Amgen’s Imdelltra Becomes First Bi-specific T-cell engager for Advanced SCLC

Know Your Risk For Blood Clots Before Taking Birth Control

In today's evolving reproductive health landscape, informed decision-making about contraception is crucial, particularly for women affected by inherited blood clotting conditions or thrombophilia. Selecting the right birth control method is pivotal, say experts, who point to research that shows the risk for potentially life-threatening blood clots is 35 times greater among women with genetic clotting disorders who use estrogen-based contraceptives.

((c) monkeybusinessimages/iStock via Getty Images Plus)

Dynamic debateRecent advances in technology and health care policies have fueled debate around screening for thrombophilia, a condition characterized by an increased tendency to develop blood clots, before starting estrogen-based contraceptives.

Current guidelines discourage universal thrombophilia testing, citing concerns such as costs and potential adverse psychological effects. Instead, selective screening, focused on individuals with personal or family histories of blood clots, is more likely to be embraced by the medical community. Also, concerns about unfair treatment by insurers or employers due to genetic disclosures underscore the complexities of this approach.

However, people in support of a more patient-centered approach to health care and this type of birth control decision-making stress the importance of identifying individuals at higher risk for blood clots.

Patient-centered approachEach year, many hundreds of women in the United States alone lose their life due to blood clots linked to estrogen-based contraception, as studies demonstrate. Advocates for genetic testing emphasize its role in facilitating personalized health care decisions, potentially reducing the incidence of clot-related fatalities, and empowering women with information and a more patient-centric approach to reproductive health care.

Cost considerations remain a significant factor, but for many, the value of preserving health and saving lives far outweighs financial concerns. While insurance coverage for genetic testing varies, studies show a willingness among women to bear screening costs, underscoring the importance of informed decision-making.

Despite the perceived low absolute risk for blood clots among individuals with genetic clotting disorders, personal factors must be considered. Tailored approaches to contraceptive decisions, guided by individual risk profiles, may be warranted, especially in certain populations with higher rates of genetic clotting disorders.

For individuals with genetic thrombophilia, contraceptive options such as copper IUDs or progestin-only pills offer effective alternatives without increasing clotting risks. Prioritizing safety and effectiveness is paramount in contraceptive decision-making.

While genetic testing may cause some level of anxiety or concern, studies indicate that most individuals do not regret pursuing testing. Knowledge empowers individuals to make proactive decisions about their health, outweighing potential psychological burdens.

Genetic disclosuresUnderstanding the implications of genetic disclosures on insurance and employment can inform decision-making processes, though these concerns may rightfully deter some individuals from pursuing testing.

Women interested in pursuing genetic testing should talk with their health care provider about their testing options. Genetic counselors can also provide valuable help. Women considering their contraception options and interested in learning more about genetic testing can get more information from the Rowan Foundation at AlexRowanFoundation.Org.

Empowering womenGenetic testing holds the promise of empowering women to engage in informed discussions with health care providers, fostering shared decision making in reproductive health care. Informed choices, guided by genetic information, may pave the way for more personalized and patient-centered care.

-StatePoint

Published May 29, 2024

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Blood Sugar Levels May Affect Cancer Outcomes In Patients With Diabetes

When it comes to high blood sugar, cancer and diabetes can create a "vicious cycle," as one expert explained.

"The inflammation and tumor markers could be causing the varying blood sugar, or it could be vice-versa,' an expert told CURE®. "It's kind of a vicious cycle in a way with the physiology."

An association has been found between inflammatory markers and blood sugar fluctuation among patients with diabetes and lung cancer. However, as one expert noted, the relationship between the two diseases remains unclear. Still, patients with diabetes can work with their health care team to promote the best possible outcomes.

In an analysis of 60 patients with type 2 diabetes and lung cancer, researchers found, "the greater the [blood glucose] fluctuation in [patients with lung cancer] after chemotherapy, the more unfavorable the therapeutic effect of chemotherapy; the higher the level of tumor markers and inflammatory cytokines [and] the more adverse reactions the patient experiences." These findings were published in the World Journal of Diabetes.

However, Dr. Amanda C. Leiter, assistant professor of Endocrinology, Diabetes and Bone Disease for the Mount Sinai Health System, explained that while an association between inflammation and high blood sugar is clear, any cause-and-effect relationship is harder to pin down.

"I think this confirms what we already know about diabetes and inflammation, and dysglycemia [blood sugar dysregulation] and high blood sugars being linked to inflammation," she said. "The study does show an association between inflammatory markers and the blood sugar fluctuations. But since this was an observational study [where patients' data was retrospectively analyzed], it's unclear which one is causing the other.

"The inflammation and tumor markers could be causing the varying blood sugar, or it could be vice-versa. It's kind of a vicious cycle in a way with the physiology. So, we know that blood sugar fluctuations can make inflammation worse, as well as vice-versa, that inflammation can also make blood sugars worse. So, it's hard to draw any causal relationship between the two, but they do establish an association and link between those two things."

Leiter discussed the importance of blood sugar control for patients with diabetes and cancer, how cancer and its treatments can contribute to blood sugar complications and more.

What is the importance of blood sugar control for patients with cancer?

It's very well-established that diabetes and high blood sugar are linked to more complications with cancer treatment. In general, in the context of a cancer diagnosis, diabetes can often fall to the wayside and there is data showing that the treatment and management of diabetes is suboptimal in the cancer treatment setting.

[It's important to] inform patients that their underlying health conditions, especially diabetes, are really important to manage when they're undergoing cancer treatments and that these high blood sugars may contribute to some complications of therapy down the road.

How can these treatments contribute to blood sugar complications?

Diabetes itself can increase the risk of a few cancer treatment-related complications, and then actual cancer treatment can contribute to high blood sugar. So, all of this is a little bit of a vicious cycle.

And so, just starting with how high blood sugar is bad for cancer treatments, we know that hyperglycemia, or high blood sugar, is linked to more complications with cancer surgeries, these patients tend to have more side effects with their chemotherapy and are also more likely to be hospitalized from the side effects of their chemotherapy. And then in general, patients who are undergoing cancer treatment are also more likely to get high blood sugars for a number of reasons.

So one [reason is] just stress in general can cause high blood sugar. There's a big link between inflammation, which is related to stress, and high blood sugar. And then also, a lot of the treatments that patients get for cancer can also contribute to this. A lot of patients, especially with their chemotherapy, get steroid treatments. And steroids can really cause high blood sugar.

And then underlying all of this is that a lot of patients with cancer already have risk factors for high blood sugar, like diabetes, or higher body mass index. The combination of all those things is a recipe for blood sugars to go up during the course of cancer treatment.

Say there is someone with diabetes who receives a cancer diagnosis, what can they do to give themselves the best chance at good outcomes?

That's a great question. I think [a good plan would include] just working with either their endocrinologist or primary care physician to come up with a plan to manage high blood sugars during the course of treatment — and this, of course, will depend on what the treatment is and what the overall goals of care are.

… And then on top of that, too, a lot of studies have been showing that — as hard as it is to exercise [during cancer treatment] — exercise is very good in the context of cancer treatment, for patient mental health, as well as for managing blood sugars. [Patients should] also make sure to adhere as much as possible to a healthy diet and working with a nutritionist either at the cancer center or with their diabetes or primary care provider.

Transcript has been edited for clarity and conciseness.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Diabetes Often Leads To Heart And Kidney Disease, Too

Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they're all closely connected.

Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don't have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don't work well, a person's heart has to work even harder to pump blood to them, which can then lead to heart disease.

The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.

While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. Syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still "astronomically higher than expected," said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women's Hospital in Boston and co-author of the study.

The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.

Your kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.

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