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

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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

Cancer Cash Crisis – Counting the cost of care beyond treatment

A new report from cancer charity Macmillan makes the case for government and the NHS to implement the recommendations laid out in the cancer strategy so that everyone with cancer gets the best possible care and support.

image source: http://www.macmillan.org.uk/

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.

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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.

NICE rejects trastuzumab emtansine for use on NHS

BMJ 2015;351:h6837

The advanced breast cancer treatment trastuzumab emtansine (marketed by Roche as Kadcyla) will not be available through normal funding routes on the NHS in England, final guidance from the UK National Institute for Health and Care Excellence has said.

The drug has been licensed to treat HER2 positive metastatic breast cancer that has stopped responding to initial treatment. It is capable of extending the life of patients with advanced breast cancer by six months, but the cost of £90 000 (€130 000; $140 000) for an average course of treatment (14.5 months) gives trastuzumab a cost per quality adjusted life year (QALY) of £166 000, well above the normal threshold for drugs used at the end of life of around £50 000 per QALY.

In October trastuzumab emtansine was one of five drugs that were reinstated to the list of drugs paid for by England’s Cancer Drugs Fund after a discount from Roche, although the size of the price reduction was not disclosed.2 This meant that women in England will continue to have access to the drug until April next year, when a new cancer drugs fund is due to be launched.

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Bone cancer researchers discover how to block, potentially treat osteosarcoma

Scientists at Princess Margaret Cancer Centre have discovered that blocking the master regulator of bone renewal stops osteosarcoma — the most common primary bone cancer in children and teens

The proof-of-concept findings, published online in Science Translational Medicine, establish the importance and function of the bone master regulator, a protein known as RANKL, in bone cancer and set the stage to develop rationalized targeted therapy for patients, says principal investigator Rama Khokha, Senior Scientist at the Princess Margaret Cancer Centre. Dr. Khokha is also a Professor in the departments of Medical Biophysics and Laboratory Medicine and Pathobiology at the University of Toronto.

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Adjuvant Chemotherapy in Rectal Cancer after Chemoradiotherapy

Abstract

The aim of this overview was to investigate whether adjuvant chemotherapy has a favourable effect on the outcome of patients with rectal cancer who had preoperative (chemo)radiotherapy.

A review of randomised clinical trials that allocated patients between fluorouracil-based and observation or between fluorouracil-based and oxaliplatin-based adjuvant chemotherapy after preoperative (chemo)radiotherapy was carried out, including their corresponding meta-analyses.

None of the five randomised trials has shown a significant benefit of fluorouracil-based adjuvant chemotherapy for overall survival or disease-free survival. Also, the three corresponding meta-analyses failed to show a benefit of adjuvant treatment. Of three randomised trials – two phase III and one phase II with a 3-year disease-free survival end point – two showed a small benefit of adding oxaliplatin to fluorouracil, one failed. The corresponding meta-analyses showed that the pooled difference was not significant.

In conclusion, the use of postoperative 5-fluorouracil-based chemotherapy with or without oxaliplatin in patients with rectal cancer after preoperative (chemo)radiotherapy is not scientifically proven.