Diabetes, metformin and incidence of and death from invasive cancer in postmenopausal women: Results from the Women’s Health Initiative

Gong, Z. et al. (2015) International Journal of Cancer

Abstract

Findings from studies of metformin use with risk of cancer incidence and outcome provide mixed results; with few studies examined associations by recency of diabetes diagnosis or duration of medication use. Thus, in the Women’s Health Initiative, we examined these associations and further explored whether associations differ by recency of diabetes and duration of metformin use.

Cox regression models were used to estimate hazard ratios (HR) and their 95% confidence intervals. Diabetes was associated with higher risk of total invasive cancer (HR, 1.13; p<0.001), and of several site-specific cancers (HR, 1.2-1.4, and up to over 2-fold). Diabetes was also associated with higher risk of death from cancer (HR, 1.46; p<0.001). There was no overall difference in cancer incidence by diabetes therapy (p=0.66). However, there was a lower risk of death from cancer for metformin users, compared to users of other medications, relative to women without diabetes, overall (HRs, 1.08 versus 1.45; p=0.007) and for breast cancer (HRs, 0.50 versus 1.29; p=0.05).

Results also suggested that lower cancer risk associated with metformin may be evident only for a longer duration of use in certain cancer sites or subgroup populations. We provide further evidence that postmenopausal women with diabetes are at higher risk of invasive cancer and cancer death. Metformin users, particularly long-term users, may be at lower risk of developing certain cancers and dying from cancer, compared to users of other anti-diabetes medications. Future studies are needed to determine the long-term effect of metformin in cancer risk and survival from cancer.

 

Consequences of cancer Toolkit

Latest Health News

Improvements in the diagnosis and treatment of cancer mean that more people are living longer after a cancer diagnosis, but not everyone is living well.

Image source: www.rcgp.org.uk/coc

The consequences of treatment can include physical and psychological effects, such as chronic fatigue, sexual difficulties, mental health problems, pain and urinary or gastrointestinal problems. Certain cancer treatments also increase the risk of other serious long-term conditions such as heart disease, osteoporosis or a second primary cancer.

Macmillan Cancer Support estimate that at least 625,000 people in the UK experience long term health conditions caused by cancer or its treatment – to estimate prevalence amongst GP practice populations, this is the equivalent of about 15 patients per 1500 list size.

Who is the toolkit for?

The toolkit provides resources and information for primary care professionals to identify and manage the consequences of cancer treatment, and support patients to live well after a…

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Bowel cancer: a vision for 2020

A report from a national bowel cancer charity sets out five ambitions for the future of bowel cancer care.

These are: one million more people screened, no one with symptoms turned away, the best treatment for every patient, more bowel cancer nurses, and support for everyone after treatment.

Press release available here

Cancer drugs fund consultation

NHS England has launched a 12-week consultation on draft proposals outlining a new Cancer Drugs Fund (CDF). The aim of the new CDF is to help patients receive new treatments with genuine promise, while real world evidence is collected for up to two years on how well they work in practice. This will then help determine whether the treatment should be accepted for routine use in the NHS in the future. The consultation period runs until 11 February 2016.

 

Additional link:  NICE press release

Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer

Article first published online: 13 NOV 2015

BACKGROUND
National guidelines recommend that patients with a cancer diagnosis engage in regular physical activity to reduce cancer-related fatigue, maintain quality of life and physical function, and improve overall prognosis and survival. This study investigates oncology provider communications about physical activity during routine clinic visits with patients with early-stage breast, colon, or prostate cancer.

METHODS
This study used a retrospective chart review for documentation of inquiries or recommendations pertaining to physical activity in clinician notes and after-visit patient summaries.

RESULTS
In a 1-month period, 55 oncology providers had 361 encounters (clinic visits) with early-stage cancer patients. Thirty-five percent of these encounters included a provider communication about “physical activity,” “exercise,” or “activity.” Encounters with a medical oncologist resulted in a physical activity communication 55% of the time, whereas encounters with other clinician specialties did so 20% of the time (P < .0001). The likelihood of a physical activity communication increased with patient age (P < .001). When the encounter was with a patient who was being seen for surveillance, chemotherapy, or endocrine treatment, the rate of physical activity communications was significantly higher (46%, 37%, and 58%, respectively) than the rate when the visit was during radiation treatment or surgery (6% and 19%, respectively; P < .0001).

CONCLUSIONS
This study shows that it is feasible for oncology providers to have physical activity communications during routine clinic visits; however, the frequency of physical activity communications varies among providers. Interventions are needed to remind and encourage all oncology providers to encourage their patients with early-stage cancer to be physically active.

via Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer – Nyrop – 2015 – Cancer – Wiley Online Library.

Patient satisfaction with telephone follow up after treatment

Cancer Nursing Practice. 14, 9, 27-33.

The National Confidential Enquiry into Patient Outcome and Death highlighted the need to improve patient outcomes and safety when undergoing chemotherapy. The audit discussed in this article assessed proactive telephone follow up by staff on a chemotherapy helpline after a patient’s first cycle of chemotherapy.

A list of patients eligible for proactive follow up was compiled from a database of those undergoing treatment. A subset of eligible patients consented to participate in a telephone satisfaction survey and 150 were eligible for proactive follow up. Of 131 calls made, most (90%) were successful and 61% reported a number of problems (range=0-5), the most common being gastrointestinal side effects and fatigue. Active management was required in 18% of patients.

Patients reported high levels of satisfaction with proactive follow up. Of those surveyed (n=49), all reported that the call was useful. The majority (98%) were satisfied with telephone calls as a means of follow up. Proactive telephone follow up is shown to be an effective and acceptable method that enhances quality of care.

via Patient satisfaction with telephone follow up after treatment : Cancer Nursing Practice: Vol. 14, No. 9 (RCNi)

Effect of chemotherapy-induced nausea on patients’ quality of life

Cancer Nursing Practice. 14, 9, 34-39

The aim of this review was to synthesise and critique the evidence on patients experiencing chemotherapy-induced nausea and vomiting (CINV) and how it affects quality of life (QoL).

CINV has been recognised internationally as a life-limiting side effect. The needs of patients are recognised but poorly managed, which has an adverse effect on their QoL. Patients are potentially vulnerable and may require ongoing nursing advocacy and support.

Databases were searched during September 2014, after which limitations and inclusion criteria were applied. Outcomes were clustered into four main themes: effect of acute and delayed nausea and vomiting on QoL; effect of highly emetogenic chemotherapy in comparison with moderately emetogenic chemotherapy; effect of non-pharmacological approaches in reducing the effects of CINV; and psychosocial effects of CINV on QoL.

The review exposed inconsistencies in symptom management during chemotherapy. CINV is prevalent despite use of antiemetic treatments. Further qualitative research is recommended to understand the effect CINV has on QoL and non-pharmacological approaches are presented to be considered as additions to care.

Read More: http://journals.rcni.com/doi/abs/10.7748/cnp.14.9.34.s21?af=R

via Effect of chemotherapy-induced nausea on patients’ quality of life : Cancer Nursing Practice: Vol. 14, No. 9 (RCNi).

Body Mass Index Is Prognostic in Metastatic Colorectal Cancer

JCO October 26, 2015 JCO.2015.61.6441

Purpose

In recent retrospective analyses of early-stage colorectal cancer (CRC), low and high body mass index (BMI) scores were associated with worsened outcomes. Whether BMI is a prognostic or predictive factor in metastatic CRC (mCRC) is unclear.

Patients and Methods

Individual data from 21,149 patients enrolled onto 25 first-line mCRC trials during 1997 to 2012 were pooled. We assessed both prognostic and predictive effects of BMI on overall survival and progression-free survival, and we accounted for patient and tumor characteristics and therapy type (targeted vnontargeted).

Results

BMI was prognostic for overall survival (P < .001) and progression-free survival (P < .001), with an L-shaped pattern. That is, risk of progression and/or death was greatest for low BMI; risk decreased as BMI increased to approximately 28 kg/m², and then it plateaued. Relative to obese patients, patients with a BMI of 18.5 kg/m² had a 27% increased risk of having a PFS event (95% CI, 20% to 34%) and a 50% increased risk of death (95% CI, 43% to 56%). Low BMI was associated with poorer survival for men than women (interaction P < .001). BMI was not predictive of treatment effect.

Conclusion

Low BMI is associated with an increased risk of progression and death among the patients enrolled on the mCRC trials, with no increased risk for elevated BMI, in contrast to the adjuvant setting. Possible explanations include negative effects related to cancer cachexia in patients with low BMI, increased drug delivery or selection bias in patients with high BMI, and potential for an interaction between BMI and molecular signaling pathways.

via Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database.

Personalising the treatment of prostate cancer

The Lancet Oncology: Published Online: 05 November 2015

Summary

The options for men with metastatic castration-resistant prostate cancer (mCRPC) are still far from ideal; however, newly published data have clarified how next-generation sequencing of cancer DNA might lead to a change in the treatment approach, treating cancers harbouring particular gene defects with drugs designed to exploit this weakness.

via Personalising the treatment of prostate cancer – The Lancet Oncology.

Impact of Precision Medicine in Diverse Cancers: A Meta-Analysis of Phase II Clinical Trials

JCO November 10, 2015 vol. 33 no. 32 3817-3825

Purpose

The impact of a personalized cancer treatment strategy (ie, matching patients with drugs based on specific biomarkers) is still a matter of debate.

Methods

We reviewed phase II single-agent studies (570 studies; 32,149 patients) published between January 1, 2010, and December 31, 2012 (PubMed search). Response rate (RR), progression-free survival (PFS), and overall survival (OS) were compared for arms that used a personalized strategy versus those that did not.

Results

Multivariable analysis (both weighted multiple linear regression and random effects meta-regression) demonstrated that the personalized approach, compared with a nonpersonalized approach, consistently and independently correlated with higher median RR (31% v 10.5%, respectively; P < .001) and prolonged median PFS (5.9 v 2.7 months, respectively; P < .001) and OS (13.7 v 8.9 months, respectively; P < .001). Nonpersonalized targeted arms had poorer outcomes compared with either personalized targeted therapy or cytotoxics, with median RR of 4%, 30%, and 11.9%, respectively; median PFS of 2.6, 6.9, and 3.3 months, respectively (all P < .001); and median OS of 8.7, 15.9, and 9.4 months, respectively (all P < .05). Personalized arms using a genomic biomarker had higher median RR and prolonged median PFS and OS (all P ≤ .05) compared with personalized arms using a protein biomarker. A personalized strategy was associated with a lower treatment-related death rate than a nonpersonalized strategy (median, 1.5% v 2.3%, respectively; P < .001).

Conclusion

Comprehensive analysis of phase II, single-agent arms revealed that, across malignancies, a personalized strategy was an independent predictor of better outcomes and fewer toxic deaths. In addition, nonpersonalized targeted therapies were associated with significantly poorer outcomes than cytotoxic agents, which in turn were worse than personalized targeted therapy.

via Impact of Precision Medicine in Diverse Cancers: A Meta-Analysis of Phase II Clinical Trials.