Alzheimer's cost triple that of other elderly

CHICAGO – The health care costs of Alzheimer's disease patients are more than triple those of other older people, and that doesn't even include the billions of hours of unpaid care from family members, a new report suggests.
Compared with people aged 65 and older without Alzheimer's, those with the mind-destroying disease are much more often hospitalized and treated in skilled-nursing centers. Their medical costs also often include nursing home care and Medicare-covered home health visits.
That all adds up to at least $33,007 in annual costs per patient, compared with $10,603 for an older person without Alzheimer's, according to a report issued Tuesday by the Alzheimer's Association.
The numbers are based on 2004 data and include average per-person Medicare, Medicaid and private insurance costs.
Costs likely have grown since then as the U.S population has aged and the number of Alzheimer's diagnoses has risen, said Angela Geiger, the Alzheimer's Association chief strategy officer.
According to the group's report, nearly 10 million caregivers — mostly family members — provided 8.5 billion hours of unpaid care for Alzheimer's patients last year.
"All of these statistics paint a really grim picture of what's going to happen ... unless we invest in solutions" to delay or prevent the disease, Geiger said.
This week a Senate committee will hear from an independent coalition of experts that has been working on a strategy for dealing with the growing Alzheimer's population.
An estimated 5.3 million Americans have the disease; by next year nearly half a million new cases will be diagnosed, according to the Alzheimer's Association.
As the disease progresses, people lose the ability to care for themselves and need help with eating, bathing, dressing and other daily activities. Eventually, they may need help with breathing and swallowing.
From 2000 to 2006, while deaths from heart disease, stroke, breast and prostate cancer declined, Alzheimer's deaths rose 47 percent.
Geiger said those trends reflect improved treatments for other diseases, while there are no treatments that can slow or prevent Alzheimer's.
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On the Net:
Alzheimer's Association: http://www.alz.org

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Study: Lots of red meat increases mortality risk

CHICAGO – The largest study of its kind finds that older Americans who eat large amounts of red meat and processed meats face a greater risk of death from heart disease and cancer. The federal study of more than half a million men and women bolsters prior evidence of the health risks of diets laden with red meat like hamburger and processed meats like hot dogs, bacon and cold cuts.
Calling the increased risk modest, lead author Rashmi Sinha of the National Cancer Institute said the findings support the advice of several health groups to limit red and processed meat intake to decrease cancer risk.
The findings appear in Monday's Archives of Internal Medicine.
Over 10 years, eating the equivalent of a quarter-pound hamburger daily gave men in the study a 22 percent higher risk of dying of cancer and a 27 percent higher risk of dying of heart disease. That's compared to those who ate the least red meat, just 5 ounces per week.
Women who ate large amounts of red meat had a 20 percent higher risk of dying of cancer and a 50 percent higher risk of dying of heart disease than women who ate less.
For processed meats, the increased risks for large quantities were slightly lower overall than for red meat. The researchers compared deaths in the people with the highest intakes to deaths in people with the lowest to calculate the increased risk.
People whose diets contained more white meat like chicken and fish had lower risks of death.
The researchers surveyed more than 545,000 people, ages 50 to 71 years old, on their eating habits, then followed them for 10 years. There were more than 70,000 deaths during that time.
Study subjects were recruited from AARP members, a group that's healthier than other similarly aged Americans. That means the findings may not apply to all groups, Sinha said. The study relied on people's memory of what they ate, which can be faulty.
In the analysis, the researchers took into account other risk factors such as smoking, family history of cancer and high body mass index.
In an accompanying editorial, Barry Popkin, director of the Interdisciplinary Obesity Center at the University of North Carolina at Chapel Hill, wrote that reducing meat intake would have benefits beyond improved health.
Livestock increase greenhouse gas emissions, contributing to global warming, he wrote, and nations should reevaluate farm subsidies that distort prices and encourage meat-based diets.
"We've promoted a diet that has added excessively to global warming," Popkin said in an interview.
Successfully shifting away from red meat can be as easy as increasing fruits and vegetables in the diet, said Elisabetta Politi of the Duke Diet and Fitness Center in Durham, N.C.
"I'm not saying everybody should turn into vegetarians," Politi said. "Meat should be a supporting actor on the plate, not the main character."
The National Pork Board and National Cattlemen's Beef Association questioned the findings.
Dietitian Ceci Snyder said in a statement for the pork board that the study "attempts to indict all red meat consumption by looking at extremes in meat consumption, as opposed to what most Americans eat."
Lean meat as part of a balanced diet can prevent chronic disease, along with exercise and avoiding smoking, said Shalene McNeill, dietitian for the beef group.
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Alcohol flush signals cancer risk for East Asians

WASHINGTON – Turn a bit red when you drink a mere half bottle of beer? If you're of East Asian descent, consider that a warning: You may be at higher risk of alcohol-caused esophageal cancer. Researchers reported the link Monday in hopes of increasing awareness that the inherited flushing trait — found in about a third of people from Japan, China and Korea — offers valuable health information.
Alcohol is a known risk factor for a variety of cancers, including esophageal, and heavier drinking is considered riskier than light drinking.
Lots of people turn slightly red if they imbibe too much. At issue here is facial flushing from a small amount of alcohol. It's due to a deficiency in an enzyme that helps metabolize alcohol, called ALDH2.
People with a severe deficiency of the enzyme usually don't drink because it makes them feel too bad; in addition to flushing they feel nausea and a rapid heartbeat.
But people with a partial deficiency — they inherited one bad copy of the enzyme-producing gene instead of two — may put up with the flushing. A series of studies by Dr. Akira Yokoyama of Japan's Kurihama Alcohol Center found that those people are six to 10 times more likely to develop esophageal cancer than people who drink a comparable amount but aren't enzyme-deficient.
"Somehow the message just hadn't gotten out," said Dr. Philip J. Brooks, who researches alcohol and cancer at the U.S. National Institutes of Health.
So he paired with Yokoyama and others to review the link for PLoS Medicine, a journal published by the Public Library of Science.
Without enough of that enzyme, alcohol breaks down into a DNA-damaging chemical similar to formaldehyde but it doesn't go the next step and turn into yet another chemical that's non-toxic, said Brooks. Don't drink, and the flushers aren't at increased risk.
Esophageal cancer is fairly rare, but it's also hard to treat. Worldwide, anywhere from 12 percent to a third of people who develop it survive five years.
Up to 8 percent of the world's population has the enzyme deficiency, meaning if even a small number of the at-risk avoided alcohol, esophageal cancer deaths could drop substantially, the review concluded.
In the U.S., most esophageal cancer is a type called adenocarcinoma that is linked to chronic, severe heartburn. The flushing-linked type is squamous cell carcinoma, less common here than abroad.

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Hunting tailored care for advanced prostate cancer

WASHINGTON – Prostate cancer has been left behind in the race for personalized medicine but that may be changing: Doctors are starting to attempt gene-guided treatment for men with advanced disease.
It's an approach already offered in treating breast and certain other cancers. The new prostate work is a small initial step at catching up. And it targets the men in most dire need — those whose prostate cancer has spread to the bones or other parts of the body, and hormone treatment to slow its march has quit working.
These are the men who ultimately wind up dying of prostate cancer, some 28,000 a year.
"Prostate cancer has learned some tricks," says Dr. Phillip Febbo of Duke University Medical Center, who is unraveling how to decode those tricks to better direct therapy — by looking directly at the tumor's genetic signature.
The research is very preliminary but if a gene-guided method ultimately works it could ease what the American Cancer Society's Dr. Durado Brooks calls today's "shotgun approach" to advanced prostate cancer. Patients slog their way through a handful of medications in no particular order, changing course only after the cancer quits responding.
"This gives us a more scientifically reasoned, evidence-based approach to treating these men — hopefully. That's the theory," Brooks cautions.
Starting next month, Duke will recruit men for a study that will help determine their treatment.
Tumors carry a pattern of gene and protein activity that signal whether a cancer is more or less aggressive and whether it is susceptible to various treatments. Those signatures already have led to breast cancer tests that predict which tumors are more likely to return, helping patients decide whether to try or skip chemotherapy, for example. Everyone with advanced colon cancer is supposed to get a genetic test before trying one of two leading treatments, to see if their tumor will respond.
Yet even though prostate cancer hits as many men as breast cancer hits women, finding genetic signatures in prostate tumors has been a struggle. Men tend to get prostate biopsies early on, before the cancer has spread. Very few get one after their cancer worsens, when the tumor has evolved, leaving few advanced tumor samples for scientists to examine which genetic activity is most crucial, Febbo explains.
But that's slowly changing, and the result is a race to find genetic signatures that might predict a therapy's usefulness.
First up, the "androgen receptor." It's the male counterpart to the estrogen receptor that determines how strongly estrogen fuels breast cancer growth.
Hormone therapy to block testosterone production is a key prostate cancer treatment. But some cancers keep growing despite low testosterone levels, and researchers in the last few years have found that how tumor cells use their androgen receptor plays a major role. The cancer might make copies of its androgen receptor so a cell now has 10 instead of two, Febbo says, the better to suck in remaining testosterone. Or the receptors may become more sensitive, able to react to the tiniest bit of testosterone instead of usual levels. Prostate tumors sometimes even start making their own testosterone.
Febbo's team genetically profiled more than 100 samples of prostate cancer. A genetic signature separates which men with hormone-resistant advanced cancer still have a very active androgen receptor and which don't — something else, perhaps a gene named Src, is fueling their cancer, he reported this month in the Journal of Clinical Oncology.
Next month, Duke and other hospitals that are part of the Defense Department's Prostate Cancer Consortium will begin recruiting 60 such patients and custom-profile their cancer to decide treatment. Those with highly active androgen receptors will get nilutamide, a receptor blocker. Those whose androgen receptors aren't the problem will receive an experimental treatment, the leukemia drug dasatanib that's known to target prostate-related factors.
Also under way: Testing whether there's a genetic signature that says which men will respond best to a different drug, docetaxel. It's proven to increase survival in hormone-resistant advanced prostate cancer but only in a fraction of patients.
Separately, doctors are closely watching studies of an experimental drug named abiraterone that's supposed to target mutated androgen receptors.
It's way too soon to predict if any of these approaches will pan out. But the genetics rationale appeals to Tim Atkeson, a Denver lawyer whose prostate cancer already had spread to his bones when he was diagnosed at the unusually young age of 49.
Atkeson read up on studies presented at leading cancer meetings and, while systematically working through treatments for the hormone-resistant, he contacted Febbo about volunteering for the gene-guided study. At the very least, he hopes to spur science in case his sons or brothers ever face the same disease.
"I keep my fingers crossed that perhaps I'll be one of the lucky ones," says Atkeson, now 51.
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

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Marine moves fingers after rare hand transplant

PITTSBURGH – Surgeons have transplanted a hand onto a Marine who was hurt in a training accident, and he has some movement in his fingers, according to the hospital where the operation occurred.
The surgery was performed at the University of Pittsburgh Medical Center by a team headed by Dr. W.P. Andrew Lee on March 14-15. The man still must undergo bone marrow infusion to reduce the need for traditional anti-rejection drugs. The drugs have side effects that include diabetes and high blood pressure.
The hospital is not releasing the 24-year-old's identity or details of how he lost his right hand, but hopes to hold a news conference next week.
"For a hand, it takes quite some time to get full movement," said spokeswoman Amy Dugas Rose. "He has some movement, which is a good sign."
The Marine will undergo intense daily physical therapy for three months to gain movement, she said.
The surgery is the first of its kind at the Pittsburgh hospital network, and only the sixth in U.S. history. The other five have occurred at Jewish Hospital Heart and Lung Center of Louisville, Ky.
The first U.S. hand transplant was performed in January 1999 on Matthew David Scott, of New Jersey, who lost his hand in December 1985 in an M-80 blast.
The first hand transplant was done in Ecuador in 1964, but the patient's body rejected the hand after two weeks.
Worldwide, there have been about 32 other patients, and 40 hands transplanted.
UPMC has two people on its hand transplant waiting list, Rose said. One is a man waiting for a double hand transplant.
Finding donors — from cadavers — is challenging, Rose said. Besides matching tissue and blood type, the gender, size and skin tone also must match.
Surgery can last eight to 10 hours as doctors attach two major arteries, veins and repair multiple tendons and nerves.

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