​A single chemotherapy treatment can result in a significant negative impact on walking gait and balance, putting patients at an increasing risk for falls, according to a new study involving breast cancer patients conducted by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James). Up to 60 percent of patients experience chemotherapy-induced peripheral neuropathy (CIPN), nerve damage that impacts feeling in the hands or feet; however, when and to what extent this damage impacts functional abilities has been largely unknown.

This new study is the first to objectively measure the functional abilities of cancer patients during and after taxane-based chemotherapy. Researchers followed 33 patients with stage I-III breast cancer, assessing functional performance (standing balance and gait) and patient-reported outcomes at five timepoints spanning before treatment began up to three months post-treatment completion.

Researchers observed a 28 percent increase in side-to-side sway (medial-lateral) after just one chemotherapy treatment. That increased to 48 percent with cumulative chemotherapy exposure. Patients also demonstrated a 5 percent reduction in walking speed after three cycles of chemotherapy.

"This is not simply a quality of life concern - CIPN can impact a patient's ability to receive treatment at all, limiting the potential for a cure. For patients who have great difficulty with neuropathy, we often have to modify their treatment regimen to make it tolerable - sometimes the therapy has to be ceased entirely," says Maryam Lustberg, MD, MPH, senior author of the study and director of breast cancer survivorship services at the OSUCCC - James. "We need to make these treatments more tolerable to patients so they can get the full benefit of the treatments."

Lustberg and her colleagues report that taxane exposure is also associated with worsened sensory symptoms and poorer postural control. There was also an association between patients' balance and self-reported sensory symptoms.

Do wealthier people receive too much medical care? In a Perspective article recently published in the New England Journal of Medicine, H. Gilbert Welch, MD, and Elliott Fisher, MD, of The Dartmouth Institute for Health Policy and Clinical Practice examine the association between income level and cancer diagnosis.

Using data from the Surveillance, Epidemiology, and End Results (SEER) program, Welch and Fisher examined incidence and mortality trends for four types of cancers: breast cancer, prostate cancer, thyroid cancer and melanoma. They chose these specific cancers because the likelihood of diagnosis is sensitive to the intensity with which physicians look for these cancers - the combined effect of factors, including the frequency of screening and diagnostic exams, the ability of exams to detect small irregularities, and the threshold used to label results as abnormal. As Welch and Fisher note, these factors can have a dramatic effect on the apparent amount of disease. In simple terms, the harder doctors look for these cancers, the more they find.

Using 2000 U.S. census data, Welch and Fisher compared incidence and mortality of the four cancers in high- vs. low-income counties (median incomes greater than $75,000 and less than $40,000, respectively). Among their findings:

• High-income counties have recorded a much greater increase in the incidence of these four cancers than low-income counties.
  
  
• The combined death rate from the four cancers is similar in high- and low-income counties, which Welch and Fisher say suggests that the underlying burden of disease is actually similar in high- and low-income counties.
  
  
• Mortality from these cancers hasn't been increasing (as one might expect given the increase in diagnosis), but rather decreasing-due largely to improved treatments for breast and prostate cancer.
  
  

What accounts for the higher incidence of cancer in high-income counties? Welch and Fisher say there could be several contributing factors: affluent people may expect and demand more testing. Also, health systems serving relatively wealthy and healthy populations may see offering more testing "as a good way to produce more patients and increase business."

The next time you walk down the produce aisle of your grocery store, you may want to reach for red onions if you are looking to fight off cancer.In the first study to examine how effective Ontario-grown onions are at killing cancer cells, University of Guelph​ researchers have found that not all onions are created equal.

Engineering professor Suresh Neethirajan and PhD student Abdulmonem Murayyan tested five onion types grown in Ontario and discovered the Ruby Ring onion variety came out on top. Onions as a superfood are still not well known. But they contain one of the highest concentrations of quercetin, a type of flavonoid, and Ontario onions boasts particularly high levels of the compound compared to some parts of the world.

The Guelph study revealed that the red onion not only has high levels of quercetin, but also high amounts of anthocyanin, which enriches the scavenging properties of quercetin molecules, said Murayyan, study's lead author.

"Anthocyanin is instrumental in providing colour to fruits and vegetables so it makes sense that the red onions, which are darkest in colour, would have the most cancer-fighting power."

Published recently in Food Research International, the study involved placing colon cancer cells in direct contact with quercetin extracted from the five different onion varieties.

"We found onions are excellent at killing cancer cells," said Murayyan. "Onions activate pathways that encourage cancer cells to undergo cell death. They promote an unfavourable environment for cancer cells and they disrupt communication between cancer cells, which inhibits growth."

The researchers have also recently determined onions are effective at killing breast cancer cells.
"The next step will be to test the vegetable's cancer-fighting powers in human trials," said Murayyan.