Tips for healthy eating

1. Eat a variety of nutrient-rich foods. You need more than 40 different nutrients for good health, and no single food supplies them all.

2. Enjoy plenty of whole grains, fruits and vegetables.

3. Maintain a healthy weight – not too fat, not too thin. The weight that’s right for you depends on your sex, height, age and heredity.

4. Eat moderate portions. (The recommended cooked meat portion is 3 ounces, about the size of a deck of cards.)

5. Eat regular meals. Skipping can lead to out-of-control hunger, and overeating.

6. Reduce, but don’t necessarily eliminate certain foods. The key is moderation.

7. Know your diet pitfalls. To improve your eating habits you need to know what’s wrong with them.

8. Make changes gradually. Remedy excesses or deficiencies in your diet with modest changes that can add up to positive, lifelong eating habits.

Source http://www.bluemountaineagle.com/news/local_news/tips-for-healthy-eating/article_c736a81e-5af9-11e0-8b0c-001cc4c03286.html

NEOADJUVANT ANDROGEN DEPRIVATION THERAPY BEFORERADIOTHERAPY HALVES PROSTATE CANCER MORTALITY

New long-term results confirm the finding that neoadjuvant androgen-deprivation therapy (ADT), combined with radiotherapy, can significantly boost survival in men with locally advanced prostate cancer.
The updated results of the Trans-Tasman Radiation Oncology Group (TROG) 96.01 trial are published online March 25 in the Lancet Oncology.
They show that a large proportion of patients with locally advanced disease can be successfully treated with as little as 6 months of neoadjuvant ADT and a relatively low dose of radiation.
The authors note that at 10 years, neoadjuvant ADT cut the prostate-cancer-specific mortality rate in half, compared with radiation treatment alone (11% vs 22%).
All-cause mortality was also reduced, by about a third, among patients who received both therapies (29% vs 43%).
These results confirm the use of neoadjuvant ADT in this population of prostate cancer patients, explained lead author James W. Denham, MD, director of the Prostate Cancer Trials Group at the University of Newcastle, New South Wales, Australia. "It also gives evidence that the treatment needs to be at least 6 months to have an effect on mortality."
"For men with intermediate-risk cancers, RTOG [Radiation Therapy Oncology Group] 9408 has shown that 4 months of neoadjuvant ADT can improve survival," he told Medscape Medical News.
Earlier Results Confirmed
Dr. Denham and colleagues previously reported 5-year results from this study. They suggested that 6 months of neoadjuvant ADT improved prostate-cancer-specific survival by reducing metastases (Lancet Oncol. 2005;6:841-850). At 10 years, they now find that, compared with radiotherapy alone, the addition of ADT improves event-free survival, decreases the cumulative incidence of prostate-specific antigen (PSA) progression, and decreases distant progression and all-cause and disease-specific mortality.
In this prostate cancer population, neoadjuvant ADT for at least 6 months is the already the standard of care in Australia and New Zealand and a number of centers in other parts of the world, explained Dr. Denham.
He also noted that although a longer duration of ADT after radiation might increase survival slightly, which has been seen in some trials from the RTOG and European Organization for Research and Treatment of Cancer, it comes at a cost — both financially and in terms of toxicity. "A point we make in the article is that the informed treatment-consent process is getting much more rigorous in many countries, and it is getting more difficult to 'persuade' men that the inconvenience and potential prolonged ill effects of long-term ADT are worth the possible additional gains," he said.
"Six months of neoadjuvant ADT and radiation is a very reasonable choice, particularly for men with coexisting medical problems that could be exacerbated by long-term ADT," Dr. Denham added.
Clear Messages for Clinical Practice
In an accompanying editorial, Chris Parker, MD, consultant clinical oncologist from the Royal Marsden Hospital, Sutton, United Kingdom, agrees that these findings strengthen the evidence and send "2 clear messages for current clinical practice."
First off, he writes, is that it offers confirmation that neoadjuvant ADT "significantly reduces mortality after radiotherapy for high-risk prostate cancer, and is a standard of care."
The second point is that it helps to" resolve the uncertainty" regarding the duration of this therapy, and strongly suggests that the duration should be at least 6 months, he notes.
Six Months Superior to 3 Months
The TROG 96.01 study compared radiotherapy alone with 3 or 6 months of neoadjuvant ADT, which was given before and during radiation therapy. In their paper, the authors report, from the 10-year data, the benefits derived from 3 months and 6 months of neoadjuvant ADT.
Their analysis involved 802 men with stage T2b, T2c, T3, and T4 N0M0 prostate cancers. They were randomly assigned to receive radiotherapy alone (n = 270), 3 months of neoadjuvant ADT plus radiotherapy (n = 265), or 6 months of neoadjuvant ADT plus radiotherapy (n = 267).
At 10 years, prostate-cancer-specific mortality was 22% for radiotherapy alone, 18.9% for 3 months of neoadjuvant therapy (hazard ratio [HR], 0.86; P = .398), and 11.4% for 6 months of neoadjuvant ADT (HR, 0.49; P = .0008).
For all-cause mortality at 10 years, the findings were similar: 42.5% for radiotherapy alone, 36.7% for 3 months of neoadjuvant ADT (HR, 0.84; P = .18), and 29.2% for 6 months of neoadjuvant ADT (HR, 0.63; P = .0008).
Conversely, the cumulative incidence of deaths at 10 years not related to prostate cancer were similar in all treatment groups: 20.4% for radiotherapy alone, 17.7% for 3 months of neoadjuvant ADT, and 17.8% for 6 months of neoadjuvant ADT (P > .40 for all paired comparisons).
During the course of the study, 16,562 PSA levels were obtained from the 802 men; the median number of PSA levels per patient was 21 (range, 1 to 43).
Progression of PSA was observed in 508 men. At 10 years, the cumulative incidence of PSA progression was 73.8% for radiotherapy alone, 60.4% for 3 months of neoadjuvant ADT (HR, 0.72; P = .003), and 52.3% for 6 months of neoadjuvant ADT (HR, 0.57; P < .0001).
Progression of the primary tumor was found in 179 men, and progression at distant sites was found in 226 men. The 10-year cumulative incidence of local progression as a first event was 28.2% for radiotherapy alone, 15.7% for 3 months of neoadjuvant ADT (HR, 0.49; P = .0005), and 13.3% for 6 months of neoadjuvant ADT (HR, 0.45; P < .0001).
More Data to Come
The authors note that data from the RTOG 92.02 study showed that patients with high Gleason scores received the most benefit from prolonged ADT, raising the possibility that "the morbidity of long-term androgen deprivation can be restricted to men with the highest risk of progression."
Although subgroup analyses of prostate-cancer-specific mortality data in TROG 96.01 did not support this hypothesis, the authors explain that the interpretation of the trial's pathology data is limited by lack of a centralized histopathologic review.
"We hope that this trial's successor, TROG 03.04 RADAR34 — which investigates adding 12 months of adjuvant ADT, with or without 18 months of zoledronate, to 6-month neoadjuvant ADT and radiotherapy — can help resolve this possibility," they write.
The study was funded by Australian Government National Health, the Medical Research Council, Hunter Medical Research Institute, AstraZeneca, and Schering-Plough. The authors and the editorialist have disclosed no relevant financial relationships.

6 Tips to Improve Hospital Employee Engagement

Memorial Health System in Springfield, Ill., embarked on a journey several years ago to improve its employee engagement. In a 2004 survey of employees at Memorial Medical Center (the health system’s flagship hospital), employee engagement scored in the 30th percentile nationally. As a result, making Memorial Health System "a great to place work" was established as one of the health system’s three strategies. Over the next five years, the system steadily improved in this area, and in 2010, the hospital scored in the 94th percentile for employee satisfaction. The system has been named an "Employer of Choice" for three years, and its affiliate, Memorial Physician Services, earned the award twice before the system applied as a whole. Brad Warren, senior vice president and chief people officer, and Brian Tieman, system director, employee relations, say making engagement an organizational imperative was a key driver in the system's success. Here they share six tactics for other hospitals looking to improve their employee engagement.

1. Make engagement part of your hospital's core strategy. Employee engagement directly impacts a hospital's success, and as such, it should be part of a hospital's overall strategy — not just a task assigned to the human resources department. “Engagement is critical in any service-oriented business,” says Mr. Warren. "We believe great patient care and service is best delivered by employees who are engaged and passionate about our mission," he says.

2. Gain support from senior leadership. Senior leaders must show their commitment to improving engagement in order for improvements to take hold. "No one will believe engagement is a priority unless [the senior leadership team], takes engagement very seriously and displays that level of engagement by modeling the way," says Mr. Warren.

Buy-in from leadership throughout the health system should come naturally. "The only way for Memorial Health System to fulfill its mission to improve the health of the people and communities we serve is to have the unfailing support of employees and their understanding of how their work supports our mission, vision and strategic goals,” he adds. “That level of support will require the highest levels of employee engagement."

3. Hold managers accountable. Senior leaders can best demonstrate their commitment to engagement by holding the leaders who are their direct reports accountable for improving engagement scores and encouraging those leaders to do the same for those who report to them. "Senior leaders need to be actively involved in ensuring a sense of accountability to the teams under their direction," says Mr. Warren. "Without this, we could become complacent."

At Memorial Health System, every department supervisor, manager or director across all affiliates meets with his or her leader to go over employee survey results and develop an action plan to address any deficiencies in the department. "We have made changes in staffing if results did not improve," says Mr. Warren.

4. Provide training. If hospitals plan to hold supervisors accountable for improving engagement, they should offer training to enhance supervisors' skills in this area.

Memorial Health System holds training sessions it cleverly calls "Great Place to Workshops," which are open to any supervisor within the organization. These sessions, offer supervisors training on leadership and provide management tools and techniques. The health system also holds a special workshop each year solely focused on helping mangers interpret employee survey results and develop action plans around them, says Mr. Warren.

The system also demonstrated its commitment to training by adding an organization development division within its human resources department. These specialists work one-on-one with managers of lower-scoring departments to develop action plans to improve engagement. They also staff open "survey labs" where managers can drop by for help interpreting survey results, developing action plans and tracking improvement progress.

5. Share best practices. Hospital leaders should also facilitate the sharing of best practices to improve employee engagement. Memorial Health System holds workshops that give managers the opportunity to share best practices for survey participation and engagement and has created best practice tip sheets featuring some of the most popular ideas. The system also invites managers of departments that have experienced significant improvements to speak and answer questions about their successes at the Great Place to Workshops.

"Having our own managers share their best practices is very well received," says Mr. Tieman. "Employees enjoy hearing success stories from their colleagues, not just, for example, by a best-selling author."

Examples of the best practices include rewarding departments that meet survey participation goals with a free luncheon or other activity, holding regular department themed events to encourage camaraderie and sending employees birthday cards in the mail thanking them for their hard work throughout the year.

However, the most successful best practice the health system uncovered seems to be one of the simplest — involving all employees, not just managers, in engagement efforts. Some departments have "green teams" — teams of employees that work throughout the year to encourage survey participation and move survey scores from the red levels that require improvement to performance that reflects attributes of an engaged workforce.

"Ultimately what has made a difference in our engagement journey is that it has been a collective effort between employees and leaders, not leaders doing it alone," says Mr. Tieman. "Yes, the manager is the leader, but every employee is part of the solution."

6. Focus on employee relationships with front-line supervisors. Memorial Health has placed extra emphasis on improving employees' relationships with their front-line supervisors in response to research suggesting this is one of the most crucial links to engagement.

Improving that relationship involves training supervisors to be more open and supportive with employees. Memorial Health System has had significant success in this area. In 2010, 83 percent of staff at Memorial said they agreed with the statement "My manager or immediate supervisor is receptive to staff suggestions," up from 41 percent in 2006.

Another key responsibility of front line supervisors is helping employees understand how their role supports the organization's mission, vision and goals. "The more information we can provide on how the work of all employees in all professions and walks in life impacts our success, the more success we'll have," says Mr. Warren.

Supervisors should not only model passion for their job but also help employees develop passion for their work through giving it meaning. "Part of the role of the supervisor is to connect our vision and mission to the work employees under their direction do every day," he says. "This is something that really can only be done through a personal relationship."

Mr. Warren adds, "’Value of employees’ is one of our seven organizational values. That tells you how critical we view employee engagement to be to our success. Buildings are important, standards are critical…but the best strategy for creating great patient experiences and delivering high-quality, patient-centered care is through the hands and hearts of engaged people."

Source http://www.beckershospitalreview.com/hospital-financial-and-business-news/6-tips-to-improve-hospital-employee-engagement.html

Tips For Lowering Cholesterol Naturally

There are many tools for lowering cholesterol naturally that you may want to consider if you have high cholesterol. Many people go on crash diets or change all sorts of things about their lives, taking drastic measures to lower their cholesterol.

You do not need to do any of these things to lower your cholesterol, however. Using natural products, changing your lifestyle gradually and introducing healthier foods are some of the best ways of lowering cholesterol naturally.

Cholesterol is a type of fat made by your liver. Some of that fat comes from the food you eat, while some of it is already in your body. All of the foods that come from animals have some form of cholesterol in them, whereas plant foods do not have cholesterol in them. Foods that are high in saturated fats can raise your cholesterol level considerably, so having a balanced diet is really the best way to approach the cholesterol situation.

Not all cholesterol is bad for you, however. Some cholesterol is necessary for good health, but too much of it can raise your blood pressure and make medical problems such as heart attacks or strokes more common. When you have extra cholesterol in your blood, it causes your arteries to narrow as they become clogged. This may even lead to the artery becoming completely blocked with cholesterol.

Using Natural Products to Lower Cholesterol

Lowering cholesterol naturally using natural products is one of the best ways to accomplish your goal. Remember that herbal treatments and other natural remedies have been around a lot longer than the conventional pharmaceutical treatments you are likely to find at your drug store.

Herbal treatments come from trees, plants and other natural sources, meaning that you must be careful about what you are taking. Herbal treatments typically are not regulated, so it really is a “use at your own risk” situation.

Many natural products seem to reduce cholesterol. The Food and Drug Administration (FDA) regulates natural herbal products, but much of the investigation into the products is not completed to the same high level as conventional medicines. Therefore, it is important to be careful when you are considering herbal treatments of any kind. Always consult your doctor before trying anything new when lowering cholesterol naturally.

The following products have been recognized for their effectiveness in lowering cholesterol:

- Garlic

- B vitamins

- Soy

- Fiber

- Chromium

- Grape seed extract

- Vitamin C

- Pantothine

There are many other natural products and herbal remedies that may assist in lowering cholesterol, so consult your doctor or locate a good herbalist for more information. You want to be careful when it comes to combining cholesterol medication and natural remedies, as some of the side effects may clash.

Making Lifestyle Changes

There are many things you can do to help lower cholesterol naturally and changing the way you choose to live your life is one of them. You may have to make lifestyle changes to lower your cholesterol levels and start putting yourself back on the road to health, but do not despair. Making some minor lifestyle changes is not very difficult and, in fact, many of the changes you make will benefit you in other areas of your life. With lower cholesterol, you will start feeling more energetic and you will have more vitality.

Exercise – this is probably the most important thing you can do to lower your cholesterol levels and keep them down. Try getting moderate exercise a few times a week (about 30 minutes a day for a few days a week). Ease yourself into a program and get your body moving, but take it easy. You don't need to run for miles or do thousands of weight lifting exercising in order to stave off the effects of high cholesterol. You just need to get active and start introducing your body to other forms of exercise beyond reaching for the remote control.

Quit smoking – this is arguably the second most important thing you can do. If you don't smoke, don't start. If you do, quit. Smoking actually lowers the level of good cholesterol in your blood, making it a lot harder to fight off the bad cholesterol. It also creates a higher risk of heart disease and can really zap the energy in your lungs. You can bring down your cholesterol and drastically lower your risk of heart disease if you quit smoking now, so what's stopping you?

Watch what you eat – eating a proper diet is not that complicated, especially when it comes to lowering your cholesterol. You will want to maintain a healthy balance in your diet, but you should also integrate a lot more fruits and vegetables. Remember that fruits and vegetables are low in calories and fat, so that will help out a great deal with your goal. Also cut down on your consumption of saturated fats, as these typically are not good for your diet. Use whole grains as much as possible and eat plenty of natural fiber products.

Keep your stress down – keep a lid on your anger and other emotions that you feel physically. You will want to try to find time in your day to de-stress from work properly without turning to destructive devices like drinking or smoking. Getting proper exercise is a great way to blow off steam, so try going for a quick run next time you feel angry. Part of lowering cholesterol in a natural way includes keeping your body away from harmful reactions such as stress because stress puts a strain on your system and can contribute to heart problems.

Dietary Changes

As we touched upon briefly, making some dietary changes is a good idea when it comes to lowering cholesterol naturally. You will want to achieve the balance of lowering high cholesterol foods and increasing the level of low cholesterol foods you eat. High fiber products and foods low in saturated fats are important in a low cholesterol diet, of course, but you will also want to integrate fruits and vegetables.

There are a number of dietary options for low cholesterol out there and several hundred diet books and websites that promise to lower your cholesterol. The truth is that there is no one single plan that can help you lower your cholesterol. Instead, you will need to work with your family and your doctor to find a dietary plan that best works with your lifestyle. Here are a few pointers:

-Eat more fruits and vegetables

-Avoid trans fats and saturated fats

-Use whole grains and whole wheat products instead of standard white products, such as flour or rice

-Stay away from high levels of carbohydrates

-Use low-fat dairy products, especially skim milk, instead of conventional dairy products

-Use lean meats, such as turkey, chicken or fish, instead of red meat

-Use olive and canola oils when cooking

-Attempt to use low-fat alternatives for dips and sauces

There are a number of other dietary secrets that you can use, but these are some basics. Try to find your own way to eat healthy and keep your cholesterol levels down. If you work with your diet, you will start to find that some of the solutions to your problems are right in front of you. Making a dietary change is not that difficult, after all.

Lowering cholesterol naturally can seem like a daunting and complicated task that will transform your whole life and have you eating unbuttered whole wheat bread and water for every meal while you run laps around your block. The truth is that there are some lifestyle changes you can make to help lower your cholesterol, but the effort is worth it. Try using some natural products, make some subtle lifestyle changes and try adding some healthy foods to your diet. You will find that lowering your cholesterol does not have to be an impossible goal and that it really isn't all that hard to do!

Always Consult Your Physician First

Although it is helpful to get health information by reading and talking with friends, make sure you consult your doctor first before trying any new treatment or changing your diet. Remember that the U.S. Food and Drug Administration does not strictly regulate the strength, purity or safety of herbs and supplements. Be sure to always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, speak with your doctor before taking medical action or changing your health routine. This information is not intended to replace the advice of a doctor. LifeScript disclaims any liability for the decisions made by its readers based on the information provided.

Source http://news.peacefmonline.com/health/201103/148593.php

Simple Tips for Relieving Common Digestive Problems

Although many television viewers are bombarded with advertisements for medications that claim to relieve or prevent digestive discomfort, some recommendations from Fox News may help people control these conditions without medical intervention.

Individuals who experience uncomfortable sensations in their chest and throat after they eat may suffer from heartburn. The news organization suggested that people who have these symptoms should avoid eating in large quantities, along with fried foods and carbonated drinks.

Those who suffer from disruptive bowel activity may benefit from increasing their fiber intake. However, the news source noted that individuals who have irritable bowel syndrome should only consume fiber from natural foods, not dietary supplements. Apples, beans and citrus fruits are all healthy sources of fiber.

According to the National Institutes of Health (NIH), about 70 million Americans have digestive diseases.

Certain foods and medications may exacerbate symptoms of these disorders, so keeping track of which products cause discomfort may help people avoid future complications or identify potential allergies.

The NIH added that overweight individuals are more likely to suffer from digestive problems, but participating in regular exercise may help reduce occurrences of heartburn or bowel troubles.

Source http://www.drcutler.com/digestive-health/simple-tips-for-relieving-common-digestive-problems-800468027/

10 Health Benefits of Eggs

Some of you may have eaten eggs over the Easter weekend so I thought I'd post ten health benefits of eggs (and it doesn't count if they were chocolate eggs!)

1. Eggs are great for the eyes. According to one study, an egg a day may prevent macular degeneraton due to the carotenoid content, specifically lutein and zeaxanthin. Both nutrients are more readily available to our bodies from eggs than from other sources.

2. In another study, researchers found that people who eat eggs every day lower their risk of developing cataracts, also because of the lutein and zeaxanthin in eggs.

3. One egg contains 6 grams of high-quality protein and all 9 essential amino acids.

4. According to a study by the Harvard School of Public Health, there is no significant link between egg consumption and heart disease. In fact, according to one study, regular consumption of eggs may help prevent blood clots, stroke, and heart attacks.

5. They are a good source of choline. One egg yolk has about 300 micrograms of choline. Choline is an important nutrient that helps regulate the brain, nervous system, and cardiovascular system.

6. They contain the right kind of fat. One egg contains just 5 grams of fat and only 1.5 grams of that is saturated fat.

7. New research shows that, contrary to previous belief, moderate consumption of eggs does not have a negative impact on cholesterol. In fact, recent studies have shown that regular consumption of two eggs per day does not affect a person's lipid profile and may, in fact, improve it. Research suggests that it is saturated fat that raises cholesterol rather than dietary cholesterol.

8. Eggs are one of the only foods that contain naturally occurring vitamin D.

9. Eggs may prevent breast cancer. In one study, women who consumed at least 6 eggs per week lowered their risk of breast cancer by 44%.

10. Eggs promote healthy hair and nails because of their high sulphur content and wide array of vitamins and minerals. Many people find their hair growing faster after adding eggs to their diet, especially if they were previously deficient in foods containing sulphur or B12.

Source  http://www.healthdiaries.com/eatthis/10-health-benefits-of-eggs.html

Advantages of Eating Fish Foods / Fish Food-Advantages of Eating

Regular consumption of fish can reduce the risk of various diseases and disorders. Selected research findings indicate the following:

Asthma - children who eat fish may be less likely to develop asthma.

Brain and eyes - fish rich in omega 3 fatty acids can contribute to the health of brain tissue and the retina (the light sensitive tissue lining the inner surface of the eye).

Cancer - the omega 3 fatty acids in fish may reduce the risk of many types of cancers by 30 to 50 per cent, especially of the oral cavity, oesophagus, colon, breast, ovary and prostate.

Cardiovascular disease - eating fish every week reduces the risk of heart disease and stroke by reducing blood clots and inflammation, improving blood vessel elasticity, lowering blood pressure, lowering blood fats and boosting 'good' cholesterol

Dementia - elderly people who eat fish or seafood at least once a week may have a lower risk of developing dementia, including Alzheimer's disease.

Depression - people who regularly eat fish have a lower incidence of depression (depression is linked to low levels of omega 3 fatty acids in the brain).

Diabetes - fish may help people with diabetes manage their blood sugar levels.

Eyesight - breastfed babies of mothers who eat fish have better eyesight, perhaps due to the omega 3 fatty acids transmitted in breast milk.

Inflammatory conditions - regular fish consumption may relieve the symptoms of rheumatoid arthritis, psoriasis and autoimmune disease.

Prematurity - eating fish during pregnancy may help reduce the risk of delivering a premature baby.

Source  http://www.medindia.net/Patients/patientinfo/fishfood_health.htm

BELIMUMAB: A NEW DRUG FOR LUPUS

The US Food and Drug Administration (FDA) has approved the use of belimumab (Benlysta, Human Genome Sciences and GlaxoSmithKline) in combination with standard therapies to treat active autoantibody-positive systematic lupus erythematosus.
This is the first lupus drug to be approved since 1955, when the FDA approved hydroxychloroquine (Plaquenil) and corticosteroids. In 1948, aspirin was approved to treat lupus.
Belimumab is a B-lymphocyte stimulator protein inhibitor that is thought to decrease the amount of abnormal B cells, which is hypothesized to be a mechanism of action in lupus.
The safety and effectiveness of belimumab was demonstrated in 2 clinical trials that randomized a total of 1684 patients to receive either belimumab or placebo in combination with standard therapy. Treatment with belimumab plus standard therapy reduced disease activity and possibly decreased the number of severe flares and steroid use.
Patients with active lupus that involved the kidneys or central nervous system and those who were previously treated with a B-cell-targeted therapy or intravenous cyclophosphamide were excluded from participating in the trials.
Study participants of African American or African descent did not significantly respond to belimumab. Additional studies will be conducted to definitively determine the safety and efficacy of belimumab in this population.
Common adverse effects reported with belimumab include nausea, diarrhea, fever, and infusion-site reactions. It is suggested that patients be treated with an antihistamine prior to a belimumab infusion.
A greater number of deaths and serious infections were reported in patients treated with belimumab than in those treated with placebo. Live vaccines should not be administered during treatment with belimumab.
It is estimated that lupus afflicts up to 1.5 million Americans, and it disproportionately affects black women.

REDUCING CHEMORADIOTHERAPY SAFE FOR SOMERABDOMYOSARCOMAS

NEW YORK (Reuters Health) Mar 03 - Reducing the use of radiotherapy and eliminating cyclophosphamide has been found safe and effective in some patients with newly diagnosed, low-risk embryonal rhabdomyosarcoma (ERMS).
The findings are the latest from The Intergroup Rhabdomyosarcoma Study Group (IRSG), and were published online February 28th in the Journal of Clinical Oncology.
In previous studies the same researchers who conducted this study found that patients with localized, grossly resected, or gross residual (orbital only) ERMS had 5-year failure-free survival rates of 83% and overall survival rates of 95%. That was using specially designed protocols for low-risk patients established by the IRSG. Those regimens included vincristine and dactinomycin with or without cyclophosphamide and radiation therapy.
The aim of the present study was to see if it was feasible, in a similar cohort of patients, to decrease toxicity by reducing radiotherapy doses and eliminating cyclophosphamide in patients at lowest risk.
The researchers stratified 342 patients by risk. The lower risk group (n=264) included embryonal ectomesenchymoma or ERMS patients categorized as stage 1 group I/IIA, stage 1 group III orbit, or stage 2 group I.
The higher risk group (n=78) included patients with stage 1 group IIB/C, stage I group III nonorbit, stage 2 group II, or stage 3 group I/II ERMS.
The researchers' specific objectives were three-fold:
1. To estimate failure-free survival rates of patients in subgroup A after vincristine and dactinomycin chemotherapy for 45 weeks, plus radiation therapy for patients with residual tumor;
2. To estimate failure-free survival rates of patients in subgroup B after vincristine and dactinomycin plus cyclophosphamide for 45 weeks, plus radiation therapy for patients with residual tumors;
3. And to ascertain local control and failure-free survival rates in three selected groups of patients given radiation therapy doses 5-10 Gy lower than in previous studies: 36 Gy for stage 1 group IIA, 45 Gy for stage 1 group III N0 orbit, and 36 Gy for stages 2/3 group IIA patients.
Estimated 5-year failure-free survival rates were 89% for patients in the lower risk group, and 85% for the higher risk group, after median follow-up of 5.1 years.
For patients with stage 1 group IIA tumors (n=62), estimated 5-year failure-free survival rates were 81%. For patients with group III orbit tumors (n=77), estimated 5-year failure-free survival was 86%.
The study group says 5-year failure-free survival and overall survival were similar to that observed in IRS-III patients, including those that were treated with reduced doses of radiation. Failure-free survival and overall survival were lower, however, than comparable IRS-IV patients that received vincristine and dactinomycin plus cyclophosphamide. Five-year failure-free survival rates were similar among the lower risk and higher risk patients.
Rhabdomyosarcoma is the most common type of soft-tissue sarcoma in children. The annual incidence of the disease in the U.S. is 4.5 cases per 1 million children younger than 14 years. About 250 new cases are diagnosed each year, nearly two thirds being embryonal rhabdomyosarcomas.

A Few Natural Tips for Women

Between premenstrual syndrome (PMS) and female endocrine disorders like polycystic ovarian syndrome (PCOS), women can have it tough. But thank goodness the natural products industry in constantly evolving with new research, new discoveries and new ways to help aggravate, thwart and prevent women’s health woes.

NewsMax.com listed a few natural supplements that are good for women with PCOS’s many symptoms. The list included chaste berry for fertility, buckwheat and omega-3s for polycystic ovaries, saw palmetto for testosterone reduction, ginseng for menstrual irregularities, and biotin (a B vitamin) for improved glucose tolerance and management of insulin resistance.

On a separate note, a study published in the American Journal of Clinical Nutrition found high intake of B vitamins—specifically thiamine (vitamin B1) and riboflavin (vitamin B2) only sourced from food—significantly lowered the risk of PMS in women (Feb. 23, 2011). Researchers conducted a case-control study nested within the Nurses’ Health Study II cohort. Participants were free of PMS at baseline (1991). After 10 years of follow up, 1,057 women were confirmed as cases and 1968 were confirmed as controls. Dietary information was collected in 1991, 1995 and 1999 by using food-frequency questionnaires.

Intakes of thiamine and riboflavin from food sources were each inversely associated with incident PMS. For example, women in the highest quintile of riboflavin intake 2 to 4 years before the diagnosis year had a 35-percent lower risk of developing PMS than did those in the lowest. No significant associations between incident PMS and dietary intakes of niacin, vitamin B-6, folate and vitamin B-12 were observed. Interestingly, intake of B vitamins from supplements was not associated with a lower risk of PMS.

Which foods are rich in thiamine and riboflavin? Thiamine is found in pork and yeast, with cereal grains an important source due to their ubiquity. Other food sources include oatmeal, flax, kale, eggs and oranges. Riboflavin can be found in milk, cheese, leafy green vegetables and almonds.

Source http://www.naturalproductsmarketplace.com/news/2011/03/a-few-natural-tips-for-women.aspx

9 Tips for Saving Your Vision

If you spend two or more hours a day in front of a computer, you might suffer from computer vision syndrome (CVS). Symptoms include headache, inability to focus, burning or tired eyes, double or blurred vision, and neck and shoulder pain.

Computer screens are the culprit. Our eyes don’t process screen characters as well as they do traditional print. Printed materials have well-defined edges and screen characters don’t. Our eyes work hard to remain focused on screen characters and to temporarily relieve stress, our eyes drift and then strain to refocus. The constant muscle flexing causes fatigue. Keep in mind that computer screens aren’t the only screens that matter — most of your electronic toys, such as cell phones and PDAs, also cause eyestrain.

1.Use proper lighting

Most office settings use bright, often harsh lighting. The more light the better, right? Unfortunately, that’s not true, but the solution to harsh bright lights is simple. Knowing that the bright lights are hurting you is often the bigger problem.

If you have a window, use blinds or curtains to limit the amount of sunlight beaming in. Use lower intensity bulbs and tubes inside. If you have both, turn off the indoor lights and open your blinds or curtains until you’re comfortable.

If you’re used to working in bright light, you might feel a bit out of sorts at first. Give yourself some time to adjust to the softer lighting. If you can’t control the lighting, consider wearing tinted glasses.

2. Reduce environmental glare

Glare is reflected light that bounces off surfaces such as walls and computer screens. Often, you don’t even realize you’re compensating for it, so finding glare might take a bit of effort. There are a few things that you can do to reduce the glare:

a. Paint bright walls a darker color and use paint with a matte finish

b. Install an anti-glare screen and/or a glare hood on your monitor

c. If you wear glasses, consider applying an anti-reflective coating to the lenses.

Glare screens help only part of the problem. They cut down on glare from the computer screen. Unfortunately, they won’t help your eyes focus better.

3.Use proper computer settings

One of the simplest ways to reduce eyestrain is to adjust your monitor’s brightness and contrast settings. There’s no right or wrong setting. Just experiment until you’re comfortable.

If the background gives off a lot of light, reduce the brightness. In addition, keep the contrast between the background and characters high. Generally speaking, your settings are probably too bright, but a setting that’s too dark is just as tiring.

4. Maximize comfort by adjusting text size and color

Adjusting the on-screen text’s size and color can provide relief. First, try enlarging the text. You’re probably using the smallest size you can to view more text on the screen, but that compounds the problem. Instead, enlarge the text to two to three times the smallest size you can read.

Almost all software and most browsers will let you adjust text size. When possible, use black text on a white background. And avoid busy backgrounds. Sometimes, you have no control, but do so when you can.

5. Take a break

If you work at a computer most of the day, work in a few breaks. The National Institute of Occupational Safety and Health (NIOSH) recommends that computer workers take, at a minimum, four 5-minute breaks in addition to the customary two 15-minute breaks during the day. If you don’t take those two 15-minute breaks, take a five-minute break for every hour you sit at the computer. The American Optometric Association (AOA) recommends a 15-minute break for every two hours of computer use.

6. Clean your screen

The easiest tip of all is to clean your screen frequently. Dust, fingerprints, and other smears are distracting and make reading more difficult. Often, you don’t even see the dust; you just look right past it. Make it a habit to wipe off your screen frequently. Every morning isn’t too often and is easy to work into your routine.

7. Position copy correctly

Glancing back and forth between a printed copy and your computer screen causes eyestrain. To ease discomfort, place the printed copy as close to your monitor as possible, in addition, use a copy stand if possible to keep the copy upright.

This is the one time you might want more light. A small desk lamp will suit your needs, but position it carefully so that it sheds light on the printed page but doesn’t shine into your face or reflect off your monitor. Remember to use soft light.

8. Position yourself correctly

Keep your distance from the monitor; most people sit too close. Position your computer monitor about 20 to 24 inches from your eyes. Your screen’s center should be about 10 to 15 degrees below your eyes. This arrangement provides the best support.

If you can’t change the distance between you and the monitor, adjust the text accordingly. For instance, if you’re sitting farther away than you should, increase the text size. It’s not the best solution, but it’s better than straining to see something that’s too far away.

9. Get computer glasses

If you just can’t get relief, you might need special glasses you can wear just for working at the computer. You can’t pick these at your favorite discount store. You’ll need a prescription from an eye doctor.

Don’t depend on prescription reading glasses to negate CVS either. Reading glasses help with distances of 16 to 21 inches. In contrast, computer glasses work for distances of 18 to 28 inches. It’s unlikely that the same pair of glasses will accommodate reading printed material and working at your computer.

Source http://www.foxnews.com/health/2011/03/08/tips-saving-vision/

INTERMITTENT ANDROGEN SUPPRESSION AS EFFECTIVE AS CONTINUOUS TREATMENT FOR PROSTATE CANCER

Intergroup trial shows that intermittent androgen suppression is non-inferior to continuous androgen deprivation in men with PSA recurrence after radical therapy

In men with PSA recurrence after radical radiotherapy, intermittent androgen suppression has been suggested by phase II trials to improve quality of life (QoL) but effects on survival were unknown. In the NCIC CTG PR.7/SWOG JPR.7/CTSU JPR.7/UK intercontinental CRUKE/01/013 randomized phase III trial, investigators compared intermittent androgen suppression vs continuous androgen deprivation to test for non-inferiority with respect to overall survival.

Eligible men had rising PSA > 3.0 ng/ml more than one year after radical radiotherapy, either initial or salvage, for localized prostate cancer. Patients could receive up to 1 year of neo/adjuvant androgen deprivation therapy. Stratification factors were time since radical radiotherapy, initial PSA, prior radical prostatectomy and prior androgen deprivation therapy. Intermittent androgen suppression was delivered for 8 months in each cycle with restart when PSA reached >10 ng/ml off treatment. Primary endpoint was overall survival; secondary endpoints included time to hormone refractory state, QoL, cholesterol/HDL/LDL, duration of treatment/non-treatment intervals, time to testosterone and potency recovery. The independent Data and Safety Monitoring Committee recommended halting the trial after a planned interim analysis demonstrated that a pre-specified stopping boundary for non-inferiority was crossed.

Investigators randomized 1,386 patients, 690 to intermittent and 696 to continuous androgen deprivation. Arms were balanced for important baseline factors. Median follow up was 6.9 years. Intermittent androgen suppression patients completed a median of 2 x 8 month cycles. A total of 524 deaths were observed (268 on intermittent vs 256 on continuous androgen deprivation). Median overall survival was 8.8 vs 9.1 years on intermittent and continuous androgen deprivation arms, respectively (p=0.009). The intermittent androgen suppression arm had more disease related (122 vs 97) and fewer unrelated (134 vs 146) deaths. Time to the hormone refractory state was statistically significantly improved on the intermittent androgen suppression arm (p=0.024). Intermittent androgen suppression patients had reduced hot flashes, but otherwise there was no evidence of differences in adverse events, including myocardial events or osteoporotic fractures.

The authors, who presented results at the fourth annual Genitourinary Cancers Symposium (17-19 February 2011, Orlando, USA), concluded that in men with PSA recurrence after radical radiotherapy, intermittent androgen suppression, given as described herein, is non-inferior to continuous androgen deprivation with respect to the overall survival.

The Genitourinary Cancers Symposium was co-sponsored by the American Society of Clinical Oncology, the American Society for Radiation Oncology and the Society of Urologic Oncology.

10 Tips to Help with Improving Your Nutrition

There are so many books on nutrition and so much information on how to eat well. Hopefully these 10 tips will help sort out the best information out there and direct you towards books that focus on the type of information you truly seek about healthy eating. But there is one fact that you can not get around if you want to continuously make good decisions about what you put in your mouth. You must do meal planning.

Planning your meals is critical to a healthy eating program because it places you in fewer situations where you eat desperately. When we eat in a desperate state - we eat too much and not the right foods (primarily fast foods). Meal planning is essentially like a teacher preparing their lesson plan for the next day or upcoming week. Look ahead a day or two and figure out your schedule and when you are going to fit nutrition into your day. If you know you have a lunch date then plan for a healthy dinner and think through your lunch suggestions so you can avoid restaurants that offer too many unhealthy choices.

1. Do not skip the grocery store and learn to make 5-10 dishes that you enjoy and fit the health bill This is an essential part of meal planning.

2. Do not be intimidated by the process, embrace and look forward to the positive changes it will have on your mental focus and your performance while training.

3. The problem with high protein and fat diets like the Atkins is that it may help you to lose weight, but it sacrifices your health.

4. This program is intended to improve your overall health. This type of eating program poses problems because of its lack of carbohydrates.

5. Without carbs, the fat that you eat is broken down for fuel. This process is called ketosis, which can cause dehydration and those who take medications for hypertension.

6. Glycemic Index (GI) refers to the degree a food increases your blood sugar which can increase your weight gain. Therefore, foods with a high GI are not best for several reasons: they leave you feeling hungry, they cause food cravings and they contribute to weight gain.

7. Studies show that people who suffer from heart attacks due to a high fat diet also had very low intakes of fiber in their diet.

8. Breakfast is a critical meal because it balances out your cravings through out the day and helps to prevent hunger spells. When you do not eat breakfast, you are also more likely to crave carbs.

9. Fat is a good part of the your diet. You want higher unsaturated fats than saturated fats. A low fat diet does not satisfy the body overall. When the good fats are part of your meals, i.e. olive oil, nuts, avocado etc. is helps to make you feel full sooner than a low fat diet. It is not uncommon for more calories to be consumed by a low fat meal than a meal that is high in fiber and complex carbs - for example, sweet potatoes with butter and grilled chicken with a slice of mozzarella cheese).

10. Insulin resistance does often occur in overweight people. It is the inability of insulin to properly process fuel, fats or sugars. So a balanced diet will also increase the proper digestion and absorption of foods in the body to keep you energized and your blood chemistry balanced which affects your skin, hair, nails, ability to train efficiently, feel sleepy, grumpy etc...

Source http://www.chicagonow.com/blogs/katalin-fitness-health-driven/2011/03/10-tips-to-help-with-improving-your-nutrition.html

5 health reasons to not quit coffee

By Kerri-Ann Jennings, M.S., R.D., Associate Nutrition Editor atEatingWell Magazine

I really like coffee. The morning ritual of brewing a cup, the smell that perks me up before I take a sip and, of course, the flavor all make it my favorite beverage aside from water (water’s delicious!). As a registered dietitian and a nutrition editor for EatingWell Magazine, I know that coffee is fine in moderation. It has lots of antioxidants and is low in calories if you don’t load it up with cream and sugar. Nonetheless, I always feel slightly guilty about drinking it—you know, in a “it’s so good, it must be bad” kind of way.

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Which is why I’m always delighted to hear of new reasons that coffee is good for your health...and there are plenty! Over 18,000 studies on coffee have been published in the past few decades, revealing these benefits, many of which Joyce Hendley wrote about in the March/April issue of EatingWell Magazine:

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1. It protects your heart: Moderate coffee drinkers (1 to 3 cups/day) have lower rates of stroke than noncoffee drinkers, an effect linked to coffee’s antioxidants. Coffee has more antioxidants per serving than blueberries, making it the biggest source of antioxidants in American diets. All those antioxidants may help suppress the damaging effect of inflammation on arteries. Immediately after drinking it, coffee raises your blood pressure and heart rate, but over the long term, it actually may lower blood pressure as coffee’s antioxidants activate nitric acid, widening blood vessels.

2. It diverts diabetes: Those antioxidants (chlorogenic acid and quinides, specifically) play another role: boosting your cells’ sensitivity to insulin, which helps regulate blood sugar. In fact, people who drink 4 or more cups of coffee each day may have a lower risk of developing type 2 diabetes, according to some studies. Other studies have shown that caffeine can blunt the insulin-sensitivity boost, so if you do drink several cups a day, try mixing in decaf occasionally.

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3. Your liver loves it: OK, so the research here is limited, but it looks like the more coffee people drink, the lower their incidence of cirrhosis and other liver diseases. One analysis of nine studies found that every 2-cup increase in daily coffee intake reduced liver cancer risk by 43 percent. Again, it’s those antioxidants—chlorogenic and caffeic acids—and caffeine that might prevent liver inflammation and inhibit cancer cells.

4. It boosts your brain power: Drinking between 1 and 5 cups a day (admittedly a big range) may help reduce risk of dementia and Alzheimer’s disease, as well as Parkinson’s disease, studies suggest. Those antioxidants may ward off brain cell damage and help the neurotransmitters involved in cognitive function to work better.

5. It helps your headaches: And not just the withdrawal headaches caused by skipping your daily dose of caffeine! Studies show that 200 milligrams of caffeine—about the amount in 16 ounces of brewed coffee—provides relief from headaches, including migraines. Exactly how caffeine relieves headaches isn’t clear. But scientists do know that caffeine boosts the activity of brain cells, causing surrounding blood vessels to constrict. One theory is that this constriction helps to relieve the pressure that causes the pain, says Robert Shapiro, M.D., Ph.D., associate professor of neurology and director of the Headache Clinic at the University of Vermont Medical School.

Now, that’s not to say that coffee doesn’t have any pitfalls—it does. Some people are super-sensitive to caffeine and get jittery or anxious after drinking coffee; habitual coffee drinkers usually develop a tolerance to caffeine that eliminates this problem (but they then need the caffeine to be alert and ward off withdrawal headaches). Coffee can also disturb sleep, especially as people age. Cutting some of the caffeine and drinking it earlier in the day can curb this effect. Lastly, unfiltered coffee (like that made with a French press) can raise LDL cholesterol, so use a filter for heart health.

But if you like coffee and you can tolerate it well, enjoy it...without the guilt.

ENDOMETRIAL CANCER SURVIVAL BETTER UNDER SPECIAL CARE

Women with high-risk endometrial cancer who were treated by gynecological oncologists had significantly better survival than patients not receiving such care, but the same study found that in the United States, only about 20% of women with endometrial cancer are treated by these specialists.
The findings are published online in the Journal of Clinical Oncology.
"The survival benefit associated with care by a gynecologic oncologist may be explained by their better understanding of the disease process, resulting in more accurate staging, followed by adjuvant treatment if indicated," the authors explain. However, they and an outside commentator point out that the superior survival could be attributed to a "stage migration" effect.
Deaths Are Increasing
The study is important, say the researchers, because the number of annual deaths from endometrial cancer has doubled over the past 20 years.
As far as they are aware, it is the first large population-based study to evaluate the influence of subspecialty care on patients with endometrial cancer.
The team, led by John Chan, MD, from the University of California San Francisco, analyzed data on 18,338 women with endometrial cancer from 1988 to 2005, obtained from the Medicare and Surveillance, Epidemiology and End Results (SEER) database.
They found that 21.4% of these women received care from gynecologic oncologists.
Compared with the remaining women, the women who received care from gynecologic oncologists were older, had more lymph nodes removed, presented with more advanced cancer (stages III to IV), had higher-grade tumors, and were more likely to receive chemotherapy for advanced disease.
They were also more likely to undergo staging procedures with lymph node assessment and to receive chemotherapy.
They showed significantly better survival rates for high-risk disease.
For women with stage II to IV disease who received care from a gynecologic oncologist, 5-year disease-specific survival was 79%, compared with 73% for women who didn't receive such care (P = .001). The difference was even greater for women with advanced-stage disease (stage III to IV), where the 5-year disease-specific survival was 72%, compared with 64% (P < .001).
However, there was no difference in survival rates for women with early, stage I and grade 1 cancers. All of them had "excellent" overall survival, the researchers note, with a 5-year disease-specific survival of 95%.
"This is an important paper, as it suggests that patients with more advanced endometrial cancer who are managed by gynecologic oncologists experience a superior outcome," said Maurie Markman MD, vice president of patient care services and national director for medical oncology at Cancer Treatment Centers for America, in Philadelphia, Pennsylvania.
"However, one must be cautious in the interpretation of the data, as 'stage migration' may be playing an important role," Dr. Markman added. This would have the effect of making it appear that patients with more advanced disease have a superior outcome when managed by a gynecologic oncologist, when in fact it is possible that the process of being seen by a gynecologic oncologist and undergoing a more extensive staging procedure results in patients being upstaged (e.g., from stage I to stage II or stage II to stage III), he explained.
The authors concur. In a subset analysis, they found that after adjusting for the effect of surgical staging in women with stage III disease, care by a gynecologic oncologist was no longer associated with an improvement in survival (84.6% vs 84.4%; P = .6).
"The result of this subset analysis suggests that the effect of gynecologic oncologist care may be partially attributed to the comprehensive staging procedures and subsequent guidance to appropriate therapy for improving survival," they write.
However, for women with stage III to IV disease, the benefit of gynecologic oncologist care might be associated not only with comprehensive surgical staging, but also with cytoreduction of metastatic disease, Dr. Chan and colleagues note. They found that, in a subset of 1689 stage IV patients, care from a gynecologic oncologist improved survival from 52% to 63%, suggesting that cytoreductive surgery might play a role in the survival advantage.
Another factor that might be at play is that care by a gynecologic oncologist might be associated with better screening and early detection of other malignancies, the authors suggest. They cite a previous study (Am J Obstet Gynecol. 2008;198:86.e1-86.e8), which found that patients with endometrial cancer who were cared for by gynecologic oncologists were more likely to receive mammography and colorectal cancer screening, compared with a matched group of women with no history of cancer cared for by primary care providers.
The authors have disclosed no relevant financial relationships. Dr. Markman reports serving as a director, officer, partner, employee, advisor, consultant, or trustee for Boehringer Ingelheim Pharmaceuticals, Genentech, Amgen, Celgene, and Hana Biosciences; and a as speaker or a member of a speakers bureau for Eli Lilly.

DENOSUMAB FOR BONE METASTASES

Randomized, Double-Blind Study of Denosumab Versus Zoledronic Acid in the Treatment of Bone Metastases in Patients With Advanced Cancer (Excluding Breast and Prostate Cancer) or Multiple Myeloma.

Henry DH, Costa L, Goldwasser F, Hirsh V, Hungria V, Prausova J, Scagliotti GV, Sleeboom H, Spencer A, Vadhan-Raj S, von Moos R, Willenbacher W, Woll PJ, Wang J, Jiang Q, Jun S, Dansey R, Yeh H.

Joan Karnell Cancer Center, Philadelphia, PA; Hospital de Santa Maria and Instituto de Medicina Molecular, Lisboa, Portugal; Teaching Hospital Cochin, Paris, France; McGill University Health Centre, Montreal, Canada; Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil; University Hospital Motol, Prague, Czech Republic; University of Torino, Orbassano, Italy; HagaZiekenhuis-Leyenburg, Den Haag, the Netherlands; The Alfred Hospital, Melbourne, Australia; MD Anderson Cancer Center, Houston, TX; Kantonsspital Graubünden, Chur, Switzerland; Medical University of Innsbruck, Innsbruck, Austria; Weston Park Hospital, University of Sheffield, Sheffield, United Kingdom; and Amgen, Thousand Oaks, CA.

Abstract

PURPOSE This study compared denosumab, a fully human monoclonal anti-receptor activator of nuclear factor kappa-B ligand antibody, with zoledronic acid (ZA) for delaying or preventing skeletal-related events (SRE) in patients with advanced cancer and bone metastases (excluding breast and prostate) or myeloma. PATIENTS AND METHODS Eligible patients were randomly assigned in a double-blind, double-dummy design to receive monthly subcutaneous denosumab 120 mg (n = 886) or intravenous ZA 4 mg (dose adjusted for renal impairment; n = 890). Daily supplemental calcium and vitamin D were strongly recommended. The primary end point was time to first on-study SRE (pathologic fracture, radiation or surgery to bone, or spinal cord compression). Results Denosumab was noninferior to ZA in delaying time to first on-study SRE (hazard ratio, 0.84; 95% CI, 0.71 to 0.98; P = .0007). Although directionally favorable, denosumab was not statistically superior to ZA in delaying time to first on-study SRE (P = .03 unadjusted; P = .06 adjusted for multiplicity) or time to first-and-subsequent (multiple) SRE (rate ratio, 0.90; 95% CI, 0.77 to 1.04; P = .14). Overall survival and disease progression were similar between groups. Hypocalcemia occurred more frequently with denosumab. Osteonecrosis of the jaw occurred at similarly low rates in both groups. Acute-phase reactions after the first dose occurred more frequently with ZA, as did renal adverse events and elevations in serum creatinine based on National Cancer Institute Common Toxicity Criteria for Adverse Events grading. CONCLUSION Denosumab was noninferior (trending to superiority) to ZA in preventing or delaying first on-study SRE in patients with advanced cancer metastatic to bone or myeloma. Denosumab represents a potential novel treatment option with the convenience of subcutaneous administration and no requirement for renal monitoring or dose adjustment.