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15 April 2003 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians, an organization of more than 115,000 internal medicine physicians and medical students. Note: ACP-ASIM changed its name to ACP on March 31. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Strong Quadriceps May Not Help Knee Arthritis

Contrary to many experts' opinion that people with knee osteoarthritis should strengthen upper leg muscles, a new study found that upper leg strength may not protect against knee osteoarthritis and in fact may worsen arthritis in people with certain knee conditions (Article, p. 613). Researchers studied 237 people with knee osteoarthritis (wear and tear arthritis), including some with two joint conditions: poor alignment of the knee and looseness of the knee joint. An editorial writer notes that the authors measured quadriceps strength only at the beginning of the 18-month study and were therefore unable to plot the relationship between muscle strength and osteoarthritis throughout the study (Editorial, p. 678).

Chemotherapy Use at End of Life

One-third of patients who died of cancer received chemotherapy in their last six months of life (Brief Communication, p. 639). Whether these results were good or bad depends on expectations. On the one hand, the results negate claims that half of patients dying of cancer receive useless chemotherapy within the last few weeks of life. However, patients with cancers considered unresponsive to chemotherapy, such as pancreatic, renal-cell or melanoma, were just as likely to receive chemotherapy in the last six months of life as patients with breast, colon or ovarian cancer, which often respond to chemotherapy.

Researchers used data from Medicare databases in two states: all Medicare patients who died of cancer in Massachusetts and five percent of Medicare patients who died of cancer in California in 1996. The authors did not give the reasons for using chemotherapy at the end of life and did not address whether chemotherapy was appropriately used.

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