Chemo doorstep drops help to keep cancer patients safe

Thousands of patients with cancer have had chemotherapy delivered to their doors so that they can more safely receive treatment during the coronavirus pandemic.

Up to 10,000 chemo home deliveries were made over three months at the peak of the outbreak, avoiding the need for patients to venture out and risk infection when their immune system was low. The drops are part of the COVID-friendly treatments introduced in response to the pandemic which have helped to ensure that 85,000 people could start treatment between March and June.

Full detail at NHS England

Celebs with cancer back NHS call for people to get symptoms checked

Celebrities with cancer have joined NHS doctors to encourage the public to come forward for vital, life-saving checks | via NHS England

Famous faces backing the move to increase take-up of NHS checks include the Nolan sisters, who have recently opened about their cancer diagnosis and former BBC Breakfast presenter Bill Turnbull.

Although the NHS treated 85,000 people for cancer during the pandemic, nearly half of the public have said they had concerns seeking help in the midst of the outbreak, and one in 10 reported that they wouldn’t contact their GP even if they had a lump or a new mole.

Full story at NHS England

NIHR: International trial shows single-dose radiotherapy as effective for treating breast cancer

National Institute Health Research |August 2020 | International trial shows single-dose radiotherapy as effective for treating breast cancer

A pioneering breast cancer therapy requiring just one shot of radiotherapy rather than conventional weeks-long treatment, has proven to be as effective for most women in treating the disease, finds research funded and supported by NIHR.

Results of the large international randomised trial, published in the BMJ, confirm the long-term effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT): a breast cancer treatment which is increasingly available throughout the world. 

TARGIT-IORT is delivered immediately after lumpectomy (tumour removal), via a small ball-shaped device placed inside the breast, directly where the cancer had been. The single-dose treatment lasts for around 20 to 30 minutes and replaces the need for extra hospital visits, benefiting both patient safety and well-being.

Researchers compared this technique to conventional external beam radiotherapy (EBRT), delivered from outside the body via a linear accelerator radiotherapy machine. This consists of daily treatment sessions, known as fractions, to the whole breast, over three to six weeks. EBRT is given over a few minutes, but requires 15 to 30 hospital visits, which could be a significant distance from where the patient lives.

At the five-year follow up, recurrence risk of localised breast cancer was 2.1% for TARGIT-IORT compared to 0.95% for EBRT showing TARGIT-IORT to be non-inferior to EBRT. There were 14 fewer deaths for the TARGIT-IORT group.

Significantly, at long-term follow up (average 8.6 years, maximum 18.9 years) there was no statistically significant difference found in any of the breast cancer outcomes, and a substantial reduction in deaths from causes other than breast cancer with TARGIT-IORT.

Researchers say they hope the treatment can be made more available to patients (Source: NIHR)

Full news release from NIHR

BMJ (2020)| Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial |370|m2836 |

Abstract

Objective To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer.

Design Prospective, open label, randomised controlled clinical trial.

Setting 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada.

Participants 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT).

Interventions Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients).

Main outcome measures Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes.

Results Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005).

Conclusion For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned.

The research findings are published in the BMJ, available here

New app developed to support patients during and following cancer treatment

County Durham and Darlington NHS Foundation Trust | July 2020| My Wellbeing Space – New App

The app, My Wellbeing Space, is a free digital service from NHS partnership Health Call and technology provider Inhealthcare and funded by the Northern Cancer Alliance. It will initially benefit patients receiving care from County Durham and Darlington NHS Foundation Trust. The content was developed by the Macmillan project team in collaboration with clinical teams and involving patients at all stages of its design and testing.

The My Wellbeing Space app can benefit patients at any stage of their treatment by providing advice and links with content including advice and links to information about: physical activity, late effects of treatment, food and nutrition, financial concerns, fatigue, emotional wellbeing and treatments.  It also includes short video clips delivered by a consultant, clinical nurse specialist, wellbeing practitioners, GP, oncologist, a patient and carer.  Patients will be given access to the app during their treatment (Source: County Durham and Darlington NHS Foundation Trust). 

Further details from County Durham and Darlington NHS Foundation Trust

Cancer Research UK: Cancer Patient Experience Survey 2020 The impact of COVID-19 on cancer patients in the UK

Cancer Research UK| July 2020| Cancer Patient Experience Survey 2020 The impact of COVID-19 on cancer patients in the UK

Taken from the Executive Summary

Overall for many cancer patients the COVID-19 pandemic appears to have had a significant impact on their testing and treatment, and most notably their care:

• 40 % of cancer patients surveyed reported that their testing had been impacted.

•One- third of patients surveyed reported that their treatment had been impacted.

• 2 in 3 cancer patients reported that their cancer care had been impacted.

• Ratings of overall cancer care as ‘very good’ decreased from 75% ‘before lockdown started’ to 37% ‘after lockdown started’.

• Possible significant differences in experience were found by region in England for testing, treatment and care (p less than .01).

• Possible significant[1] differences in experience for care was flagged for social economic status (SES), nation, region and cancer type (p less than .01).

• 71% of cancer patients stated that they had been treated in the same hospital as usual, with no significant differences by SES, cancer type, nation or region.

This has resulted in a negative impact on the emotional well-being of many cancer patients:

• The most common emotions reported were ‘anxious’ and ‘frustrated’. This was consistent for all patients surveyed, those who reported to have their testing and treatment impacted, and across breakdowns (SES, nation region and cancer type).

• ‘Catching COVID-19’ and ‘becoming seriously ill from COVID-19’ were the most selected concerns, and there was a lot of frustration reported in the open text comments

Full report available from Cancer Research UK

NHS rolls out ‘COVID-friendly’ cancer treatments #covid19rftlks

NHS England | August 2020 | NHS rolls out ‘COVID-friendly’ cancer treatments

‘COVID-friendly’ cancer treatments that are safer for patients during the pandemic will be expanded and extended through a £160 million initiative, NHS chief executive Sir Simon Stevens announced today.

The funding will pay for drugs that treat patients without having such a big impact on their immune system or offer other benefits such as fewer hospital visits.

Thousands of patients have already benefitted from almost 50 treatments approved for use as ‘swaps’ for existing drugs and more will be available from this week, thanks to a series of deals struck between the NHS and pharma companies.

Some of these new options mean that patients can take tablets at home or receive medicines with fewer side-effects instead of undergoing hospital-based treatment that can leave them more susceptible to coronavirus and other infections.

Targeted hormone therapies such as enzalutamide for prostate cancer and broadened use of lenalidomide in the treatment of myeloma – bone marrow cancer – are among the options now available for clinicians and patients.

The funding for COVID-friendly drugs is just one of the innovations adopted by the NHS to care for patients since the first case was confirmed in this country on January 31.

NHS England NHS rolls out ‘COVID-friendly’ cancer treatments

The Guardian NHS England spends £160m on new ‘Covid-friendly’ cancer drugs

Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials

Chlebowski RT, Anderson GL, Aragaki AK, et al. |2020|Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials |JAMA|324 |4| P. 369–380. doi:10.1001/jama.2020.9482

Key Points

Question  What is the association of estrogen plus progestin or estrogen alone with breast cancer incidence and breast cancer mortality?

Findings  In long-term follow up of 2 placebo-controlled randomized clinical trials involving 27 347 postmenopausal women, prior randomized use of conjugated equine estrogen (CEE), compared with placebo, among women with prior hysterectomy was significantly associated with lower risk of breast cancer (annualized incidence, 0.30% vs 0.37%; hazard ratio [HR], 0.78); and breast cancer mortality (annualized mortality, 0.031% vs 0.046%; HR, 0.60), whereas prior randomized use of CEE plus medroxyprogesterone acetate (MPA), compared with placebo, among women with an intact uterus, was significantly associated with higher risk of breast cancer (annualized incidence, 0.45% vs 0.36%; HR, 1.28) and no significant difference in breast cancer mortality (annualized mortality, 0.045% vs 0.035%; HR, 1.35).

Meaning  Among postmenopausal women, prior randomized use of CEE in women with prior hysterectomy was significantly associated with a lower risk of breast cancer incidence and mortality, whereas prior randomized use of CEE plus MPA in women with an intact uterus was significantly associated with a higher risk of breast cancer incidence and no significant difference in breast cancer mortality.

Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women’s Health Initiative Randomized Clinical Trials