Listening to music may ease cancer patients' pain

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(Reuters Health) - Listening to music at home may reduce cancer patients’ pain and fatigue and ease symptoms like loss of appetite and difficulty concentrating, according to research in Taiwan.

In the study, breast cancer patients assigned to 30 minutes of music listening five times a week had “noticeably” reduced side effects of cancer and its treatment over 24 weeks, researchers report in the European Journal of Cancer Care.

The patients said the music helped their physical and psychological wellbeing because it distanced them from negative thoughts about cancer.

“Music therapy is convenient, does not involve invasive procedures, and can easily be used by people in the comfort of their homes,” said senior study author Kuei-Ru Chou of Taipei Medical University.

“Home-based music interventions can also be used with no cost,” Chou told Reuters Health by email. “Healthcare services have become expensive in the present time.”

The researchers recruited 60 breast cancer patients and randomly assigned half of them to a group that would listen to music at home on an MP3 player provided by the study team with a selection of classical, parlor, popular, Taiwanese and religious music to choose from. The other patients were also given a player and the same instructions about how often to listen, but their selections were various types of ambient music, mainly consisting of environmental sounds, which research has shown does little to reduce pain or symptoms, the study team notes.

Before the women had surgery, and after six, 12 and 24 weeks of music listening, all patients rated the severity of 25 physical symptoms on a five-point scale, as well as rating five categories of fatigue on a separate five-point scale, and the level of pain they felt on a 100-point scale.

The average symptom severity scores of the music therapy group had dropped by five points at the six-week assessment, seven points at 12 weeks and nearly nine points after 24 weeks. Pain scores and overall fatigue scores fell at each assessment as well.

For those listening to music, physical and mental fatigue had also dropped at six weeks but not later.

In contrast, pain and symptom severity scores in the control group increased and remained higher than at the start of the trial.

Based on the results, music therapy may not relieve long-term physical and mental fatigue, the study authors caution. And future studies should use objective measures of pain and fatigue, in addition to the subjective measures used in this study, Chou said.

The researchers are also interested in learning how and why music therapy reduces symptoms and pain. Because listening to music promotes endorphins, dopamine and serotonin in the brain, the chemicals may spark joy and positive emotions that distract patients from the negative emotions, the study authors speculate.

Music could affect functions of the cardiovascular, respiratory, muscular, skeletal, nervous and metabolic systems as well, relieving muscle tension and pain, they add.

“From the neurophysiological point of view,” said Tereza Alcantara-Silva of the Federal University of Goias in Brazil, music-evoked emotions can modulate activity in a variety of brain areas.

“Music plays a major role in self-regulation of emotional contexts,” said Alcantara-Silva, who wasn’t involved in the study, by email. “Music therapy can bring several benefits to cancer patients, helping them to find ways to deal with stress, fear, and loneliness.”

SOURCE: bit.ly/2Idu5cY European Journal of Cancer Care, online June 5, 2019.

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Got an antibiotic prescription from your dentist? Chances are, it might be unnecessary

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(Reuters Health) - More than three-quarters of antibiotic prescriptions written by dentists before dental procedures are unnecessary and might do more harm than good, a new U.S. study found.

Dentists write one of every ten antibiotic prescriptions in the United States, and despite national declines, antibiotic prescribing by dentists has held steady over the years, researchers wrote.

Dentists need to be included in the public health conversation regarding appropriate antibiotic use and antimicrobial resistance, lead author Katie Suda of the University of Illinois, Chicago, told Reuters Health by phone.

Antibiotics before dental procedures are recommended for a small subset of patients with certain medical conditions, to prevent a serious heart infection that might arise from the release of oral bacteria into the bloodstream during the procedures. The infection, endocarditis, is an inflammation of the lining of the heart’s chambers and valves.

To see if antibiotics are being prescribed for dental patients according to established guidelines, Suda and her team used an insurance database to analyze prescriptions written during 168,000 dental visits from 2011 to 2015.

They found that 80.9% of prescriptions for antibiotics to be taken before procedures were unnecessary.

Among the 91,438 patients in the study, only 20.9% had a cardiac condition that put them at the highest risk of developing endocarditis and warranted an antibiotic prescription.

Patients with artificial joint implants had more than double the odds of receiving unnecessary antibiotic prescriptions compared with patients who did not have the implants. This is despite the fact that the American Academy of Orthopaedic Surgeons and the American Dental Association now say people with prosthetic joint devices do not need antibiotics before dental procedures.

In particular, the antibiotic clindamycin was highly likely to be unnecessarily prescribed. Clindamycin has been linked with a severe form of diarrhea known as Clostridium difficile (C. diff). A single dose of clindamycin carries the same risk of C. diff infection as a prolonged course of the antibiotic, the researchers wrote, making it all the more alarming that clindamycin was among the overused antibiotics.

Misuse and overuse of antibiotics encourages bacteria to evolve and find ways to resist the medicines. The World Health Organization has called antibiotic resistance a global health emergency.

Why is there so much over-prescribing by dentists? Experts say dentists may face pressure from patients or patients’ cardiologists and orthopedic surgeons, who insist on antibiotics.

“Dentists feel like they are in a really tough position,” said Dr. Emily Spivak of the University of Utah School of Medicine, who wrote an editorial that was published with the study.

“They’re not physicians and they feel like they have to give (antibiotics) because they will be held accountable from the surgeon or the cardiologist if the patient gets an infection,” she told Reuters Health.

Other factors driving unnecessary prescribing may include dentists’ lack of awareness of the most recent guidelines, lack of agreement with these guidelines and the practice of ‘defensive medicine,’ experts said.

Spivak, however, believes the current study may over-inflate the numbers as it includes only commercially insured patients.

The ‘worried well’ or those who suffer from health anxiety may be driving some of this prescribing, she added.

Experts say patients should feel empowered to ask questions when their dentists prescribe antibiotics, and they shouldn’t pressure dentists to provide them with the drugs.

“An informed patient who asks questions can allow for a discussion between the dentist and the patient to truly understand whether they need an antibiotic,” Dr. Salim Virani of the Baylor College of Medicine, told Reuters Health by email.

SOURCE: bit.ly/2KdK109 and bit.ly/2R91tEt JAMA Network Open, online May 31, 2019

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Female soldiers wanting to suppress periods face barriers

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(Reuters Health) - Military women wanting to stop menstruating while they are deployed may face a number of barriers, a new commentary suggests.

The majority of surveyed military women say they would like to suppress menstruation during deployment but very few are doing so, according to the paper in Obstetrics & Gynecology that explores why more military women are not accessing that option.

One answer may be that not enough military women and their health providers even know that hormonal contraceptives used continuously will suppress menstruation.

“Women are counseled to stop taking contraceptives before deployment and that negates all the valuable health benefits, including suppression, that come with them,” said the commentary’s author, Sheena Eagan, an assistant professor at the Brody School of Medicine at East Carolina University in Greenville, North Carolina, and a specialist in military medicine ethics. “There’s a recurring theme in surveys: women want to access cycle control and they want to suppress menstruation before they are deployed.”

Unfortunately, there are many barriers blocking women’s access to menses suppression in the military, Eagan said, including the instructions to stop taking contraceptives before deployment because there is a rule against sexual intercourse while deployed. “I wanted to highlight the misconception I saw throughout the literature that equates contraceptive use with pregnancy prevention,” she said.

After reviewing the medical literature on the topic of menses suppression in the military, Eagan found that 66% to 86% of women surveyed wanted the ability to stop menstruating during deployment. In contrast, a mere 7% reported having done so.

Part of the problem may be lack of education among both the women and their health providers, Eagan said. A 2009 report found that only a third of service women had received any pre-deployment counseling on menstrual regulation and suppression. Moreover, nearly 70% of women reported that their primary healthcare providers were medics or corpsmen. Although training varies depending on the branch of service, these types of providers normally do not hold professional or graduate degrees, Eagan noted.

Eagan said she isn’t suggesting that menses suppression be mandated for all female soldiers, but “it should be part of women’s autonomous choice.”

The issues of menses regulation and control aren’t limited to military women, said Dr. Charles Ascher-Walsh, director of gynecology for the Mount Sinai Health System in New York City. “Obviously, when women are deployed it’s more convenient not to be menstruating,” he said. “But there are many women who would have the same kinds of benefits, such as when they are traveling for work.”

In general, Ascher-Walsh said, “there’s a lack of education among women and their doctors that this is a possibility - and a safe possibility. And doctors don’t offer it as much as I think they should.”

Still, the article may have made the process sound more straightforward than it sometimes is, Ascher-Walsh said. “It’s not as simple as: do this and you are guaranteed not to bleed,” he explained.

That’s because not all women will stop cycling on hormonal contraceptives, Ascher-Walsh said. With some methods, “you can end up with spotting every day and that’s worse than having your period,” he added. “So you don’t want to do it right before you are deployed since that can make it worse rather than better.”

The best option if a female soldier wants to try a method to halt menstruation is to experiment with it well before deployment, Ascher-Walsh said. Among the possible options, continuous birth control is “the most likely to stop a woman’s periods and be reliable,” Ascher-Walsh said.

SOURCE: bit.ly/2F89nsS Obstetrics & Gynecology, online June 11, 2019.

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Chronic depression after heart attack tied to increased risk of death

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(Reuters Health) - Heart attack survivors with chronic mood disorders may be more likely to die prematurely than their counterparts who don’t suffer these problems, a recent study suggests.

Patients with anxiety or depression have previously been shown to have longer hospital stays and a worse prognosis after a heart attack, researchers note in the European Journal of Preventive Cardiology. But earlier research hasn’t given doctors a clear sense of whether patients with specific types of emotional distress might put patients at greater risk for serious complications or premature death.

For the current study, researchers assessed almost 58,000 patients for emotional distress two months after a heart attack, and again at 12 months after the event. Overall, 21% of the patients reported persistent psychological problems in both assessments.

Researchers followed a majority of patients for at least 4 years. Compared to those who didn’t report any emotional distress at all, people who felt depressed or anxious at both assessments were 46% more likely to die of cardiovascular causes during the follow-up period and 54% more likely to die from other causes.

“Temporary mood swings, if they are not too frequent or dramatic, are a normal part of life,” said senior study author Erik Olsson of Uppsala University in Sweden.

“Feeling a little depressed after a heart attack might even be a good thing if it makes you withdraw a bit and get some rest,” Olsson added. “Emotional states help us regulate our behaviors.”

About 15% of the patients in the study experienced some symptoms of emotional distress two months after the heart attack that they no longer reported after one year. Their odds of dying during the study period were no different from people who didn’t have anxiety or depression at either assessment.

It’s possible that people who reported depression and anxiety at both assessments had a harder time following doctors’ orders for an ideal recovery, Olsson said by email.

“Chronic emotional distress makes it harder to adopt the lifestyle changes that improve prognosis after a heart attack,” Olsson said. “These include quitting smoking, being physically active, eating healthily, reducing stress and taking prescribed medications.”

About 11% of the patients initially reported no symptoms of emotional distress but did feel some degree of depression or anxiety after one year.

These people didn’t appear at increased risk for dying of cardiovascular causes during the study period compared with patients reporting no emotional distress, but did have a 46% greater risk of dying from other causes.

These people may have had distress that wasn’t directly related to their heart attack, Olsson said. Instead, they might have experienced depression or anxiety due to other risk factors for mood disorders like poverty, limited education or lack of a spouse or job.

The study wasn’t a controlled experiment designed to prove whether or how mood disorders might directly hasten death after a heart attack.

It’s also possible that some people in the study had undiagnosed depression or anxiety prior to the heart attack that influenced their survival odds, the study authors note.

Researchers also looked at depression and anxiety combined, making it impossible to identify any differences in how each of these conditions might independently impact survival after a heart attack.

It’s also unclear whether treating depression or anxiety could impact outcomes, said Dr. Robert Carney of Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri, who wrote an accompanying editorial.

“We do not know for certain whether treating depression or anxiety improves survival, but there is some evidence that it probably does,” Carney said by email. “At the very least, being free of depression and anxiety improves quality of life.”

SOURCE: bit.ly/2XJOo6Y and bit.ly/2IcxqJg European Journal of Preventive Cardiology, online June 3, 2019.

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Traumatic injuries linked to later social dysfunction

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(Reuters Health) - Nearly half of trauma patients, even those without brain injuries, experience social deficits that make it harder for them to interact with friends and stay involved in the community, a recent study suggests.

Traumatic brain injuries have long been linked to an increased risk of a wide range of short-term and long-term physical and mental health problems that can dramatically reduce quality of life, researchers note in the journal Surgery. But doctors don’t yet have a clear picture of what type of social impairments may follow other types of traumatic injuries.

“Social functioning is considered a critical determinant of quality of life,” said lead study author Dr. Juan Herrera-Escobar of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Broadly speaking, social function includes the ability to participate in organized and informal activities with friends, relatives, and people in the community or the workplace. Serious injuries can lead to physical and emotional issues that contribute to social deficits, and long hospital stays that keep patients away from their daily routines for weeks on end can make matters worse.

For the current study, researchers followed 805 adults hospitalized for moderate to severe traumatic injuries. During the year after the injury, 364 of them, or 45%, reported experiencing social dysfunction.

In the study, researchers assessed social function 6 months and 12 months after injuries. Each time, they asked patients how often physical or emotional challenges interfered with social activities in the previous four weeks.

Compared to patients who reported no social dysfunction, those who did tended to be younger and were more likely to be African American and have no more than a high school education. Patients with social dysfunction were also more likely to have had longer hospital stays, required mechanical ventilation in the hospital and have previous psychiatric illness.

People with a history of a major psychiatric illness, for example, were almost three times more likely to experience social dysfunction. Low education, meanwhile, more than doubled the risk of social dysfunction.

In addition, people with social dysfunction were over 16 times more likely to have post-traumatic stress disorder (PTSD) than those without social dysfunction, and about five and a half times more likely to have not returned to work after their accident.

It’s possible that people with lots of social support from family and friends or from patient support groups might have fewer challenges with social dysfunction after their injuries, Herrera-Escobar said by email.

“A strong family environment fosters resilience, which has been associated with better long-term outcomes after trauma,” Herrera-Escobar added. “We also believe that getting appropriate and timely treatments (rehabilitation, mental health services, etc.) for physical and mental health conditions can also help improve their social outcomes.”

The study lacked data on social functioning before patients’ injuries, and it’s possible that some people had impairments beforehand, the study team notes.

Even so, the results underscore the importance of considering social function in trauma care from the start instead of waiting to address this until after patients go home from the hospital, said Dr. Tim Platts-Mills, an emergency medicine researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.

Pain management and treating people for depression, PTSD and other psychiatric issues may help minimize the social dysfunction, Platt-Mills said by email.

“The best approach is not to wait six weeks and then conclude that there is a problem,” Platt-Mills said. “A better approach is to work with the patient’s clinical team to try to address these problems early on.”

SOURCE: bit.ly/2Xb9NsA Surgery, online May 17, 2019.

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