Timing of end-of-life discussions for patients with blood cancers

A majority of hematologic oncologists report that end-of-life (EOL) discussions happen with patients with blood cancers too late, according to an article published online by JAMA Internal Medicine.

Oreofe O. Odejide, M.D., of the Dana-Farber Cancer Institute, Boston, and coauthors examined the timing of EOL discussions through a survey completed by 349 hematologic oncologists (57.3 percent response rate).

About 56 percent of hematologic oncologists (based on a slightly smaller number who answered a survey question about timing) reported EOL discussions happened “too late.” Oncologists in tertiary centers were more likely to report late EOL discussions with patients than those in community centers.

Read the original research article abstract here

Read the full commentary via ScienceDaily


Most cancer cases are avoidable, say researchers

Study says environment and lifestyle factors such as toxic chemicals and radiation are main cause of disease

Most cases of cancer result from avoidable factors such as toxic chemicals and radiation, according to research published online in the journal, Nature.

The findings clash with research published earlier this year which found that differences in cellular processes were the chief reason some tissues became cancerous more frequently than others. That study led to claims that certain cancers were mainly the result of bad luck, and suggested these types would be relatively resistant to prevention efforts.

The new study used four approaches to conclude only 10-30% of cancers were down to the way the body naturally functions or “luck”.

Link to the research: Substantial Contribution of Extrinsic Risk Factors to Cancer Development. Song Wu, Scott Powers, Wei Zhu & Yusuf A. Hannun  Nature. Published online 16 December 2015

Survival rates for patients with prostate cancer better with surgery than radiotherapy

An evaluation of survival rates has shown that cancer patients with localised prostate cancer – the most common form of prostate cancer – have a better chance of survival if treated by surgery than by radiotherapy. These findings hold true even after accounting for type of radiation and the aggressiveness of cancer. This is the most robust analysis (meta-analysis) to date of published literature comparing surgery and radiotherapy for localised prostate cancer.

Full reference: Christopher J.D. Wallis et al. Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis. European Urology, December 2015

National Bowel Cancer Audit report 2015

The National Bowel Cancer Audit Report 2015 has been published by the Royal College of Surgeons in partnership with the Association of Coloproctology of Great Britain and Ireland.  The report shows that the number of people surviving bowel cancer following major surgery has increased significantly in recent years.  The results presented in this report are based upon patients diagnosed with bowel cancer between 1 April 2013 and 31 March 2014.

PARP inhibitors in ovarian cancer: Clinical evidence for informed treatment decisions

Jonathan A Ledermann and Fatima El-Khouly. British Journal of Cancer 113, S10-S16 (15 December 2015)

Ovarian cancer is the fifth leading cause of female cancer deaths in the Western world. Significant progress has been made in the treatment of patients with ovarian cancer, however, the majority of patients experience disease recurrence and new therapies are being sought for such patients. Clinical investigation of poly(ADP-ribose) polymerase (PARP) inhibitors for ovarian cancer treatment has demonstrated promising activity in this disease. Here, we review the development of PARP inhibitors and their future role in the treatment of patients with ovarian cancer. Studies of olaparib, the first PARP inhibitor to be approved in Europe and the USA, in patients with recurrent ovarian cancer have demonstrated clinical efficacy with improvements in progression-free survival. In maintenance therapy of platinum-sensitive ovarian cancer there is supporting evidence of clinical benefit from exploratory endpoints that include time to first subsequent treatment and time to second subsequent treatment. Adverse events that should be monitored following treatment with PARP inhibitors include nausea, vomiting, fatigue and anaemia. Based on the evidence presented, patients who will receive the greatest benefit from PARP inhibition are those with platinum-sensitive relapsed ovarian cancer and a BRCA mutation.

Read the abstract here

The effectiveness of buprenorphine for treating cancer pain: an abridged Cochrane review

Mia Schmidt-Hansen et al. BMJ Supportive & Palliative Care. Published Online: 15 December 2015

Objectives To assess the effectiveness and tolerability of buprenorphine for cancer pain in adults and children.

Methods We searched CENTRAL, MEDLINE, EMBASE, ISI Web of Science, ISI BIOSIS, ClinicalTrials.gov, metaRegister of Controlled Trials, WHO International Clinical Trials Registry Platform and the Proceedings of the Congress of the European Federation of International Association for the Study of Pain to early 2015.

Results We included 19 randomised controlled trials comparing buprenorphine with placebo, buprenorphine or another active drug for cancer pain. The trials included 1421 patients and examined 16 different intervention comparisons. Of the 11 studies that compared buprenorphine to another drug, 5, 3 and 3 studies, respectively, found that buprenorphine was superior, no different or inferior to the alternative treatment in side effects profile or patient preference/acceptability. Pain intensity ratings did not differ significantly between intramuscular buprenorphine and buprenorphine suppository, although intramuscular treatment was associated with more adverse events (1 study). One study found faster onset of pain relief after sublingual than subdermal buprenorphine, with similar analgesia duration and adverse event rates. 2 studies found transdermal buprenorphine superior to placebo, whereas a third study found no difference between placebo and different doses of transdermal buprenorphine. No clear dose–response relationship was found for transdermal buprenorphine. The quality of this evidence base was limited by under-reporting, small sample sizes and attrition.

Conclusions Buprenorphine might be considered as a fourth-line option compared with the more standard therapies of morphine, oxycodone and fentanyl, and even then it would only be suitable for some patients.