Apps for Doctors Treating Mesothelioma Patients Offer Quick Access to Critical Information

By Nancy Meredith

Physicians are known for keeping long hours and for being on call and available to their hospital, their patients, and even their families. In the past, that meant dropping whatever they were doing to immediately head to the hospital for a consultation. However, in this day of Wi-Fi, smartphones and iPhones, doctors can use the technology to stay where they are and access critical medical information including patient records, patient monitoring systems and key medical reference material. The use of mobile phone apps is making a difference in the ability of physicians to be responsive, and can be extremely beneficial for oncologists maintaining watch over their critically ill patients with mesothelioma, lung cancer or other cancers.

Mesothelioma is an asbestos-caused cancer that is highly aggressive and is resistant to standard cancer treatments. As a result, patients are often closely monitored to allow their oncologist to quickly change treatments to prevent the disease from progressing to causing life-threatening complications. Since the doctor cannot always be near the patient or the hospital, a phone app with a patient monitoring capability is the next best thing.

Doctors Readily Adopt the New Technology

In a study by Manhattan Research, the authors found that seventy-five percent of U.S. physicians own some form of Apple device, and that they are quickly embracing the technology for use in their practice. “Physicians also express strong interest in being able to access electronic medical records through the iPad – as more EMR [electronic medical record] providers offer this ability, iPad accessibility may be a deciding factor for some practices when selecting an EMR provider,” said Meredith Ressi, president of Manhattan Research.

The ability to use mobile devices in their profession to assist their patients and colleagues has spawned a plethora of apps. In fact, over 6,000 medical apps are available today, according to Dr. Itifat Hussain, founder of iMedicalapps.com. Apps exist for patient support, educational purposes, drug references, to use as medical calculators and even to translate medical terms to foreign languages. While not all of them are useful or practical for physicians, it is important that physicians stay aware of the latest offerings.

Apps Provide Help to the Oncologist

As support to the “untethered physician,” Hussain and his team of physicians and medical students provide commentary and reviews of mobile medical technology and applications on iMedicalapps.com. The top app they recommend is from MedScape.

The app is critical for physicians treating mesothelioma patients to stay abreast of the latest clinical information, to learn more about the disease from key medical articles and to use the “powerful drug interaction checker” to help prevent patient toxicity. With the number of medicines a mesothelioma patient often takes, a pocket drug reference guide can allow the doctor to make quick decisions should an issue arise.

Some apps specific to oncology and useful for mesothelioma patients and their physicians, listed on iMedicalApps.com, include:

Cancer.net – this app is for the cancer patient and offers reference material and the ability to store questions, as well as suggesting questions for the patient to ask.
Mobile MIM viewer – the first FDA approved mobile DICOM (CT & MRI) images viewer.
Mobile mini NMR (nuclear magnetic resonance) device – operated by a smart phone to detect cancer cells in under one hour (from Harvard and MIT researchers).
Cancer Trials App – oncologists can find information on cancer clinical trials that could be relevant to their patients.

9/11 Health Care Bill Reopens Victims' Compensation Fund

FDNY Retirements Jump Since 9/11

The number of New York firefighters who have taken disability retirement has increased sharply since the terrorist attacks of Sept. 11, 2001, New York researchers report.

In a new online article in the American Journal of Industrial Medicine, researchers at the Albert Einstein College of Medicine in Bronx, New York and New York University analyzed the increased proportion of service-connected accidental disability retirements on the Fire Department of New York pension system.

In the seven years before 9/11, 48 percent of the 3,261 New York firefighters who retired took accidental disability retirements. In seven years after 9/11, 4,502 firefighters retired and 66 percent were accidental disability retirements, nearly half of which were related to injuries or illness from the World Trade Center attacks.

The researchers said that the increase in accidental disability retirements was for the most part due to respiratory-related illnesses. Firefighters have an increased risk of exposure to airborne hazards. Additional increases were attributed to psychological-related illnesses and musculoskeletal injuries from the World Trade Center.

The researchers concluded that the 9/11 attacks affected the health of the FDNY firefighters leading to more retirements than expected and a larger proportion of retirees claiming accidental disability pensions. Pension benefits associated with World Trade Center accidental disability retirements have increased the financial burden on the FDNY pension system by $826 million.

Researchers at the Mount Sinai Medical Center in New York recently reported in the American Journal of Industrial Medicine that NY emergency personnel who responded after the World Trade Center terrorist attacks have shown an increased incidence of pulmonary inflammation. More than 50,000 men and women were exposed to products of combustion, asbestos and particulate matter after the September 11 2001 terrorist attacks.

A previous medical study published last year in the New England Journal of Medicine reported that New York firefighters who worked at Ground Zero still have significantly abnormal lung function nearly a decade later. Some dust from the collapsed World Trade Center towers contained asbestos and other toxics, according to the U.S. Environmental Protection Agency.

In December, Congress provided $1.4 billion over five years for ongoing monitoring and treatment of illnesses stemming from exposure to toxic dust and debris after the 9/11 attacks. Over time, the monitoring program may help define what qualifies as a 9/11-related illness. Several groups are currently conducting studies of cancer deaths among ground zero workers.

Some dust from the World Trade Center destruction contained asbestos and other contaminants, according to the Environmental Protection Agency. Inhaling airborne asbestos is closely associated with respiratory disease including lung cancer and mesothelioma, a cancer of the lining of the lung. Symptoms of mesothelioma typically take 20 to 40 years to appear after exposure to asbestos.

NYC Responders Show Pulmonary Disease

New York emergency personnel who responded after the World Trade Center attacks have shown an increased incidence of chronic pulmonary inflammation, researchers at Mt. Sinai reported in a recent clinical study. More than 50,000 men and women were exposed to products of combustion, asbestos and particulate matter after the terrorist attacks on September 11, 2001.

Mount Sinai researchers studied the medical records of almost 20,000 New York firefighters and emergency responders as part of a World Trade Center Monitoring and Treatment Program. The research, published in 2011 in the American Journal of Industrial Medicine, revealed an elevated number of cases of a pulmonary condition called sarcoid like granulomatous pulmonary disease. The average yearly occurrence of the disease among first responders more than tripled from 15 cases per 100,000 in health screenings before Sept. 11, 2001 to 54 cases per 100,000 in 2003 and 2004 —the peak years, according to the new study. Two other studies have reported similar findings.

Sarcoid Like Granulomatous Pulmonary Disease causes inflammation in one or more organs including the lungs and lymph nodes. Granulomas are small tumor-like nodules in the lungs, lymph glands, liver and salivary glands. Granuloma formation may lead to scarring of the lung, known as fibrosis. The cause of the disease is unknown, but it has been linked to multiple environmental and occupational exposures. A portion of those who develop the disease may suffer permanent lung damage.

“Our findings support the hypothesis that environmental exposures generated by the destruction of the World Trade Center may cause ‘Sarcoid like’ Granulomatous Pulmonary Disease,” said Laura Crowley, assistant professor of preventive medicine at Mount Sinai School of Medicine in a press release.

Some research has shown an association between sarcoid like granulomas, sarcoidosis and cancer, but exactly how they are associated remains unclear.

Crowley said monitoring of World Trade Center responders including periodic chest x-rays, must continue so that the NY responders health issues are identified and treated in the early stages.

Philip Landrigan, MD, chair of the Department of Preventive Medicine at the Mount Sinai School of Medicine, said the results of the study clearly support the critical need for ongoing monitoring and treatment for WTC responders.

A medical study published last year in the New England Journal of Medicine reported that New York firefighters and rescue workers who worked at Ground Zero after the 9/11 terrorist attacks still have significantly abnormal lung function years later. Some dust from the World Trade Center destruction contained asbestos and other contaminants, according to the Environmental Protection Agency. Inhaling airborne asbestos is closely associated with respiratory disease including lung cancer and mesothelioma, a cancer of the lining of the lung. Symptoms of mesothelioma typically take 20 to 40 years to appear after exposure to asbestos.

Blocking Cell Proteins That Fuel Mesothelioma

Conventional chemotherapy, radiation treatments and surgery have shown only limited effectiveness in improving the survival of patients with mesothelioma, a malignant cancer caused by asbestos exposure. Patients typically die within a year of diagnosis because mesothelioma is notoriously resistant to chemotherapy and other treatments. A better understanding of the biology of mesothelioma, which produces tumors in the lining of the lung or abdomen, may prove helpful in identifying targets for new therapies. In a January 2011 article in the journal Neoplasia, researchers at Harvard Medical School and Brigham and Women’s Hospital in Boston discuss their cancer research and efforts to “switch off” proteins that contribute to growth of malignant mesothelioma cells. The occurrence of pleural mesothelioma has increased in the United States and abroad since 1970, reflecting the heavy consumption of asbestos starting around World War II. About 3,000 people a year die of mesothelioma in the U.S. Some studies have suggested that certain cell surface proteins—known as Receptor Tyrosin Kinases—are involved in the complex transformation of normal cells into cancer cells in many types of human cancer, including apparently mesothelioma. But it’s still unclear whether the cancer cell transformation depends on a single kinase protein or multiple kinases. The researchers say that blocking tyrosine kinases has proven effective for treating certain human cancers including breast cancer, gastrointestinal tumors, leukemia and non-small cell lung cancer. But therapies targeting tyrosine kinases have not produced notable successes in treating mesothelioma. The researchers cultured 10 lines of mesothelioma cells. The mesothelioma cells showed coordinated expression of elevated levels of certain receptor proteins that cause cells to divide. The elevated protein levels were not present in normal cells. The researchers then treated the mesothelioma cells with drugs that interfered with cell communication by blocking the receptor proteins. The coordinated activation of multiple receptor proteins may allow mesothelioma cells to resist chemotherapy drugs targeting single proteins. The researchers reported that the greatest reduction in the viability of the mesothelioma cells occurred when they blocked multiple types of receptor proteins rather than singling out individual proteins. They hypothesized that inhibiting heat shock protein 90, which belongs to a class of proteins called chaperones that help other growth proteins function properly, might interfere with multiple receptor proteins. HSP 90 is associated with proteins linked to growth and development. The researchers reported that the growth of mesothelioma cells was significantly reduced after HSP 90 was blocked by an inhibitor drug. The results of their research suggest that blocking heat shock protein 90 deserves further study as a new therapy for treating mesothelioma. Further study is needed to determine if the lab results can be replicated in a clinical setting.

Asbestos Fuels Mesothelioma Epidemic in Hong Kong

With a booming Asian economy, Hong Kong used asbestos extensively in the 1950s and 1960s, particularly in the shipyard and construction industries. Asbestos exposure is closely associated with asbestos-related respiratory diseases such as pleural mesothelioma that often appear decades after workers inhale asbestos fibers.

Since 2000, Hong Kong has experienced an epidemic of malignant mesothelioma, a cancer of the lining of the lungs or abdomen, according to a recent article in the journal Environmental Health Perspectives. The epidemic parallels the peak usage of asbestos in the early 1960s since symptoms of asbestos-related disease typically take 30 to 40 years to appear.

Researchers from Australia and China predict that the number of cases of mesothelioma in Hong Kong will peak around 2014, then slowly taper off based on data from the Hong Kong Cancer Registry.

Malignant mesothelioma was rare before the 1950s, but has increased sharply since the 1970s in many parts of the world. Exposure to asbestos in the workplace is considered the highest risk factor for developing asbestos cancer.

The researchers observed a notable increase in incidence of mesothelioma from 1976 to 2006 in Hong kong. The highest incidence was among males 70 years or older.

The increasing incidence of mesothelioma in Hong Kong is similar to trends observed in many countries including France, Germany, Great Britain, the Netherlands, Australia and Japan. The number of cases of mesothelioma in the United States, which restricts asbestos use, has increased to 2,500 to 3,000 a year. The incidence of mesothelioma in many South American countries such as Brazil is expected to keep rising for 10 to 20 more years because of later restrictions on asbestos use.

Hong Kong banned the import and sale of blue asbestos (crocidolite) and brown asbestos (amosite) in 1996. But the country has allowed the continued use of chrysotile asbestos in various industries. While the asbestos industry has claimed that chrysotile asbestos is less toxic than other forms, health organizations have said chrysotile asbestos is a human carcinogen and also causes malignant mesothelioma.

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