Statins and the Risk of Pancreatic Cancer in Type 2 Diabetic Patients – A Population-Based Cohort Study

International Journal of Cancer : DOI: 10.1002/ijc.29813

The aim of this study was to determine whether statin use exerts a protective effect against pancreatic cancer in type 2 diabetic patients. A retrospective population-based cohort study was designed to analyze the National Health Insurance Research database (NHIRD) from 1997-2010 in Taiwan.

A total of 1,140,617 patients with a first-time diagnosis of type 2 diabetes were enrolled. The event was defined as newly diagnosed pancreatic cancer. A Cox proportional hazards regression model with time-dependent covariates was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of pancreatic cancer associated with statin use in the diabetic cohort.

A total of 2,341 patients with newly diagnosed pancreatic cancer were identified in the diabetic cohort during the follow-up period of 6,968,217.1 person-years. In this cohort, 450,282 patients were defined as statin users (statin use ≥28 cumulative defined daily dose [cDDD] in 1 year) and 0.14% had pancreatic cancer; 690,335 patients were statin non-users (statin use <28 cDDD in 1 year) and 0.25% had pancreatic cancer.

Statin use significantly decreased the risk of pancreatic cancer (adjusted HRs: 0.78 in 28-83 cDDD per year; 0.48 in 84-180 cDDD per year; and 0.33 in >180 cDDD per year) after adjusting for multiple confounders.

There was a significant dose-effect of statin use for the risk of pancreatic cancer (P for trend: <0.001). Statin use may be associated with a reduced risk of pancreatic cancer in type 2 diabetic patients.

More research is needed to clarify this association.

via Statins and the Risk of Pancreatic Cancer in Type 2 Diabetic Patients – A Population-Based Cohort Study – Chen – International Journal of Cancer – Wiley Online Library.

Are beta-blockers on the therapeutic horizon for ovarian cancer treatment?

Cancer: Article first published online: 24 AUG 2015

Widely used medications for other disease processes, such as beta-blockers used for the management of hypertension, may provide therapeutic potential in patients with cancer, perhaps by altering the tumor microenvironment.

The article by Watkins et al in the current issue performed a comprehensive review of beta-blocker use in women with ovarian cancer, and identified nonselective beta-blockers associated with longer overall survival.

via Are beta-blockers on the therapeutic horizon for ovarian cancer treatment? – Bunch – 2015 – Cancer – Wiley Online Library.

Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives

Cancer: Volume 121, Issue 17, pages 2951–2959, September 1, 2015

BACKGROUND
Ethnic minorities, especially African Americans and Latinos, bear a disproportionate burden of colorectal cancer (CRC), as reflected in incidence, cancer stage, and mortality statistics. In all ethnic groups, first-degree relatives (FDRs) of CRC cases are at an elevated disease risk. However, underuse of CRC screening persists and is particularly evident among minority groups. The current study tested a stepped intervention to increase CRC screening among an ethnically diverse sample of FDRs of CRC cases.

METHODS
A statewide cancer registry was used to recruit CRC cases and through them their FDRs. Relatives who were not current on CRC screening were randomized to intervention or usual-care control arms. The stepped intervention consisted of ethnically targeted and individually tailored print materials followed by telephone counseling for those unscreened at 6 months.

RESULTS
The study sample of 1280 individuals consisted of 403 Latino, 284 African American, 242 Asian, and 351 white FDRs. Statistically significant effects were observed for the cumulative print plus telephone intervention at 12 months (26% in the intervention vs 18% in the control group) and the print intervention alone at 6 months (15% in the intervention vs 10% in the control group). The effect of the print intervention alone versus the cumulative interventions was not statistically significantly different. Stratified analyses indicated that the intervention was effective among white, Latino, and Asian individuals, but not among African-Americans.

CONCLUSIONS
Overall, the intervention was effective in increasing screening rates. Oversampling racial/ethnic minorities allowed for the examination of effects within subgroups, revealing no effect among African American individuals. This finding illustrates the importance of including sufficient numbers of participants from diverse ethnic subgroups in intervention research to enable such stratified analyses.

via Randomized trial to increase colorectal cancer screening in an ethnically diverse sample of first-degree relatives – Bastani – 2015 – Cancer – Wiley Online Library.

Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology

JCO August 20, 2015 vol. 33 no. 24 2705-2711

Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape.

The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors.

In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice.

The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.

via Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology.

Systematic review of acupuncture to control hot flashes in cancer patients

Cancer: Article first published online: 17 AUG 2015

Hot flashes (HFs) are a common side effect of cancer treatment. The purpose of this systematic review was to evaluate evidence related to the use of acupuncture for HFs in cancer patients.

EMBASE, MEDLINE, Cochrane (all databases), PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from their inception through December 2014. Included studies had to be randomized controlled trials with a usual-care and/or placebo comparison group that investigated acupuncture to treat HFs in cancer patients. No language limits were applied.

The risk of bias (ROB) was rated as low, high, or unclear according to Cochrane criteria. Both within-group and between-group changes were evaluated. Four hundred two items were identified, and 192 duplicates were omitted; this left 210 publications to be screened. Eight studies met the inclusion criteria, and all involved women with breast cancer. All studies showed significant within-group improvement from the baseline for true acupuncture (TA). One study showed significant improvement in favor of TA over sham acupuncture (SA; P < .001), 1 study found in favor of TA over SA for nighttime HFs only (P = .03), and 1 study found in favor of TA over SA or untreated controls (P < .01 and P < .001, respectively). Between-group (TA vs SA) effect size (ES) estimates for daytime and nighttime HFs were calculated (ES range, 0.04-0.9) whenever possible. No studies were rated with a low ROB.

In conclusion, the current level of evidence is insufficient to either support or refute the benefits of acupuncture for the management of HFs in cancer patients. Future studies should provide within-group and between-group ES estimates in addition to P values.

via Systematic review of acupuncture to control hot flashes in cancer patients – Garcia – 2015 – Cancer – Wiley Online Library.

Light/moderate drinking linked to increased risk of some cancers in women

Even light and moderate drinking (up to one drink a day for women and up to two drinks a day for men) is associated with an increased risk of certain alcohol related cancers in women and male smokers, suggests a large study published by The BMJ today.

The study, which involved almost 136,000 people, found women who drank the equivalent of a glass of wine a day over a 30-year period were 13% more likely to develop one of the alcohol-related cancers (breast cancer being the most common) than women who didn’t drink at all.

The study found low to moderate drinking increased the risk of certain types of cancers already thought to be linked to alcohol, but only among women or people who smoked. Men who didn’t smoke and drank moderately had no increased risk of any type of cancer.

Full reference: Yin Cao et al. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. The BMJ, August 2015.

Imaging software could speed up breast cancer diagnosis

New software could speed up breast cancer diagnosis with 90% accuracy without the need for a specialist, according to research published in the open access journal Breast Cancer Research.

Introduction: Pathologists currently diagnose breast lesions through histologic assessment, which requires fixation and
tissue preparation. The diagnostic criteria used to classify breast lesions are qualitative and subjective, and inter-observer
discordance has been shown to be a significant challenge in the diagnosis of selected breast lesions, particularly for
borderline proliferative lesions. Thus, there is an opportunity to develop tools to rapidly visualize and quantitatively
interpret breast tissue morphology for a variety of clinical applications.

Methods: Toward this end, we acquired images of freshly excised breast tissue specimens from a total of 34 patients
using confocal fluorescence microscopy and proflavine as a topical stain. We developed computerized algorithms to
segment and quantify nuclear and ductal parameters that characterize breast architectural features. A total of 33
parameters were evaluated and used as input to develop a decision tree model to classify benign and malignant breast
tissue. Benign features were classified in tissue specimens acquired from 30 patients and malignant features were
classified in specimens from 22 patients.

Results: The decision tree model that achieved the highest accuracy for distinguishing between benign and malignant
breast features used the following parameters: standard deviation of inter-nuclear distance and number of duct
lumens. The model achieved 81 % sensitivity and 93 % specificity, corresponding to an area under the curve of 0.93
and an overall accuracy of 90 %. The model classified IDC and DCIS with 92 % and 96 % accuracy, respectively. The
cross-validated model achieved 75 % sensitivity and 93 % specificity and an overall accuracy of 88 %.

Conclusions: These results suggest that proflavine staining and confocal fluorescence microscopy combined with
image analysis strategies to segment morphological features could potentially be used to quantitatively diagnose
freshly obtained breast tissue at the point of care without the need for tissue preparation.

Full reference:  Dobbs, J et al. Micro-anatomical quantitative optical imaging: toward automated assessment of breast tissues. Breast Cancer Research, 2015; 17 (1)

E-CIGARETTES AROUND 95% LESS HARMFUL THAN TOBACCO ESTIMATES LANDMARK REVIEW

Expert independent review concludes that e-cigarettes have potential to help smokers quit.

An expert independent evidence review published today by Public Health England (PHE) concludes that e-cigarettes are significantly less harmful to health than tobacco and have the potential to help smokers quit smoking.

Key findings of the review include:

• the current best estimate is that e-cigarettes are around 95% less harmful than smoking
• nearly half the population (44.8%) don’t realise e-cigarettes are much less harmful than smoking
• there is no evidence so far that e-cigarettes are acting as a route into smoking for children or non-smokers

The review, commissioned by PHE and led by Professor Ann McNeill (King’s College London) and Professor Peter Hajek (Queen Mary University of London), suggests that e-cigarettes may be contributing to falling smoking rates among adults and young people. Following the review PHE has published a paper on the implications of the evidence for policy and practice.

The comprehensive review of the evidence finds that almost all of the 2.6 million adults using e-cigarettes in Great Britain are current or ex-smokers, most of whom are using the devices to help them quit smoking or to prevent them going back to cigarettes. It also provides reassurance that very few adults and young people who have never smoked are becoming regular e-cigarette users (less than 1% in each group).

Full review E-cigarettes: an evidence update – A report commissioned by Public Health England

Related articles:

BBC News: E-cigarettes could be prescribed by the NHS to help smokers quit, report says

Guardian: Vaping: e-cigarettes safer than smoking, says Public Health England

Video: E-cigs ‘a game changer’ for smokers says report

Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics

BMC Cancer 2015, 15:578

Background
The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care.

Methods
Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data.

Results
Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain.

Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner.

Conclusion
Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice.

via BMC Cancer | Abstract | Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics.

Knowledge and attitudes regarding medical research studies among patients with breast cancer and gynecological diseases

BMC Cancer 2015, 15:587

Background
Medical research studies are becoming increasingly important for optimizing the prevention, diagnosis and treatment of illnesses. Participation in research studies can have many benefits for patients. In randomized and controlled clinical studies, they can receive the best possible medical care currently available. However, only a small proportion of patients nowadays are treated within the framework of medical research. The primary endpoint of this study was to discover what level of knowledge patients have about clinical studies and how they currently perceive them, in order to identify ways of optimizing the information provided about studies from the patients’ point of view.

Methods
The study included 2546 patients (breast cancer 21.6 %, gynecological cancer 8.3 %, obstetrics 32.7 %, endometriosis 7.8 %, fertility treatment 3.2 %, other benign gynecological illnesses 19.2 %, no information for 7.2 %) in the outpatient clinic (45.2 %) and in the in-patient sector (54.8 %) at the Department of Gynecology at Erlangen University Hospital and associated centers. In the single-center study, conducted between January 2011 and January 2012, the patients were asked about their level of knowledge regarding the background to medical research studies and the ways in which they are carried out and used. The patients were also asked how they perceived medical studies and how they thought study conditions might be optimized. The three-page questionnaire was included in the feedback sheet received by patients as part of the hospital’s quality management system.

Results
As a whole, the group only had moderate knowledge about clinical studies. A majority of the respondents considered that studies were valuable (91.6 %), but only a few were also willing to take part in them (58.4 %). Knowledge and willingness to participate strongly depended on age (P < 0.001), educational level (P < 0.001) and patient group (P < 0.001). Most patients would prefer to decide about participating in studies through a discussion with their outpatient physicians.

Conclusions
The information that patients have about clinical studies affects whether they participate in them. It is therefore extremely important for patients to be well informed, for their anxieties about participation to be relieved, and for the benefits of participation to be explained to them.

via BMC Cancer | Abstract | Knowledge and attitudes regarding medical research studies among patients with breast cancer and gynecological diseases.