NHS England has published new cancer ratings providing a snapshot of how well different areas of the country are diagnosing and treating cancer and supporting patients. The overall rating for each clinical commissioning group is based on four indicators or metrics; early diagnosis, one year survival, 62 day waits after referral, and overall patient experience.
Herst, J. et al. Clinical Oncology. Published online: September 30 2016
A clinical practice guideline for early stage Hodgkin lymphoma is proposed.
The recommendations, based on a systematic review, have been reviewed by an external panel.
Evidence quality was evaluated with the Cochrane Risk of Bias tool and we used GRADE.
Combined modality therapy or chemotherapy alone are options for early-stage Hodgkin lymphoma.
PET scanning was not considered a good tool to identify patients for whom IFRT could be omitted.
In the past, treatment for patients with early-stage Hodgkin lymphoma consisted mainly of radiotherapy. Now, chemotherapy alone and chemoradiotherapy are treatment options. These guidelines aim to provide recommendations on the optimal management of early-stage Hodgkin lymphoma.
We conducted a systematic review searching MEDLINE, EMBASE, the Cochrane Library and other literature sources from 2003 to 2015, and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Two authors independently reviewed and selected studies, and appraised the evidence quality. The document underwent internal and external review by content, methodology experts, a patient representative and clinicians in Ontario.
We have issued recommendations for patients with classical Hodgkin lymphoma and with nodular lymphocyte predominant Hodgkin lymphoma; with favourable and unfavourable prognosis; and for the use of positron emission tomography to direct treatment. We have provided our interpretation of the evidence and considerations for implementation. Examples of recommendations are: ‘Patients with early-stage classical Hodgkin lymphoma should not be treated with radiotherapy alone’; ‘chemotherapy plus radiotherapy or chemotherapy alone are recommended treatment options for patients with early-stage non-bulky Hodgkin lymphoma’; ‘The Working Group does not recommend the use of a negative interim positron emission tomography scan alone to identify patients with early-stage Hodgkin lymphoma for whom radiotherapy can be omitted without a reduction in progression-free survival’.
Through the use of GRADE, recommendations were geared towards patient important outcomes and their strength reflected the available evidence and its interpretation from the patients’ point of view.
Kleeff, J. et al. (2016) British Journal of Cancer.115, pp. 887-894
Background: Diabetes mellitus is frequently observed in pancreatic cancer patients and is both a risk factor and an early manifestation of the disease.
Methods: We analysed the prognostic impact of diabetes on the outcome of pancreatic cancer following resection and adjuvant chemotherapy using individual patient data from three European Study Group for Pancreatic Cancer randomised controlled trials. Analyses were carried out to assess the association between clinical characteristics and the presence of preoperative diabetes, as well as the effect of diabetic status on overall survival.
Results: In total, 1105 patients were included in the analysis, of whom 257 (23%) had confirmed diabetes and 848 (77%) did not. Median (95% confidence interval (CI)) unadjusted overall survival in non-diabetic patients was 22.3 (20.8–24.1) months compared with 18.8 (16.9–22.1) months for diabetic patients (P=0.24). Diabetic patients were older, had increased weight and more co-morbidities. Following adjustment, multivariable analysis demonstrated that diabetic patients had an increased risk of death (hazard ratio: 1.19 (95% CI 1.01, 1.40), P=0.034). Maximum tumour size of diabetic patients was larger at randomisation (33.6 vs 29.7mm, P=0.026).
Conclusions: Diabetes mellitus was associated with increased tumour size and reduced survival following pancreatic cancer resection and adjuvant chemotherapy.
Niksic, N. et al. (2016) British Journal of Cancer.115, pp. 876–886
Background: Campaigns aimed at raising cancer awareness and encouraging early presentation have been implemented in England. However, little is known about whether people with low cancer awareness and increased barriers to seeking medical help have worse cancer survival, and whether there is a geographical variation in cancer awareness and barriers in England.
Methods: From population-based surveys (n=35 308), using the Cancer Research UK Cancer Awareness Measure, we calculated the age- and sex-standardised symptom awareness and barriers scores for 52 primary care trusts (PCTs). These measures were evaluated in relation to the sex-, age-, and type of cancer-standardised cancer survival index of the corresponding PCT, from the National Cancer Registry, using linear regression. Breast, lung, and bowel cancer survival were analysed separately.
Results: Cancer symptom awareness and barriers scores varied greatly between geographical regions in England, with the worst scores observed in socioeconomically deprived parts of East London. Low cancer awareness score was associated with poor cancer survival at PCT level (estimated slope=1.56, 95% CI: 0.56; 2.57). The barriers score was not associated with overall cancer survival, but it was associated with breast cancer survival (estimated slope=−0.66, 95% CI: −1.20; −0.11). Specific barriers, such as embarrassment and difficulties in arranging transport to the doctor’s surgery, were associated with worse breast cancer survival.
Conclusions: Cancer symptom awareness and cancer survival are associated. Campaigns should focus on improving awareness about cancer symptoms, especially in socioeconomically deprived areas. Efforts should be made to alleviate barriers to seeking medical help in women with symptoms of breast cancer.
ScienceDaily | Published online: September 23 2016
A clinical trial for types of advanced cancer is the first of its kind to show that precision medicine — or tailoring treatment for individual people — can slow down the time it takes for a tumor to grow back, according to research presented at the Molecular Analysis for Personalized Therapy (MAP) conference.
Results from the trial, which took place at the Gustave Roussy Cancer Campus in Paris, found that 199 out of 1110 patients with advanced cancer, who had their genes mapped and their treatment tailored, had around 30 per cent longer before their cancer started growing again compared to any of the previous therapies the patients had tried. This ranged from between five and 32 months.
This trial involved patients who had no other treatment options left and who had already tried three or more cancer therapies. The team found potential faulty molecules to target for 411 of these patients and experimental drugs to hit the targets for 199 of these patients.
All Party Parliamentary Group on Cancer & Macmillan Cancer Support | Published online: 23 September 2016
In July 2015, the Independent Cancer Taskforce published its report Achieving WorldClass Cancer Outcomes: A Strategy for England 2015–2020 (the England Cancer Strategy). Following on from this in May 2016 NHS England published an Implementation Plan: Achieving World-Class Cancer Outcomes: Taking the strategy forward (the Implementation Plan) which outlined how the recommendations from the England Cancer Strategy will be rolled out nationwide. Following the publication of the Implementation Plan, the APPGC launched an inquiry into the progress made since the publication of the England Cancer Strategy. Having reviewed submissions from over 30 stakeholders and listened to oral evidence from those leading the implementation of the England Cancer Strategy, we have identified three key recommendations
This inquiry finds that, one year on from the publication of the England Cancer Strategy, there remains broad consensus amongst witnesses and respondents to the inquiry on its recommendations. This report outlines three recommendations on funding, transparency and accountability, and involvement of organisations with expertise and interest in cancer.
Sanchez, G. et al. Cochrane Skin Group. Published online: 25 September 2016
Keratinocyte cancer (BCC and cSCC of the skin) is the most commonly identified type of skin cancer. The main risk is exposure to ultraviolet radiation, which is a component of sunlight. Prevention has become an important way to manage this cancer, so it is important to assess the effectiveness of methods used to prevent keratinocyte cancer in the general population. In this review, we assessed the effects of using topical sunscreen and physical barrier methods (such as sun-protective clothing, hats, sunglasses, and the active search for shade when outdoors) compared with no specific precautionary interventions aimed at preventing the development of BCC and cSCC in adults and children.
We searched the medical literature up to May 2016 for randomised controlled trials that evaluated preventive strategies. We found only one study suitable for inclusion. This study compared the daily application of sunscreen (with or without beta-carotene, which is a precursor of vitamin A) compared with the occasional use of sunscreen (with or without beta-carotene) in the general population, without restriction by gender or age. The study was undertaken in Australia, where 1621 participants, 55% of them with fair skin, were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology (which is a method used to detect cancerous cells under the microscope).
We found no difference between the number of people who developed BCC or cSCC in the two groups over the time period of the trial. So, there did not seem to be a difference in applying sunscreen daily compared with using it occasionally.
Altman, B.J. et al. Nature Reviews Cancer. 16. pp. 619–634
The resurgence of research into cancer metabolism has recently broadened interests beyond glucose and the Warburg effect to other nutrients, including glutamine. Because oncogenic alterations of metabolism render cancer cells addicted to nutrients, pathways involved in glycolysis or glutaminolysis could be exploited for therapeutic purposes. In this Review, we provide an updated overview of glutamine metabolism and its involvement in tumorigenesis in vitro and in vivo, and explore the recent potential applications of basic science discoveries in the clinical setting.
Brinkman, T.M. et al. (2016) Journal of Clinical Oncology. 34(28) pp. 3417-342
Purpose: In the general population, psychological symptoms frequently co-occur; however, profiles of symptom comorbidities have not been examined among adolescent survivors of childhood cancer.
Patients and Methods: Parents of 3,893 5-year survivors of childhood cancer who were treated between 1970 and 1999 and who were assessed in adolescence (age 12 to 17 years) completed the Behavior Problems Index. Age- and sex-standardizedz scores were calculated for symptom domains by using the Childhood Cancer Survivor Study sibling cohort. Latent profile analysis identified profiles of comorbid symptoms, and multivariable multinomial logistic regression modeling examined associations between cancer treatment exposures and physical late effects and identified symptom profiles. Odds ratios (ORs) and 95% CIs for latent class membership were estimated and analyses were stratified by cranial radiation therapy (CRT; CRT or no CRT).
Results: Four symptoms profiles were identified: no significant symptoms (CRT, 63%; no CRT, 70%); elevated anxiety and/or depression, social withdrawal, and attention problems (internalizing; CRT, 31%; no CRT, 16%); elevated headstrong behavior and attention problems (externalizing; CRT, no observed; no CRT, 9%); and elevated internalizing and externalizing symptoms (global symptoms; CRT, 6%; no CRT, 5%). Treatment with ≥ 30 Gy CRT conferred greater risk of internalizing (OR, 1.7; 95% CI, 1.0 to 2.8) and global symptoms (OR, 3.2; 95% CI, 1.2 to 8.4). Among the no CRT group, corticosteroid treatment was associated with externalizing symptoms (OR, 1.9; 95% CI, 1.2 to 2.8) and ≥ 4.3 g/m2 intravenous methotrexate exposure was associated with global symptoms (OR, 1.5; 95% CI, 0.9 to 2.4). Treatment late effects, including obesity, cancer-related pain, and sensory impairments, were significantly associated with increased risk of comorbid symptoms.
Conclusion: Behavioral, emotional, and social symptoms frequently co-occur in adolescent survivors of childhood cancer and are associated with treatment exposures and physical late effects. Assessment and consideration of symptom profiles are essential for directing appropriate mental health treatment for adolescent survivors.