Prostate cancer patients who were monitored more frequently after treatment did not live significantly longer than patients who were monitored once a year, according to study findings led by a University of North Carolina Lineberger Comprehensive Cancer Center researcher.
Researchers presented findings from an analysis of data from nearly 10,500 prostate cancer patients in the United States from 2005 to 2010. The study’s primary goal was to determine if more frequent monitoring with the prostate-specific antigen test after treatment improved patients’ long-term survival. The researchers found that survival risk was not significantly different for patients who had PSA monitoring every three months compared with patients who had monitoring once a year.
“This suggests that for prostate cancer patients, once-a-year monitoring may be enough,” said UNC Lineberger’s Ronald C. Chen, MD, MPH, associate professor in the UNC School of Medicine Department of Radiation Oncology, who was the study’s first author. “This is not a surprising finding because prostate cancer is often a slow-growing disease.”
After completing treatment for prostate cancer, patients need routine monitoring to detect a potential recurrence of the cancer and get treated early, Chen said, with the goal of improving long-term survival. For patients who have finished either surgery or radiation, the PSA test is used to check regularly to look for recurrence. However, Chen said guidelines have differed as to how often the test is needed.
“If more frequent testing does not help patients live longer, then it can actually harm the patient in terms of the cost of testing, and causing stress and anxiety,” said University of North Carolina School of Medicine’s Ramsankar Basak, PhD, a study co-author. “We hope that results of this study will help change future guidelines on monitoring of prostate cancer patients after treatment.”

University of North Carolina Lineberger Comprehensive Cancer Center
unclineberger.org/news/prostate-cancer-treatment-followup

The development of new medical products that are considered the highest priority for people in developing countries is highly concentrated – among five pharmaceutical companies and on five diseases.
The 2018 Access to Medicine Index is an independent ranking of 20 of the leading pharmaceutical companies on their efforts to improve access to medicine in low- and middle-income countries. Takeda rises furthest in 2018, jumping ten places to fifth. GSK retains its position at the top of the Index. Novartis moves into second, ahead of Johnson & Johnson and Merck KGaA, which complete the group of leaders in 2018.
The four leaders, together with Sanofi (in 6th), account for 63% of the priority research and development (R&D) being undertaken.
“The fact that a handful of companies are carrying the bulk of the priority R&D load shows how fragile the situation is. A retreat by even one of these players would have a significant impact,” said Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation. “If more companies joined this group, that would bring much needed resilience.”
The Index found that the industry’s engagement in such R&D is focused on five diseases, with half of all such activity targeting malaria, HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis. All five diseases are the target of global health initiatives and have international donors behind them. In total, 45 diseases have been identified as a priority for R&D by the WHO and others.
The analysis indicates that the majority of the priority R&D projects are being carried out with public sector research organisations. However, some companies are developing priority products without such facilitation. One example is Merck KGaA developing tests and treatments for schistosomiasis, a water-borne parasitic disease that affects around 252 million people.
“This is evidence that, when society agrees on the priorities, this clearly works in focusing the industry’s efforts,” said Danny Edwards, research lead for the Index. “Our analysis found evidence of this not only in R&D but also in the actions companies take to make medicines accessible after they reach the market. In short, where there is a call to action or donor funding, more companies will get involved, particularly in areas with low commercial potential.”
The concentration in companies and diseases is also seen in other activities important for access to medicine: for example, small groups of companies account for the increases in fairer pricing strategies, and in access planning while products are still in the pipeline.
 
Progress over the last two years
The Index measures companies in seven areas of corporate behaviour that are important for increasing access to medicine.
Overall, the industry continues to mature in its approach to access to medicine. Three companies have set new or strengthened access strategies since the 2016 Index. Five companies are scaling up commercial models that explicitly view people living in underserved communities as customers. Companies are also more transparent about where they have patents in force, which is valuable information for international medicines procurers. Also, strategies that set different prices for different segments of a country’s population continue to become more sensitive to what people can afford.
However, performance continues to lag in some areas. For example, while companies are refining their pricing strategies to improve the affordability of more products, they are applying them in few countries, mostly emerging markets.  Also, while licensing has enabled the manufacture and distribution of generic versions of all recommended treatments for people living with HIV/AIDS, its use remains confined to that disease and to hepatitis C but could be extended to other diseases.
The companies have more projects in the pipeline that target global health priorities than they did two years ago. Since the 2016 Index, at least 66 products have moved through the pipeline to reach the market. They are for 14 diseases that the Index covers, with half of them targeting cancers. Other examples include: 

• Three new pills that each can cure all six major genotypes of hepatitis C. Gilead has voluntary licensing agreements in place with 11 India-based generic pharmaceutical manufacturers which enable the manufacture and distribution of two of these products in 105 developing countries. (Gilead and AbbVie)
• A child-friendly chewable form of a tablet for roundworm and whipworm, which currently infects an estimated 795 million people. The company has pledged a donation programme of 200 million doses per year until 2020. (Johnson & Johnson)

65% of cancer deaths globally in developing countries 

Cancer is taking an increasing toll in low- and middle-income countries, where approximately 65% of cancer deaths now occur. The Index examined company efforts to increase access to cancer products for the first time this year, focusing on those that are included on the World Health Organization (WHO) list of medicines it considers essential for all healthcare systems. It identified 72 such products. Novartis markets the largest proportion of these, including half of the cancer products that have an access initiative attached to them.
Efforts during the R&D phase to plan access initiatives for cancer products lag far behind those for communicable diseases. Plans are in place for 5% of candidate cancer products by the time they reach the later stages of development, compared with 54% for communicable disease pipeline products.
“There have been massive improvements in global health in the past decades, with all major pharmaceutical companies taking action. To close the gaps that remain, a greater diversity of companies must get involved and stay engaged for the long haul.” Jayasree K. Iyer, Executive Director.
   www.accesstomedicinefoundation.org

Carestream Health has signed an agreement with Royal Philips to sell its healthcare information systems (HCIS) business to Philips.
Carestream’s HCIS business unit provides imaging IT solutions to multi-site hospitals, radiology services providers, imaging centers and specialty medical clinics around the world. The business has developed strong customer relationships in attractive, high-growth healthcare segments and is positioned for continued growth and success.
As a result of this acquisition, Philips’ expanded healthcare IT business will feature Carestream’s enterprise imaging platform—including best in class VNA, diagnostic and enterprise viewers, multimedia reporting, workflow orchestrator and clinical, operational and business analytics tools—as part of its broad portfolio.
“We have had global success in providing radiology and enterprise imaging IT systems to help medical professionals provide quality care and enhance their operations,” said Ludovic D’Aprea, Carestream’s General Manager for Healthcare Information Solutions. “By becoming part of Philips, the HCIS business will have a greater opportunity to thrive and grow. Both organizations share a commitment to meaningful innovation which is deeply embedded in each company’s culture. Customers will have access to a broader portfolio of healthcare IT solutions to simplify medical image management, enable effective collaboration and enhance patient care.”
Like Carestream, Philips has built a strong, global business based on customer focus, world-class technical excellence and continuous innovation.
“Philips partners with global healthcare providers to connect people, information and technology with the commitment to deliver on the Quadruple Aim of improved patient experiences, better health outcomes, improved staff experiences, and lower costs of care,” said Robert Cascella, Chief Business Leader Precision Diagnosis at Royal Philips. “This acquisition will enhance our ability to provide flexible solutions to hospitals and health systems. The combination of our successful innovations in imaging system platforms, workflow optimization and artificial intelligence-enabled informatics, combined with Carestream’s cloud-based enterprise imaging informatics platform and complementary geographic footprint will provide a solid foundation to deliver on the promise of precision diagnosis.”
Carestream will retain its medical imaging, dental and industrial films, non-destructive testing, and precision coating businesses which are not impacted by the sale. “These established businesses have solid financial foundations, innovative technology platforms and have earned the trust of loyal customers around the world,” said David C. Westgate, Chairman, President and CEO of Carestream. “Our focus will be on delivering innovation that is life changing—for patients, customers, channel partners, communities and other stakeholders—and we will grow the company for long-term success.”
Following receipt of all regulatory and applicable government approvals, input from works councils and unions, and meeting all pre-conditions, the two companies will work towards closing the sale in the second half of 2019 and will continue to operate independently until closing. www.carestream.com

Machine learning using real-time symptom reports can accurately detect lymphedema, a distressing side effect of breast cancer treatment that is more easily treated when identified early, finds a new study led by NYU Rory Meyers College of Nursing.
“Using a well-trained classification algorithm to detect lymphedema based on real-time symptom reports is a highly promising tool that may improve lymphedema outcomes,” said Mei R Fu, PhD, RN, FAAN, associate professor of nursing at NYU Meyers and the study’s lead author.
Lymphedema is a build-up of lymph fluid that causes swelling in the arms or legs and is commonly caused by the removal of lymph nodes as part of cancer treatment. It can occur immediately after cancer surgery or as late as 20 years after surgery; a recent study found that more than 41 percent of breast cancer patients experienced lymphedema in their arms within 10 years of their surgery.
Lymphedema is one of the most dreaded adverse effects from breast cancer treatment because of its chronic nature and debilitating symptoms, including arm swelling, heaviness, tightness, achiness, stiffness, burning, and decreased mobility. While there is no cure for lymphedema, early detection and intervention can reduce symptoms and keep it from worsening, although early detection remains a challenge.
“Clinicians often detect or diagnose lymphedema based on their observation of swelling. However, by the time swelling can be observed or measured, lymphedema has typically occurred for some time, which may lead to poor clinical outcomes,” said Fu.
“In our digital era, integrating technology into health care has led to advances in detecting and predicting various medical conditions,” said Yao Wang, PhD, professor of electrical and computer engineering at NYU Tandon School of Engineering and the study’s coauthor.
A type of artificial intelligence, machine learning is of interest to researchers due to its ability to construct algorithms that continually improve predictions and generate automated knowledge through data-driven predictions or decisions with incoming data—in this case, symptom reports. Machine learning is particularly beneficial when there are many relevant factors that are not independent, which is true for lymphedema symptoms.
In this study, the researchers used a web-based tool to collect information from 355 women who had undergone treatment for breast cancer, including surgery. In addition to sharing demographic and clinical information, including whether they had been diagnosed with lymphedema, participants were asked whether they were currently experiencing 26 different lymphedema symptoms.
Statistical and machine learning procedures were performed for data analysis. Five different classification algorithms of machine learning were compared: Decision Tree of C4.5, Decision Tree of C5.0, gradient boosting model, artificial neural network, and support vector machine. The algorithms were also compared with a conventional statistical approach that determines the optimal threshold for the symptom count based on the receiver operating curve.
The researchers found that all five machine learning approaches outperformed the standard statistical approach, and the artificial neural network achieved the best performance for detecting lymphedema. The artificial neural network was 93.75 percent accurate, correctly classifying patients to have true lymphedema cases or non-lymphedema cases based on the symptoms reported.
“Such detection accuracy is significantly higher than that achievable by current and often used clinical methods,” said Fu.
The researchers note that conducting such real-time lymphedema assessment encourages patients to monitor their lymphedema status without having to visit a healthcare professional. Based on patients’ symptoms and resulting risk for lymphedema, the assessment system could alert patients at risk to schedule in-person clinical visits for further evaluation. This may lessen the burden of unnecessary clinical visits on patients and the healthcare system.
“This has the potential to reduce healthcare costs and optimize the use of healthcare resources through early lymphedema detection and intervention, which could reduce the risk of lymphedema progressing to more severe stages,” Fu said.

New York Universitywww.nyu.edu/about/news-publications/news/2018/june/machine-learning-helps-detect-lymphedema-among-breast-cancer-sur.html