Cause-specific mortality in women with breast cancer in situ

He, W. et al. International Journal of Cancer. Published online: 4 September 201

Image source: Dr David Becker – Wellcome Images // CC BY-NC-ND 4.0

Image shows a confocal image of breast cancer cells in
culture.

The long-term mortality remains unknown in women diagnosed with breast cancer in situ (BCIS). Here we assessed the cause-specific mortality in BCIS patients. This population-based cohort study included 12 243 women diagnosed with BCIS in Sweden between 1980 and 2011. Patients were followed until death, emigration, or 31 December 2013, whichever came first.

The 30-year cumulative incidence of breast cancer-specific mortality was 6.3%, which is considerably lower than 49.7% observed for other-cause mortality. Women diagnosed with BCIS were more likely to die from breast cancer (standardize mortality ratio [SMR], 3.85; 95%CI, 3.47-4.27) but less likely to die from cardiovascular disease (SMR, 0.88; 95% CI, 0.82-0.95) than women in the general population. Specifically, the SMRs for breast cancer-specific mortality decreased over time from 5.17 (95%CI, 3.95-6.81) among BCIS diagnosed during 1980-1989 to 3.03 (95%CI, 2.35-3.91) among those diagnosed during 2000-2011. Furthermore, higher risk of death from other causes was seen among those with older age at BCIS diagnosis, lower levels of education, nulliparity, higher Charlson Comorbidity Index, and being hospitalized before BCIS diagnosis; whereas lower risk of death from breast cancer was seen among BCIS diagnosed in the later time period and those with younger age at first birth.

We conclude that most women diagnosed with BCIS die from causes other than breast cancer, which highlights the need for actions not only to reduce non-breast cancer mortality but also to identify patient where extensive curative BCIS treatment is not adding to survival.

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“What about diet?” A qualitative study of cancer survivors’ views on diet and cancer and their sources of information

Beeken, R.J. et al. (2016) European Journal of Cancer Care. 25(5). pp. 774–783

Given the abundance of misreporting about diet and cancer in the media and online, cancer survivors are at risk of misinformation. The aim of this study was to explore cancer survivors’ beliefs about diet quality and cancer, the impact on their behaviour and sources of information. Semi-structured interviews were conducted with adult cancer survivors in the United Kingdom who had been diagnosed with any cancer in adulthood and were not currently receiving treatment (n = 19).

Interviews were analysed using Thematic Analysis. Emergent themes highlighted that participants were aware of diet affecting risk for the development of cancer, but were less clear about its role in recurrence. Nonetheless, their cancer diagnosis appeared to be a prompt for dietary change; predominantly to promote general health. Changes were generally consistent with healthy eating recommendations, although dietary supplements and other non-evidence-based actions were mentioned. Participants reported that they had not generally received professional advice about diet and were keen to know more, but were often unsure about information from other sources.

The views of our participants suggest cancer survivors would welcome guidance from health professionals. Advice that provides clear recommendations, and which emphasises the benefits of healthy eating for overall well-being, may be particularly well-received.

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Coffee and green tea consumption in relation to brain tumor risk

Ogawa, T. et al. International Journal of Cancer. Published online: 25 August 2016

Few prospective studies have investigated the etiology of brain tumor, especially among Asian populations. Both coffee and green tea are popular beverages, but their relation with brain tumor risk, particularly with glioma, has been inconsistent in epidemiological studies. In this study, we evaluated the association between coffee and greed tea intake and brain tumor risk in a Japanese population.

We evaluated a cohort of 106,324 subjects (50,438 men and 55,886 women) in the Japan Public Health Center-based Prospective Study (JPHC Study). Subjects were followed from 1990 for Cohort I and 1993 for Cohort II until December 31, 2012. 157 (70 men and 87 women) newly diagnosed cases of brain tumor were identified during the study period. Hazard ratio (HR) and 95% confidence intervals (95%CIs) for the association between coffee or green tea consumption and brain tumor risk were assessed using a Cox proportional hazards regression model.

We found a significant inverse association between coffee consumption and brain tumor risk in both total subjects (≥3 cups/day; HR=0.47, 95%CI=0.22-0.98) and in women (≥3 cups/day; HR=0.24, 95%CI=0.06-0.99), although the number of cases in the highest category was small. Furthermore, glioma risk tended to decrease with higher coffee consumption (≥3 cups/day; HR=0.54, 95%CI=0.16-1.80). No association was seen between green tea and brain tumor risk.

In conclusion, our study suggested that coffee consumption might reduce the risk of brain tumor, including that of glioma, in the Japanese population.

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Excess weight linked to eight more cancer types

Limiting weight gain may help to reduce risk of eight cancers | Science Daily| New England Journal of Medicine

 

An international team of researchers has identified eight additional types of cancer linked to excess weight and obesity: stomach, liver, gall bladder, pancreas, ovary, meningioma (a type of brain tumor), thyroid cancer and the blood cancer multiple myeloma.

Limiting weight gain over the decades could help to reduce the risk of these cancers, the data suggest.

The findings, published Aug. 25 in The New England Journal of Medicine, are based on a review of more than 1,000 studies of excess weight and cancer risk analyzed by the World Health Organization’s International Agency for Cancer on Research (IARC), based in France.

Full reference: Lauby-Secretan, B. et al.  Body Fatness and Cancer — Viewpoint of the IARC Working Group. New England Journal of Medicine, 2016; 375 (8): 794 DOI: 10.1056/NEJMsr1606602

Scientists discover drug combination slows lung cancer cell growth

Image shows lung cancer cell dividing. Source: Anne Weston, Wellcome images // CC BY-NC-ND 4.0

Scientists have shown that a drug combination slows cancer cell growth in a type of non small cell lung cancer when tested in the lab, offering potential for developing new treatments in the future.  Cancer Research UK | British Journal of Cancer

The drug combination delivers a double whammy to the way the KRAS gene makes cancer cells grow. KRAS is estimated to be mutated in 15 to 25 per cent of people with non-small cell lung adenocarcinomas – a disease affecting around 10,400 people in England each year.

The study looked at whether blocking the functions of two proteins called MEK and m-TOR would stop or slow down the growth of non-small cell lung adenocarcinoma cells in the laboratory.

Full reference: Broutin, S. et al.  Insights into significance of combined inhibition of MEK and m-TOR signalling output in KRAS mutant non-small-cell lung cancer. Br J Cancer 115: 549-552; doi:10.1038/bjc.2016.220

Longstanding Challenges in Lung Cancer: Are We Meeting Them?

Snee, M. & Hatton, M.Q. Clinical Oncology. Published online: 20 August 2016

Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0 

It is now over half a century since Doll and Hill published their seminal paper documenting the association between cigarette consumption and the incidence of lung cancer in British doctors, which established, beyond all reasonable doubt, that smoking tobacco causes lung cancer [1]. That this cancer is still the leading cause of cancer death in the UK and causing millions of deaths worldwide is testament to a failure of global public health policy and the veracity of the tobacco companies in producing and selling a product that is estimated to reduce the life expectancy of its users by 10 years [2].

View the abstract here

Study confirms long-term effects of ‘chemobrain’ in mice

ScienceDaily | Published online: 19 August 2016

Women undergoing chemotherapy for breast cancer have long complained of lingering cognitive impairments after treatment. These effects are referred to as “chemobrain,” a feeling of mental fogginess. A new study from the University of Illinois reports long-lasting cognitive impairments in mice when they are administered a chemotherapy regimen used to treat breast cancer in humans.

The results are published in the journal Behavioural Brain Research.

“Cancer survival rates have increased substantially and continue to improve due to both earlier detection and better medical treatments,” said Catarina Rendeiro, a postdoctoral scholar at the Beckman Institute for Advanced Science and Technology. The study’s lead author, Rendeiro collaborated with an interdisciplinary group at Illinois, including Justin Rhodes, a professor of psychology and a Beckman Institute affiliate; and William Helferich, a professor of nutrition in the department of food science and human nutrition.

“Quality of life after chemotherapy is critically important, and chemobrain is significant in these survivors,” Helferich said.

Patient complaints and clinical observations after chemotherapy spurred an interest in chemobrain. While many researchers have examined these effects in humans as well as animals, most such studies do not assess long-term effects. The physical toll of chemotherapy is great and accounts for the short-term cognitive impairments, Rhodes said.

Read the full commentary here

Read the original research abstract here

Vitamin D and patients with palliative cancer

Björkhem-Bergman, L. & Bergman, P. (2016) BMJ Supportive & Palliative Care. 6:287-291

Vitamin D is a hormone that is synthesised in the skin in the presence of sunlight. Sufficient vitamin D levels are important—not only for a healthy skeleton—but also for a healthy immune system. Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased ‘all-cause mortality’ and especially mortality due to cancer. Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life.

We review the role of vitamin D in the immune system, in relation to cancer disease, pain and depression. We have recently performed an observational study in 100 patients with palliative cancer in Sweden. The main result was that low vitamin D levels were associated with higher opioid dose, that is, more pain. We also describe a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being.

Vitamin D supplementation is not connected with any adverse side effects and is easy to administrate. Thus, we hypothesise that vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. However, more clinical studies in this field are needed before firm conclusions can be drawn.

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Need for nutritional support, eating-related distress and experience of terminally ill patients with cancer: a survey in an inpatient hospice

Amano, K. et al. (2016) BMJ Supportive & Palliative Care. 6:373-376

Objectives: Cancer cachexia creates a large burden for terminally ill patients with cancer. The main causes are a lack of knowledge of cancer cachexia and unsuccessful attempts to increase body weight. The role of nutritional support has not been clarified, and patients’ eating-related distress is poorly understood. There has been no study investigating into needs for nutritional support in an inpatient hospice. The primary aim of this study was to explore needs for nutritional support, eating-related distress and patients’ experiences.

Methods A survey was conducted involving 60 patients with advanced cancer in an inpatient hospice. We first asked about need for nutrition therapy in the inpatient hospice. We then asked whether patients had unmet needs for four items. The last question was composed of 19 items concerning patients’ experience of eating-related distress.

Results Thirty-seven patients responded (62%). Most of the patients, 28 of 37 (76%), had general unmet needs for nutrition therapy for cancer cachexia, and more than half needed specific support, such as ‘attention’ and ‘explanation’. The top 5 of the 19 items were mainly about daily diet, nutrition and losing weight. Of these, the top four belonged to the group of coping strategies and the fifth to the group of mechanisms originating from patients themselves.

Conclusions A number of terminally ill patients with cancer admitted to an inpatient hospice had need for nutritional support and experienced high levels of eating-related distress.

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Two drugs set to be removed from the Cancer Drugs Fund

OnMedica | Published online: 18 August 2016

The National Institute for Health and Care Excellence has issued draft guidance recommending that two drugs are removed from the Cancer Drugs Fund because they are not cost effective. The drugs, everolimus (Afinitor made by Novartis) for breast cancer and ibrutinib (Imbruvica, Janssen) for mantle cell lymphoma are being appraised under the new CDF system. The ultimate decision on whether the drugs will be removed will rest with NHS England

Under the new CDF system as a gateway fund for new cancer drugs, NICE recommends drugs are funded through the CDF if there is not enough information to make an immediate decision on whether they should be available on the NHS to enable patients to access the drugs while the company generates the supporting information required.

NICE rejected everolimus (in combination with the drug exemestane) for treating HER2-negative, hormone-receptor-positive advanced breast cancer in 2013 and it was then made available through the CDF.

Read the full news story here