Research Roundup	Print Issue
January 27, 2009, Volume 55, No. 19

Undiagnosed Psoriasis Cases Put Lives at Risk

Armed with research concluding that psoriasis is associated with an increased risk of heart attacks and other cardiovascular conditions, Dr. Joel M. Gelfand, assistant professor of dermatology in the School of Medicine and colleagues released an editorial consensus in the American Journal of Cardiology, calling for psoriasis patients to be educated about and screened for cardiovascular risk factors. Dr. Gelfand’s latest research estimates that, in addition to the seven million Americans adults diagnosed with psoriasis, as many as 3.6 million Americans are living with active, undiagnosed psoriasis, unaware of an increased risk of cardiovascular disease and heart attacks.

In the largest study of nonhospitalized patients with psoriasis and coronary artery disease to date, where more than 130,000 patients were tracked for 5.4 years, Dr. Gelfand determined that psoriasis is an independent risk factor for a heart attack. Other research shows that hypertension, diabetes, elevated cholesterol, and obesity are also more common in patients with psoriasis than in the general population.

“Psoriasis patients, particularly those with severe disease, should be educated about their increased risk of blocked arteries and heart attacks, screened for major cardiovascular risk factors­—such as elevated blood pressure or cholesterol—and treated for modifiable cardiovascular risk factors,” recommended Dr. Gelfand. “Psoriasis patients are encouraged to make lifestyle adjustments that will improve their overall cardiovascular health.”

In a separate article, published online in the Journal of the American Academy of Dermatology, Dr. Gelfand and School of Medicine doctoral candidate Shanu Kohli Kurd, estimated that 600,000 to 3.6 million Americans are living with undiagnosed active psoriasis. A disparity was found as well—undiagnosed patients were more likely to be male, nonwhite, less educated and unmarried, compared to diagnosed patients.

“Given the serious medical conditions often associated with psoriasis, including metabolic disorders and cardiovascular disease, it is very important for people with a persistent rash to seek medical attention, especially if the rash is quite extensive,” said Dr. Gelfand.

Internet Gambling Stays Low Among Youth

Although there was a precipitous decline in 2007, card playing for money on the Internet has remained at the same low level among both high school and college-age males, according to the latest National Annenberg Survey of Youth.

Card playing for money at least once a month on the Internet among male youth remained at the same level in 2008 (3.3%) as in 2007 (2.4%). Weekly rates of gambling also did not change, going from 1.1% to 1.7%. Card playing in general remained at about the same levels for both monthly (26.0% to 25.6%) and weekly (5.0% to 4.2%) play.

“The card playing fad that we saw earlier in the decade appears to have lost its steam among young people ages 14 to 22,” said Dan Romer, director of the Annenberg Adolescent Risk Communication Institute that conducts the annual survey. In addition, the strong drop in weekly use of Internet sites following passage of the Unlawful Internet Gambling Enforcement Act (UIGEA) of 2006 appears to remain in place.

Despite the leveling off of card playing, access to Internet gambling sites remains open to those youth who are able to bypass the law by using third-party payment systems. Projected on a national basis, more than 300,000 youth in the study age range (14 to 22) gamble for money at least once a week on the Internet, and over 700,000 do so at least once a month.

New regulations under the UIGEA have recently been released by the US Treasury Department. It remains to be seen how these rules will affect access to Internet poker play in young people.

“The continued use of online gambling sites by many young people indicates that they are still risking their financial futures on poker,” added Dr. Romer. “This calls for continued efforts to educate young people about the hazards of Internet gambling.”

The relative stability of card playing did not extend to other forms of gambling. In total, other forms of gambling (sports, slots, lotteries, and horse racing) increased from 31.4% to 38.9% on a monthly basis in male youth. Nevertheless, the long-term trend in weekly gambling since the survey started has been downward, going from 20.3% in 2002 to this year’s 14.6% in males and from 9.2% to 4.4% in females.

Gambling of all kinds in young women tends to lag behind men. About 25% of young women report any gambling on a monthly basis compared to about 48% of young men. Although about 8% of young women report playing cards for money on a monthly basis.

Requirement to Forgo Cancer Treatment Causes Racial Disparities in Hospice Use

Racial disparities in end of life cancer care may be caused by a preference for continuing aggressive treatment—a decision that blocks enrollment in hospice care—according to a study by Dr. Jessica Fishman and Dr. David J. Casarett, of the School of Medicine and Veterans Affairs Center for Health Equity Research and Promotion, and colleagues.

In this study, African-American patients with cancer were less willing to give up treatment, compared to white patients. In addition, African-American patients reported greater needs for hospice services (i.e. counselor, respite care, chaplain, nurse), despite the fact that their cancer treatment preferences would exclude them from most hospice programs. The study, published online by CANCER, a peer-reviewed journal of the American Cancer Society, indicates that the eligibility criteria for hospice services should be reconsidered.

“Hospice should not require patients to give up cancer treatment in order to enroll, because this prevents those patients with the greatest need from receiving hospice care,” said Dr. Casarett. “We should determine eligibility for hospice in the same way that we determine eligibility for other medical treatments and services: based on the patient’s need.”

Breast Cancer Survivors Call for More “Survivorship Care” from Primary Care Providers

As the nation’s growing population of breast cancer survivors ages, many patients will likely develop common chronic illnesses like diabetes and heart disease, and they’ll need specialized care to balance those problems with the late effects of cancer therapies they received. They’ll also need screenings and advice about new strategies for preventing recurrences of their disease.

But many patients give low marks to the post-cancer care they receive from their primary care physicians, who generally serve as a patient’s main health care provider after they’re released from active treatment with their oncologists, according to a study from the Penn’s Abramson Cancer Center published in the Journal of Clinical Oncology.

“Getting primary care physicians involved in a comprehensive survivorship care plan is critical to delivering high quality, accessible care to diverse groups of cancer survivors,” said Dr. Jun J. Mao, the lead author of the study and assistant professor of family medicine and community health who leads integrative medicine efforts at Penn’s Abramson Cancer Center. “Currently, however, lack of communication between oncologists and primary care physicians is felt by survivors to be a major limitation of our existing system, so treatment summaries or survivorship plans may serve as important tools to bridge the communication gap and improve care delivery by primary care physicians.”

In a study of 300 breast cancer survivors cared for at the Abramson Cancer Center’s Rowan Breast Center, the researchers found that patients offered mixed reviews of the survivorship care they received from their primary care physicians. While most patients said they were happy with the general care, psychosocial support and health promotion information they received, they reported being less satisfied by their physicians’ knowledge of late effects of cancer therapies and ways to treat symptoms related to their disease or its treatment. Only 28% of patients felt that their primary care physicians and oncologists communicated well together—a partnership that the Penn researchers say will be a key way to create survivorship plans in the future.

Most patients surveyed felt that educational interventions to strengthen survivorship care in the primary care setting would be valuable, with 72% saying they felt it was important to teach themselves in order to create a cohesive care plan with both types of doctors. Seventy percent of patients endorsed the idea of developing a primary care clinic specifically for breast cancer survivors—a group that is two million strong, the largest group of all cancer survivors in the United States.

As a nationally recognized leader in the field of cancer survivorship, the Abramson Cancer Center is uniquely positioned to create models of survivorship care and tools to help cancer survivors of all kinds. Penn’s Living Well After Cancer Program, for adult and childhood cancer survivors, is a LIVESTRONG Survivorship Center of Excellence.

“Our goal is to provide optimal care and guidance to patients from diagnosis through the post-treatment survivorship period. Providers at Penn recognize that cancer patients require specialized care even as they begin new lives as survivors,” said study co-author Dr. Linda A. Jacobs, director of the Abramson Cancer Center’s LIVESTRONG Survivorship Center of Excellence.