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Food as medicine compared to statins for terminally-ill patients

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When people are in the late stages of a terminal illness and still on drugs that won't see benefits for years, drugs unrelated to their particular terminal illness, drugs that cost a lot of money, may have unwanted side effects, and usually unwanted if a change in diet can achieve similar results, do they finally feel they're free at last to use food as medicine for possible healing purposes, or do they conclude that they're not getting enough treatments? People in the late stages of cancer and other terminal illnesses are not only unharmed by discontinuing statins for cholesterol management, they may benefit, according to a research presentation, "Managing comorbidities in oncology: A multisite randomized controlled trial of continuing versus discontinuing statins in the setting of life-limiting illness. | 2014 ASCO Annual Meeting Abstracts," on May 30, 2014 by researchers at Duke University Medicine representing a national research network.

People in the late stages of cancer and other terminal illnesses are not only unharmed by discontinuing statins for cholesterol management, they may benefit, according to a study presented on May 30, 2014 at the ASCO 50th Annual Meeting by researchers at Duke University Medicine representing a national research network. ASCO is the American Society of Clinical Oncology.

The finding addresses a thorny question in treating people with life-limiting illnesses: When, if ever, is it appropriate to discontinue medications prescribed for other conditions that will likely not lead to their death?

In an analysis presented at the American Society of Clinical Oncology annual meeting in Chicago, the researchers reported that discontinuing statins in patients with advanced illnesses resulted in improved overall quality of life, lower costs and no increased deaths. In fact, the patients who stopped taking statins appeared to live slightly longer.

"When you look at the number of medications people take when they are dying, it doubles in the last year of life," said lead author Amy Abernethy, M.D., Ph.D., according to the May 30, 2014 news release, "Stopping statins may benefit terminally ill patients." Abernethy is the director of the Center for Learning Health Care at the Duke Clinical Research Institute and a member of the Duke Cancer Institute. Abernethy represented the Palliative Care Research Cooperative Group, a national research network focused on improving care for people with serious illnesses.

"Cancer patients, for example, take medications for pain, nausea and other problems associated with advanced disease," Abernethy said, according to the news release. "Many don't have an appetite, and simply swallowing medications can be a problem. So the issue is whether some longstanding medications such as cholesterol-lowering drugs might be safely discontinued, but there has been little research to help guide clinicians in making that recommendation."

Abernethy said the researchers identified statins as a good candidate to explore the issue, because the drug is widely prescribed and benefits can take years to accrue

Other drugs the researchers could eventually study include medications for blood pressure and blood clots. In their study of statins, Abernethy and colleagues enrolled 381 patients who faced the likelihood of dying within a year. All patients had been taking statins for at least three months; roughly half were randomized to continue taking the drug, the other half to discontinuing it.

The researchers followed the patients for up to a year to monitor survival, cardiovascular events and changes in quality of life. Among the 192 study patients who continued statins, the median survival was 190 days; the 192 participants who stopped taking the drugs had a median survival of 229 days.

Those who discontinued the drugs reported a better overall quality of life, particularly in their psychological wellbeing, and saved money: $716 per person over the course of the trial for name-brand drugs, and $629 for generics

Using U.S. population estimates, the researchers reported that as much as $603 million a year could be saved if patients in the late stages of fatal illnesses were to cut out statins. "This is a decision that needs to be discussed between patients and their doctors; it's not something that should be done independently or in a one-size-fits-all manner," Abernethy said, according to the news release. "But our study found that patients who discontinued statins reported improvements in quality of life. This runs counter to the idea that discontinuing a treatment would cause people to somehow feel as if they were getting less care or inadequate care."

Palliative care means extra support

Abernethy is a leading advocate for extending palliative care -- extra support from care teams to relieve both pain and improve quality of life -- to patients facing life-limiting illnesses. She said findings from this study should force new discussions.

"These are conversations that need to be had," she said, according to the news release. "This brings us to a new era of asking how to right-size care, and how to bring evidence to that issue. There is an important message here that taking things away isn't always bad."

In addition to Abernethy, study authors include Don Taylor at Duke, along with Jean Kutner, Diane Fairclough and Patrick J. Blatchford at the University of Colorado; Laura Hanson at the University of North Carolina; Christine Ritchie at the University of California, San Francisco; and Janet Bull, Four Seasons. The National Institute of Nursing Research provided funding for the study (UC4-NR012584, U24-NR014637). For further information, check out the abstract of the presentation, "Managing comorbidities in oncology: A multisite randomized controlled trial of continuing versus discontinuing statins in the setting of life-limiting illness. | 2014 ASCO Annual Meeting Abstracts."

For people predicted to live less than a year, why continue drugs for chronic illnesses that take years to progress, such as statins to lower cholesterol, blood thinners, or similar drugs not specifically related to treating the illness that's causing the person to be terminal? The answer may lie in making the drug manufacturers richer rather than suggesting a change in diet, fixing a nutrition issue if the food essence is not being absorbed, or suggesting activities to improve the quality of life for the person terminally ill?

It's noteworthy that patients who did stop their statins, according to the research, lived somewhat longer. It's also noteworthy that nothing is mentioned about any nutritional changes, such as denser nutrition, as many terminally ill patients have little or no appetite, often due to the type of medicines they take specifically for their terminal illness, as compared to chronic progressive health issues such as measuring cholesterol levels in a terminally-ill patient. How few doctors not practicing functional/integrative medicine are even aware of which dietary changes, plant extracts, and other such dietary approaches have what type of effects on patients or what nutrients have helped in various validated studies of food as medicine. You may wish to see the UC Health article "Food as medicine."

That article says the Center for Health and Nutrition Research (CHNR) at UC Davis received $6.4 million from the Vitamin Case Consumer Settlement fund, which was used to fund 33 research projects. Several are published in a special issue of California Agriculture, “Food as medicine: Can what we eat help cure what ails us?” To read the articles and issue in full, go to this site.

It's noteworthy how few doctors working with terminally ill patients focus on micronutrients rather than prescription drugs such as statins or blood thinners. There's a whole world of nutrition articles that doctors can share with patients. For example, CHNR pilot projects focused on how micronutrients, biofactors and phytochemicals can help reduce the risk of chronic diseases.

How many doctors talk to their patients about the omega-3 fatty acids in foods such as walnuts, flax seeds and salmon? Some do, but when it comes to the situation with terminally ill patients, the family and the patient may not be told which foods may protect against a range of diseases associated with inflammation, including asthma and the hypertension-related inflammation that can damage kidneys or what foods have anti-cancer properties. Read more.

On the other hand, if a patient is terminally ill, the remaining days should be spent focusing on quality of life and pain control. Then again, there's another issue, the impact of hope and dietary changes on anyone's health. You also may wish to see, "Anti-Cancer Diet - pH Balance - Chi Machine International." Or check, out, "Survivor Stories | Cancer Defeated." Patients want to know whether food changes can help.

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