UPMC Physician Resources

Study Shows Overlooked Benefit of Successful Healthy Lifestyle Programs: Improved Quality of Life

The value of a healthy lifestyle isn’t reflected only in the numbers on the scale or the blood pressure cuff. University of Pittsburgh Graduate School of Public Health researchers demonstrated that it also can be measured through improved “health-related quality of life.”

In an analysis published in the August issue of the journal Quality of Life Research, the scientists showed that participation in a community-based behavioral lifestyle intervention program to improve health not only helped people lose weight, increase their physical activity levels, and reduce their risk of diabetes and heart disease, but also increased their health-related quality of life by an average of nearly 10 percent. The research was funded by the National Institutes of Health (NIH).

“These community-based lifestyle intervention programs have additional valuable benefits, beyond the improvement of risk factors for type 2 diabetes and heart disease,” said lead author Yvonne L. Eaglehouse, PhD, a postdoctoral researcher at Pitt Public Health. “Our study demonstrates that these programs, delivered in diverse community settings such as senior centers and worksites, simultaneously and significantly improved the quality of life of the participants.”

Dr. Eaglehouse and her colleagues investigated the impact of the Group Lifestyle Balance program, modified from the lifestyle intervention program used in the highly successful US Diabetes Prevention Program (DPP). The DPP was a national study demonstrating that people at risk for diabetes who lost a modest amount of weight and increased their physical activity levels sharply reduced their chances of developing diabetes and metabolic syndrome and outperformed people who took a diabetes drug instead.

Group Lifestyle Balance is a 22-session program administered over a one-year period aimed at helping people make lifestyle changes to improve their risk for diabetes and heart disease. The goals of the program are to help participants reduce their weight by 7 percent and increase their moderate-intensity physical activity (such as brisk walking) to 150 minutes per week.

As part of the Pitt community intervention effort, a total of 223 participants were enrolled to test the effectiveness of the Group Lifestyle Balance program at a worksite and three community centers in the Pittsburgh area. The participants averaged 58 years of age and had pre-diabetes or metabolic syndrome or both.

Before beginning the program, each participant ranked his or her current health on a scale from 0 “worst imaginable health state” to 100 “best imaginable health state.” The US average is 79.2, whereas the participants averaged 71.5 at baseline.

After completing the year-long Group Lifestyle Balance program, the participants increased their average health-related quality-of-life score to 78.2. When looking at only those with baseline health-related quality of life below the U.S. average, there was an even greater magnitude of improvement, from 61.8 at baseline to 74 at the end of the program. Once scores were adjusted for meeting weight loss and physical activity goals, participants who met the program goals were found to have increased their health-related quality-of-life score by nine more points compared to those participants who met neither program goal.

“It is exciting that we were able to document an improvement in health-related quality of life in addition to improvement in risk factors for diabetes and cardiovascular disease,” said senior author Andrea Kriska, PhD, professor in Pitt Public Health’s Department of Epidemiology and principal investigator of the NIH study. “This important benefit was most evident in those who started the intervention program having a relatively lower quality of life—in other words, those who needed to improve the most.”

Additional authors on this research are M. Kaye Kramer, DrPH, RN, Vincent C. Arena, PhD, and Rachel G. Miller, MS, all of Pitt; and Gerald L. Shafer, PhD, of Carroll College in Helena, Montana.

This study was funded by NIH National Institute of Diabetes and Digestive and Kidney Diseases grant R18 DK081323-04.

UPMC Comprehensive Pulmonary Hypertension Program Earns National Distinction

The Comprehensive Pulmonary Hypertension Program at UPMC has been added to the short list of programs nationwide to earn accreditation by the Pulmonary Hypertension Association (PHA) as a Center of Comprehensive Care. UPMC is one of 39 medical centers nationally to receive the distinction for the quality of its pulmonary hypertension program.

“The accreditation is an important component in recognizing the exceptional care that we offer our patients,” said Stephen Y. Chan, MD, PhD, associate professor of medicine, University of Pittsburgh School of Medicine, and director, UPMC Center for Pulmonary Vascular Biology and Medicine at the Vascular Medicine Institute at the University of Pittsburgh. “With the significant resources and expertise that we are focusing on pulmonary hypertension, this accreditation and our already sterling reputation as a first-class research center in pulmonary hypertension make us one of the top programs in the world for both research and clinical care.”

Pulmonary hypertension is high blood pressure that occurs in the arteries in the lungs, making it difficult for blood to flow from the heart to the lungs. Symptoms of the disease, which can lead to heart failure, include shortness of breath, fatigue and chest pain, and in its early stages might not be noticeable for months or even years. A rare and life-threatening condition, it becomes progressively worse, making early and accurate diagnosis important to allow treatment methods to extend and improve the quality of life for many patients.

Featuring one of the largest multidisciplinary teams in the country, the UPMC Comprehensive Pulmonary Hypertension Program is a joint program of the UPMC Heart and Vascular Institute and the Pitt Division of Pulmonary, Allergy and Critical Care Medicine. It offers state-of-the-art diagnostics and a full range of therapy, as well as opportunity for patients to participate in cutting-edge clinical research aimed at improving diagnosis and treatment methods.

“Many centers have one or two people focused on pulmonary hypertension, but here at UPMC we have more than 60 people—researchers, physicians, nurses, pharmacists and clinical practitioners—all committed to fighting this disease,” Dr. Chan said. “We are pushing discovery forward, and getting closer to the point of creating new therapies that won’t just make our patients feel better, but rather will help reverse, prevent and hopefully cure pulmonary hypertension.”

The accreditation process began two years ago and is based on criteria established by the PHA that includes the program’s overall commitment to patients with the disease, scope of services offered and expertise of the care team. Programs that receive the distinction also agree to contribute to the PHA Registry, a new patient registry used to evaluate outcomes for people living with pulmonary hypertension to help researchers learn more about the disease.

Children’s Hospital of Pittsburgh of UPMC Part of New Pennsylvania Program to Improve Behavioral Health for Kids

PrintChildren’s Hospital of Pittsburgh of UPMC’s primary care network, Children’s Community Pediatrics (CCP), has been selected by the HealthChoices managed care organizations to take part in a new program to improve behavioral health treatment for children in the state.

Ted Dallas, secretary of the Department of Human Services in Pennsylvania, announced the selection of organizations to administer behavioral health treatment through the new Telephonic Psychiatric Consultation Service Program (TiPS). The announcement was made today at Children’s Hospital, with Dallas joining Christopher Gessner, president of Children’s Hospital, and Abigail Schlesinger, MD, medical director, Community Based Services, Behavioral Science Division of Children’s Hospital.

TiPS is a new program designed to provide real-time resources to physicians seeking consultation and advice for pediatric patients with behavioral health concerns who are served by Medicaid. A physician who uses the TiPS service will have access to a child and adolescent psychiatrist to discuss treatment options and get help linking the child to appropriate treatment if services outside of primary care are deemed necessary.

CCP, through its award-winning behavioral health program, will be manning the hotline to provide telephone consultation to any physician who is prescribing behavioral health medications to kids.

“It is critical that all children, regardless of where they live, have access to quality health care services,” said Dallas. “Access to child psychiatry has been a significant problem nationwide for years. Today’s announcement means that more of our kids will have the services they need, and not just another prescription.”

“Being able to provide behavioral health services in the primary care setting was a vision of ours and something that we’ve been doing for 8 years now,” said Dr. Schlesinger. “We’re excited to partner with the state of Pennsylvania to further enhance families’ ability to access behavioral health services in our region.”

CCP will serve the 26 counties in both the Southwest and Northwest zones. The Children’s Hospital of Philadelphia will serve the Southeast zone and Penn State Children’s Hospital will serve the Northeast and Lehigh/Capital zones.

For more information, visit www.childrenspeds.com.

Regenerative Medicine Improves Strength and Function in Severe Muscle Injuries

Results of a study conducted by researchers at the University of Pittsburgh School of Medicine and the McGowan Institute for Regenerative Medicine showed significant improvement in strength and range of motion, as well as evidence for skeletal muscle regeneration, in 13 patients who were surgically implanted with bioscaffolds derived from pig tissue to treat muscle injuries. The patients had failed to respond to conventional treatment before use of the extracellular matrix (ECM). The findings were published online today in npj Regenerative Medicine.

“Previously, there was no effective treatment for these patients, but this approach holds significant promise,” said senior investigator Stephen F. Badylak, DVM, PhD, MD, professor of surgery at Pitt and deputy director of the McGowan Institute, a joint effort of Pitt and UPMC. “This approach could be a game changer and not just an incremental advance.”

For the Muscle Tendon Tissue Unit Repair and Reinforcement Reconstructive Surgery Research Study, which was sponsored by the US Department of Defense, 11 men and two women who had lost at least 25 percent of leg or arm muscle volume and function first underwent a customized regimen of physical therapy for four to 16 weeks.

Lead study surgeon J. Peter Rubin, MD, UPMC Professor and Chair of Plastic Surgery, Pitt School of Medicine, then surgically implanted a “quilt” of compressed ECM sheets designed to fill in their injury sites. Within 48 hours of the operation, the participants resumed physical therapy for up to 24 additional weeks.

By six months after implantation, patients showed an average improvement of 37.3 percent in strength and 27.1 percent in range of motion tasks compared with pre-operative performance numbers. CT or MRI imaging also showed an increase in post-operative soft tissue formation in all 13 patients.

“For well-selected patients with this type of loss, we now have a treatment available to help improve their function,” Dr. Rubin said.

The new data builds upon a previous Pitt study that showed damaged leg muscles grew stronger and showed signs of regeneration in three out of five men whose old injuries were surgically implanted with ECM derived from pig bladder. Those patients also underwent similar pre- and post-operative physical therapy.

The recent results included more patients with varying limb injuries; used three different types of pig tissues for ECM bioscaffolds; investigated neurogenic cells as a component of the functional remodeling process; and included CT and MRI imaging to evaluate the remodeled muscle tissue.

“The three different types of matrix materials used all worked the same, which is significant because it means this is a generic property of these materials and gives the surgeons a choice for using whichever tissue they like,” Dr. Badylak said. “Prior to the surgery, each patient went through physical therapy focused on getting them to the point where they couldn’t get any better. We then started active rehab 24 hours after surgery, which proved to be critically important for these patients.”

The research team included lead authors Jenna Dziki, Dr. Badylak, Dr. Rubin, and others from Pitt and McGowan. The project was supported by a research grant from the US Department of the Interior, grant D11AC00006.

The US Department of Defense’s Limb Salvage and Regenerative Medicine Initiative and the Muscle Tendon Tissue Unit Repair and Reinforcement Reconstructive Surgery Research Study are collaboratively managed by the Office of the Secretary of Defense. The initiative is focused on rapidly and safely transitioning advanced medical technology in commercially viable capabilities to provide wounded warriors the safest and most advanced care possible today.

More Doesn’t Mean Better When it Comes to Trauma Centers

University of Pittsburgh School of Medicine researchers have demonstrated for the first time that changes over time in the volume of patients seen by trauma centers influence the likelihood of seriously injured patients living or dying.

The findings, reported online and scheduled for an upcoming issue of the journal Annals of Surgery, mean that changes in patient volume across all affected centers should be considered when designating a new trauma center in a region.

“It takes about three years for the impact of increased patient volume to translate into improved patient outcomes,” said lead author Joshua Brown, MD, MS, a research fellow in the Division of Trauma and General Surgery in the Pitt School of Medicine’s Department of Surgery. “Siphoning of patients through unregulated growth of unnecessary trauma centers can have a profound detrimental impact on patients that isn’t immediately obvious. Before designating a new trauma center, serious consideration should be given to how that designation will affect patient volumes over time at trauma centers throughout the region.”

A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the US, the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest).

Dr. Brown and his colleagues examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. The researchers compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate.

Each 1 percent increase in patient volume at a trauma center was associated with 73 percent better odds of a patient surviving. Conversely, each 1 percent decrease in volume was linked to a two-fold worsening in the odds of a patient surviving.

“So, the study suggests the negative impact of declining patient volume is significantly greater than that of the positive impact of increasing patient volume,” said senior author Jason Sperry, MD, MPH, associate professor in the Pitt School of Medicine Departments of Surgery and Critical Care Medicine. “Granting unnecessary designation to a trauma center in a region that doesn’t have the patient volume to support it not only hurts patient outcomes at that new center, but it will likely lead to a decline in patient outcomes at other nearby centers.”

Follow-up study will be needed to determine why patient volume is linked to patient outcomes, but the researchers suspect that as centers increase their number of patients, they also increase their resources, infrastructure and experience. Although advances in care and diagnostics may be more readily adopted at higher-volume trauma centers, this alone did not explain the influence of trauma center volume changes on patient outcomes over time.

“Taking care of patients who sustain complex traumatic injuries is a truly multidisciplinary effort, so it requires an institutional-level commitment of resources and staff,” said Dr. Brown. “There are many dynamics at play here that make the issue more involved than simply increased opportunity to hone surgical skills.”

Additional authors on this study include Matthew R. Rosengart, MD, MPH, Jeremy M. Kahn, MD, MS, Deepika Mohan, MD, MPH, Brian S. Zuckerbraun, MD, Timothy R. Billiar, MD, Andrew B. Peitzman, MD, and Derek C. Angus, MD, MPH, all of Pitt.

No funding directly supported this study, though Dr. Brown receives support from the National Institutes of Health grant 5T32GM008516.

Children’s Hospital of Pittsburgh of UPMC Earns National Recognition as Patient-Centered Medical Home

PrintChildren’s Hospital of Pittsburgh of UPMC’s Primary Care Center, part of the Division of General Academic Pediatrics, has received Level III Patient-Centered Medical Home (PCMH) Recognition from the National Committee for Quality Assurance (NCQA) for using evidence-based, patient-centered processes that focus on highly coordinated care and long‐term, participative relationships.

The three-year recognition is based on standards aligned with joint principles of the Patient-Centered Medical Home, a model of primary care that combines teamwork and information technology to improve care, to improve patients’ experience of care and to reduce costs.

“As the pediatric office for many of Pittsburgh’s underserved children, we are dedicated to providing the highest quality of care to the children in our region who are in need. This national recognition demonstrates our comprehensive approach and ongoing commitment to patient-centered care,” said Stacey Cook, MD, PhD, physician, General Academic Pediatrics, Children’s Hospital. “We provide increased access, implement quality improvement measures and provide continuing outreach to our families each and every day.”

Medical homes foster ongoing partnerships between patients, their families and their personal clinicians, instead of approaching care as the sum of episodic office visits. Each patient’s care is overseen by clinician-led care teams that coordinate treatment across the health care system.

“NCQA Patient-Centered Medical Home Recognition raises the bar in defining high-quality care by emphasizing access, health information technology and coordinated care focused on patients,” said NCQA President Margaret E. O’Kane. “Recognition shows that Children’s Hospital of Pittsburgh of UPMC has the tools, systems and resources to provide its patients with the right care, at the right time.”

NCQA standards are aligned with the joint principles of the Patient-Centered Medical Home established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association.

UPMC First in Region to Use New Fully Dissolving Heart Stent

UPMC is the first hospital in western Pennsylvania to use Abbott’s fully dissolving Absorb GT1 Biodegradable Vascular Scaffold System (BVS), a first-of-its-kind device recently approved by the Food and Drug Administration. It functions by opening a blocked artery in the heart, restoring blood flow and providing relief from symptoms of coronary artery disease (CAD). A 58-year-old woman with severe coronary artery disease was the first patient to receive the absorbable device Tuesday.

“We’re only at the beginning of understanding the potential benefits of this technology that could have long-lasting impacts for our patients,” said Catalin Toma, MD, assistant professor, Division of Cardiology, University of Pittsburgh School of Medicine, and director for interventional cardiology research at the UPMC Heart and Vascular Institute and one of the initial medical experts with access to the technology. “By resorbing in time, these implants allow for restoration of the vessel’s natural function without the restriction of the traditional metallic cage of the stent. This may have a positive effect on vessel healing for months and years to come.”

The most common type of heart disease, CAD occurs when arteries that supply blood to the heart become narrowed or blocked due to plaque buildup, leading to chest pain and shortness of breath, as well as an increased risk of heart attack. When patients present with heart attacks or chest discomfort due to plaque buildup, the obstruction is treated with metallic stents. Although this technology has been greatly improved in the past years, potential issues related to the permanent coronary implant may require additional procedures even many years after the initial operation.

Absorb GT1 BVS is made of naturally resorbable material that slowly disappears in about three years, leaving behind a restored vessel, free of a permanent implant. Metallic stents permanently restrict vessel movement, limiting future treatment options. Unrestricted vessels with restored function have the potential to flex, pulse and dilate in response to various demands on the heart, based on people’s lifestyle and activities, and allow for potential treatment options down the road. Similar to current generation drug-eluting stents, the BVS is coated with a drug that prevents the re-narrowing of the vessel over time.

The procedure is similar to regular coronary stenting intervention, which is performed by accessing the artery in the groin or wrist, and threading catheters to the coronary arteries. The blockage is first opened with an angioplasty balloon, followed by balloon-expandable scaffold implantation. While complex and hardened blockages are better served by regular metallic stents at this stage of the technology, the BVS could be beneficial for younger patients with their first CAD presentation, Dr. Toma noted.

UPMC Presbyterian Shadyside is one of the few centers in the US with experience in implanting the scaffolds. The hospital participated in the ABSORB III trial, which led to the recent FDA approval of the device, as well as the ABSORB IV trial, which compares the BVS to the top-performing current metallic stent technology.

The UPMC Heart and Vascular Institute is one of the world’s premier centers for comprehensive care, developing revolutionary devices and new models of treatment that improve the lives of those facing the most complex heart and vascular conditions.

Certain Characteristics Predispose Women to Different Hot Flash and Night Sweat Patterns

Most women will get hot flashes or night sweats at some point in life. However, when these symptoms occur and how long they last can vary dramatically among women. New findings show that women fit into four distinct groups when it comes to getting hot flashes and night sweats, with potential ramifications for therapy and prevention of future health conditions, according to the research led by the University of Pittsburgh Graduate School of Public Health.

The epidemiological investigation followed hundreds of women for an average of 15 years and identified characteristics that predisposed them to certain trajectories for getting hot flashes and night sweats—collectively known as “vasomotor symptoms.” The findings are published in today’s issue of Menopause: The Journal of the North American Menopause Society and were funded by the National Institutes of Health.

“Most women get vasomotor symptoms, and we used to think  these symptoms lasted from three to five years, right around the time of the final menstrual period,” said senior author Rebecca Thurston, PhD, a professor in Pitt’s Department of Psychiatry and an epidemiologist at Pitt Public Health. “We now know that these symptoms persist for far longer—typically seven to 10 years—and occur at different times for different women. This is strong evidence that we need to further investigate the underlying physiological causes of vasomotor symptoms and their link to potentially preventable health conditions.”

Hot flashes and night sweats involve a sudden flush of feverish heat and are linked to menopause, the time when a woman’s menstrual period stops.

Dr. Thurston and her colleagues followed 1,455 women enrolled in the Study of Women’s Health Across the Nation (SWAN) who had not yet gone through menopause when they enrolled. The women lived in Pittsburgh, Boston, Detroit, Chicago, Los Angeles, Oakland, Calif., or Newark, N.J., and were not on hormone therapy, nor did they have a hysterectomy. Each year, the women reported their vasomotor symptoms, along with receiving a clinical examination and sometimes a blood test.

The researchers found that the women could be relatively equally divided into four distinct trajectories for vasomotor symptoms as they went through menopause transition, and that certain characteristics were more common in different categories:

• A consistently low chance of having symptoms throughout the menopause transition was more common in Chinese women.
• A consistently high chance of having symptoms throughout the transition was more common in black women, those with less education, those who reported drinking alcohol moderately or heavily, and those who reported symptoms of depression or anxiety.
• An early onset of symptoms in the decade before the final period with cessation thereafter was more common among women who were obese, had symptoms of depression or anxiety, were in poorer health than their peers and at an older age at menopause.
• A late onset of symptoms after the final period that gradually declined in the following decade was more common in women with a lower body mass index (ratio of weight to height), those who smoke and black women.

Hormonal fluctuations were correlated with vasomotor symptoms but were not perfectly consistent, indicating that they did not fully account for the symptoms.

“It’s fascinating that we can distinguish these unique patterns and then pinpoint specific characteristics associated with each of these trajectories,” said co-author Maria M. Brooks, PhD, professor of epidemiology and associate professor of biostatistics at Pitt Public Health, and principal investigator of the coordinating center for SWAN. “When we see patterns like this, it indicates that there’s something going on beyond hot flashes and night sweats being a passing nuisance. Depending on which category a woman falls into, there may be important implications regarding her health.”

In a different, recent study, Dr. Thurston found evidence that some of these trajectories were associated with risk factors for cardiovascular disease.

“At this point, we can’t completely untangle any causal relationship between vasomotor symptoms and health outcomes or suggest preventative measures for vasomotor symptoms without further study,” said Dr. Thurston. “But women and their doctors can use these findings now to help them get a better idea what they’re likely to experience as they go through menopause and to plan the best ways to manage their symptoms.”

Additional authors on this study are Ping G. Tepper, PhD, Samar R. El Khoudary, PhD, Joyce T. Bromberger, PhD, Kristine Ruppert, PhD, and Bobby Jones, PhD, all of Pitt; John F. Randolph Jr., MD, of the University of Massachusetts; Sybil L. Crawford, PhD, Sioban Harlow, PhD, Daniel S. McConnell, PhD, and Huiyong Zheng, PhD, all of the University of Michigan; Ellen B. Gold, PhD, and Bill L. Lasley, PhD, both of the University of California, Davis; Hadine Joffe, MD, MSc, of Harvard University; Rachel Hess, MD, of the University of Utah; and Nancy E. Avis, PhD, of Wake Forest University.

SWAN has grant support from the NIH through the National Institute on Aging, the National Institute of Nursing Research and the Office of Research on Women’s Health (grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, and U01AG012495).

University of Pittsburgh Researchers Part of “BELIEVE” Team that Received $28 Million, Five-Year NIH Award to Find HIV/AIDS Cure

The National Institutes for Health (NIH) awarded a five-year grant, totaling $28 million, to The George Washington University (GW), which will collaborate with University of Pittsburgh researchers, as well as 17 other medical institutions, to find a cure for HIV.

This award is the second iteration of the Martin Delaney Collaboratory program, which fosters public-private partnerships to accelerate HIV/AIDS cure research. Delaney, an influential AIDS activist, championed partnerships involving government, academia and industry.

The Pittsburgh arm of the project is being led by Thomas Smithgall, PhD, the William S. McEllroy Professor and Chairman of the Department of Microbiology and Molecular Genetics, Pitt School of Medicine.

The project is named, “Bench to Bed Enhanced Lymphocyte Infusions to Engineer Viral Eradication (BELIEVE).” The goal of this collaborative effort is to find ways to eliminate HIV reservoirs, through an innovative cell therapy approach that will focus on augmenting individuals’ natural immunity. Work in the Smithgall laboratory is focused on drug discovery targeting an HIV-1 protein that suppresses the body’s immune response to the virus.  According to Dr. Smithgall, “Working with the BELIEVE consortium, we will be in a position to examine the potential of these novel compounds to restore natural immune responses to HIV-infected cells, a critical component of an HIV cure strategy.”

The University of Pittsburgh researchers are part of a team led by GW, working with Altor Bioscience and Torque. The initiative is led by Douglas Nixon, MD, PhD, principal investigator and chair of the Department of Microbiology, Immunology, and Tropical Medicine in the GW School of Medicine and Health Sciences.

“We know that through this strategic collaboration with our research partners and a commitment to finding a cure, we will move closer to reaching our goals of eradicating HIV/AIDS,” said Nixon.

In addition to Pitt, the institutions involved in this research are Children’s National Health System; NIH; Howard University; University of Arizona; Brigham Young University; University of Minnesota; Johns Hopkins University; Seattle Children’s Hospital; Beth Israel Deaconess Medical Center, Harvard University; University of Pennsylvania; Georgetown University; Albert Einstein College of Medicine; University of Toronto, Canada; Simon Fraser University, British Columbia, Canada; Centro de Investigación en Enfermedades Infecciosas, Mexico City, Mexico; and the University of São Paulo, Brazil.

Advertising by US Cancer Centers Soars Over Past Decade, New Analysis Shows

Cancer centers promoting their services dramatically increased their advertising spending from 2005 to 2014, with the bulk of the spending by for-profit organizations, according to the results of a study published Monday.

Researchers at Indiana University (IU) School of Medicine and the University of Pittsburgh School of Medicine and Graduate School of Public Health reported that 890 cancer centers spent $173 million for advertising in 2014, and just 20 centers accounted for 86 percent of the spending.

One company, Cancer Treatment Centers of America, a for-profit firm with a national network of five hospitals, spent $101.7 million, 59 percent of the total. In contrast, 25 of the nation’s 60 National Cancer Institute (NCI)-designated cancer centers spent no money on advertising, and of those that did, half spent less than $4,000, the authors said.

Of the 20 centers that accounted for the bulk of spending, five were for-profit institutions, 17 were Commission on Cancer-accredited and nine were NCI-designated centers.

The report was published Monday by the journal JAMA Internal Medicine.

“Spending on cancer center advertising has more than tripled since 2005, and a small percent of cancer centers are responsible for the majority of spending. Patients should be aware that cancer centers that spend the most on advertising may not necessarily provide the highest quality of cancer care,” said study first author Laura Vater, MPH, a fourth-year medical student at the IU School of Medicine.

Additional work is needed to better understand how advertising may affect the cost and quality of care, she said.

In a 2014 study published in the Annals of Internal Medicine, Vater and colleagues analyzed the content of cancer center advertising and concluded that “clinical advertisements by cancer centers frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs or insurance availability.”

For the new study, the researchers used data from Kantar Media, an agency that tracks advertising and calculates expenditures. They obtained data for television, magazine, radio, newspaper, billboard and internet advertising. The expenditures were adjusted to 2014 U.S. dollars using the Consumer Price Index.

The researchers also identified the centers that were NCI-designated, accredited by the Commission on Cancer, were not-for-profit versus for-profit organizations, and by location.

Spending in all advertising categories grew from 2005 to 2014, led by television where $37 million was spent in 2005, rising to a peak of $107 million in 2011. Television spending declined somewhat after that, but still stood at $87 million in 2014. Print media spending rose from $11 million to $34 million. In a time when internet advertising was growing, cancer center online ads were among them—internet display advertisements rose from $300,000 in 2005 to $9 million in 2014.

“More work is needed to understand the effects of cancer center advertising on the web, as more and more people search for health information online,” said senior author Yael Schenker, MD, assistant professor in the Pitt School of Medicine. “One concern is that when advertisements are listed at the top of internet search results, patients may have trouble finding and recognizing good information.”

After Cancer Treatment Centers of America, the two biggest advertisers in 2014 were MD Anderson Cancer Center, which spent $13.9 million, and Memorial Sloan Kettering Cancer Center at $9.1 million.

The authors noted that the expenditure calculations could be low because advertising in cancer-specific magazines was not included, nor was advertising by affiliated organizations designed to encourage charitable donations.

The research was supported by a National Institutes of Health grant KL2TR000146 and by a University of Pittsburgh Department of Medicine Junior Scholar Award.

In addition to Vater and Dr. Schenker, researchers contributing to the study were Julie M. Donohue, PhD, of the University of Pittsburgh Graduate School of Public Health, and Seo Young Park, PhD, of the University of Pittsburgh Department of Medicine.

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