When the truth hurts

Information given to patients with cancer about the survival benefit of palliative chemotherapy is not clear, with consequent implications for decision making and informed consent, according to a UK qualitative study. Researchers observed and recorded consultations between oncologists and patients with advanced cancer, including lung, pancreatic, and colorectal malignancies. In most of the consultations, analysis showed that discussion of the survival benefit of palliative therapy was either non-existent or vague. The authors comment that although there are clear differences in the way practitioners and patients perceive the term “palliative”, it appears that oncologists may benefit from guidance on how to inform patients about survival benefits of palliative chemotherapy, in order to assist patients in making important decisions about treatment and to ensure proper informed consent.

BMJ 2008; 337; a752

Smoke-free for clearer coronaries

The enactment of legislation banning smoking in public places in Scotland appears to have reduced the total number of hospital admissions for acute coronary syndrome, according to UK researchers. Smoking has been prohibited in enclosed public places in Scotland since March 2006. Information was collected prospectively on smoking status and exposure to second-hand smoke, along with biochemical findings, from all patients admitted with acute coronary syndrome to nine major hospitals during the 10-month period before the enactment of the legislation. The information was collected during the same period the following year. Overall, admissions for acute coronary syndrome decreased by 17% in Scotland, compared with 4% in England, where there is no such legislation. The reduction in admissions was greater for non-smokers (21%), than for smokers (14%). People who had never smoked reported a significant decrease in exposure to second-hand smoke, confirmed by decreased serum cotinine levels. The authors comment that changing social attitudes to smoking may be an important step in discouraging young people from beginning to smoke, with clear health benefits for the future.

N Engl J Med 2008; 359: 482-491

Infertility v technology

Singleton births resulting from assisted fertilisation are known to be associated with a greater chance of adverse outcomes; whether this effect is due to reproductive technology or to maternal factors associated with infertility has been unclear. In a population-based cohort study, Norwegian researchers assessed birth outcomes for over 2000 women who had conceived at least one child spontaneously and another after assisted fertilisation. Results were compared with those of the general population for over one million births after spontaneous conception, and 8000 births after assisted fertilisation. Overall, assisted fertilisation conceptions were associated with lower mean birthweight, shorter duration of gestation, and increased risks of being small-for-gestational age and perinatal death. In the comparison between siblings born to mothers with infertility problems, the results for all outcomes did not differ, leading the authors to speculate that these adverse outcomes may be associated with factors leading to infertility, rather than those related to reproductive technology.

Lancet 2008; 31 Jul [Epub ahead of print]

Growth hormone and HIV

Patients on antiretroviral therapy for treatment of HIV can experience visceral adiposity and metabolic complications, with increasing cardiovascular risk. Reduced secretion of growth hormone (GH) may be a contributing factor. In a US randomised, double-blind controlled trial of 56 people with HIV, patients were allocated to receive either subcutaneous low-dose GH or a placebo for 18 months. The group receiving GH experienced a significant decrease in visceral fat, truncal obesity, triglycerides, and diastolic blood pressure, but an increase in 2-hour glucose levels on glucose tolerance testing compared with the placebo group. The authors comment that a cautious approach is warranted, particularly in patients with insulin resistance.

JAMA 2008; 300: 509-519