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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Mesh implants work for bladder leakage, long-term safety unclear

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(Reuters Health) - Several different types of mesh implant surgery may be effective for treating bladder leaks, but the long-term safety and effectiveness of the procedures isn’t yet clear, a new analysis suggests.

Researchers examined data from 175 clinical trials that randomly assigned a total of 21,598 women with stress urinary incontinence to receive different types of surgical treatments.

Over the short-term, three types of surgeries appeared most effective at curing the incontinence. Two newer procedures using slings to support the bladder had cure rates of about 89% and an older abdominal surgery to suture the bladder had a cure rate of about 77%.

“With regard to surgical treatments, there is limited evidence to suggest that there is one ‘best’ option for the treatment of stress urinary incontinence. Rather there are several trade-offs and risks that women need to be aware of and consider alongside their clinician when making their treatment choice,” said study co-author Dawn Craig of Newcastle University in the UK.

“Based on our findings, the jury is still out on the long-term risks of vaginal mesh for stress urinary incontinence,” Craig said by email.

Up to half of adult women experience stress urinary incontinence, when the pelvic floor muscles are too weak to support the bladder. As a result, urine leaks during coughing, sneezing or exercise. Childbirth is a common reason for weak pelvic muscles, and obesity worsens the problem.

Surgical treatment for stress urinary incontinence has evolved over the past two decades from open abdominal operations to support the bladder with sutures to less invasive procedures that insert mesh slings instead. Recently, however, the safety of mesh implants for stress incontinence has come under scrutiny due to reports of severe complications, litigation and product withdrawals, researchers note in The BMJ.

One of the more effective mesh sling options in the study was a traditional suburethral sling, which involves placing a sling under the urethra and using one of a variety of techniques to secure it in place.

The other mesh sling option with similar effectiveness was the midurethral sling, a newer minimally-invasive procedure that enables surgeons to insert a narrow strip of synthetic mesh without the need to secure it in place.

In contrast, the older type of surgery known as an open coloposuspension requires cutting through the abdomen to reach the bladder and then using sutures to support the neck of the bladder, the group of muscles that connect the bladder to the urethra. These muscles tighten to hold urine in the bladder and relax to release urine.

Most of the available safety data was for the newer mesh sling procedures.

Mesh procedures done with one vaginal incision and two groin or thigh incisions - known as transobturator midurethral sling surgery - had more repeat surgeries and groin pain but fewer vascular complications, bladder or urethral perforations, or voiding difficulties than so-called retropubic midurethral surgery done with one vaginal incision and two abdominal incisions.

“We do not have good long-term follow up data for any of these surgeries as the trials analyzed lasted up to five years at most and mesh can cause problems many years after insertion,” said Rufus Cartwright of Oxford University Hospitals NHS Trust in the UK, who co-authored an accompanying editorial.

Some women might be able to address stress urinary incontinence without surgery, previous research has found. Lifestyle changes like avoiding caffeine, drinking small amounts of fluid, using the bathroom at scheduled times throughout the day and doing exercises that target the pelvic floor muscles can improve bladder control.

“Women should consider surgery for incontinence if their symptoms are severely affecting their quality of life, and they haven’t responded to conservative treatment (pelvic floor exercises),” Cartwright said by email. “The choice between the different procedures should be based on a process of shared decision making with the surgeon.”

SOURCE: bit.ly/31w78Jv and bit.ly/2KeSIIt The BMJ, online June 5, 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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