol and a 2% reduction in triglycerides.

JOURNAL: Journal of the American Medical Association 2003;289:323-330

AUTHORS: Dr. Anne McTiernan

ABSTRACT: Regular, moderate exercise can lower the risk of heart disease among older women by boosting fitness and trimming tummy fat, new research shows.

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COMMENTARY: The study found that postmenopausal women who began an exercise program of brisk walking or cycling five days a week lowered their levels of abdominal fat by about 6% and lost weight, regardless of body weight or age.

Not surprisingly, the most active women lost the most body fat and the most weight.

Women who did no cardiovascular exercise but performed stretching exercises one day a week actually saw intra-abdominal fat and weight increase slightly after a year.

The results suggest a strategy for lowering the risk of heart disease, a leading cause of death among women. Intra-abdominal fat is considered a major risk factor for heart disease and is also associated with type 2 diabetes, high blood pressure and high cholesterol.

Fit individuals, or those able to maintain an elevated heart rate over time, are also less likely to die of heart disease regardless of body weight, Dr. Anne McTiernan from the Fred Hutchinson Cancer Research Center in Seattle, Washington, and colleagues explain.

Therefore, the study has implications for the soaring rates of obesity in the US. Nearly two-thirds of the adult population is now considered overweight or obese, as measured by body mass index (BMI). An adult with a BMI above 25 is considered overweight and one with a BMI exceeding 29 is considered obese.

Dieting, previous studies have shown, may be just part of the solution. To investigate the effect of regular exercise on body fat and weight, researchers divided 168 inactive women aged 50 to 75 years into two groups. All women had BMIs over 25.

The exercisers were instructed to walk on a treadmill or cycle on a stationary bicycle for at least 45 minutes, five days a week, for one year. Weight training was recommended but not required. Women in the control group performed a series of stretching exercises one day a week for the year.

The most active women, or those who exercised more than 3 hours and 15 minutes a week, lost about 7% of their intra-abdominal fat, compared with a loss of 6% among intermediate exercisers, as measured by a CT scan. Those who exercised less than 2 hours and 15 minutes a week lost 3.4% of their intra-abdominal fat, while women in the control group gained 0.1% intra-abdominal fat, the study found.

Body weight decreased by an average of 1.3 kilograms (kg) or nearly three pounds in the group of exercises, while body weight rose very slightly (.2 pounds) in the group of stretchers.

"Women should be relieved that when they increase their exercise levels, they are doing good things for their bodies and health, even if they don't see much change on the scale," McTiernan said in an interview.

According to a study cited in her article, losing just over two pounds is associated with a 1% reduction in cholesterol and a 2% reduction in triglycerides, a type of body fat associated with heart disease. Losing this amount of weight can also reduce fasting blood sugar, an indicator of diabetes risk.

STUDY: Preventing infant sleeping problems should be more cost-effective than treating them after they have arisen.

JOURNAL: Arch Dis Child. 2003;88:108-111

AUTHORS: M. Nikolopoulou and Ian St. James-Roberts

ABSTRACT: Newborn infants that feed too often are at high risk for disrupted night sleep. However, these infants may benefit from a simple preventive behavioral program.

COMMENTARY: Many Western parents find infant and child night waking to be a source of substantial stress, both for themselves and their relationships with their children.

In a community sample of 316 newborn infants, those who had more than 11 feeds per 24 hours at one week of age were 2.7 times (95% confidence interval, 1.5 - 4.8) more likely to fail to sleep through the night at 12 weeks of age.

The infants and their families were randomized to receive one of three interventions: a three-step behavioral program, an educational booklet and helpline access for sleeping problems, or routine services. The behavioral program consisted of maximizing the difference between night and day environments by minimizing light and social interaction at night; avoiding feeding or cuddling at night; and from the age of three weeks, gradually delaying feeds when the baby awoke at night.

At 12 weeks, 82% of at-risk infants who received the behavioral program slept through the night, compared with 61% of at-risk infants who received the other interventions. The findings were similar for both bottle- and breast-fed babies.

"Preventing infant sleeping problems should be more cost-effective than treating them after they have arisen," the authors write. "This study provides evidence that it is possible to identify infants who are at risk of failing to sleep through the night at an early age, and that a simple, three step, preventive behavioral program increases the number who sleep through the night by 21%."