Web-based stress management for newly diagnosed cancer patients (STREAM-1)

Grossert, A. et al. BMC Cancer. Published online: 3 November 2016


Background: Being diagnosed with cancer causes major psychological distress, yet the majority of newly diagnosed cancer patients lack psychological support. Internet interventions overcome many barriers for seeking face-to-face support and allow for independence in time and place. We assess efficacy and feasibility of the first web-based stress management intervention (STREAM: STREss-Aktiv-Mindern) for newly diagnosed, German-speaking cancer patients.

Methods/design: In a prospective, wait-list controlled trial 120 newly diagnosed cancer patients will be included within 12 weeks of starting anti-cancer treatment and randomized between an immediate (intervention group) or delayed (control group) 8-week, web-based intervention. The intervention consists of eight modules with weekly written feedback by a psychologist (“minimal-contact”) based on well-established stress management manuals including downloadable audio-files and exercises. The aim of this study is to evaluate efficacy in terms of improvement in quality of life (FACT-F), as well as decrease in anxiety and depression (HADS), as compared to patients in the wait-list control group. A sample size of 120 patients allows demonstrating a clinically relevant difference of nine points in the FACT score after the intervention (T2) with a two-sided alpha of 0.05 and 80 % power. As this is the first online stress management intervention for German-speaking cancer patients, more descriptive outcomes are equally important to further refine the group of patients with the largest potential for benefit who then will be targeted more specifically in future trials. These descriptive endpoints include: patients’ characteristics (type of cancer, type of treatment, socio-demographic factors), dropout rate and dropout reasons, adherence and satisfaction with the program.

Discussion: New technologies open new opportunities: minimal-contact psychological interventions are becoming standard of care in several psychological disorders, where their efficacy is often comparable to face-to-face interventions. With our study we open this field to the population of newly diagnosed cancer patients. We will not only assess clinical efficacy but also further refine the target population who has the most potential to benefit. An internet-based minimal-contact stress management program might be an attractive, time- and cost-effective way to effectively deliver psychological support to newly diagnosed cancer patients and an opportunity to include those who currently are not reached by conventional support.

Read the full article here

Vitamin B6 and Cancer Risk: A Field Synopsis and Meta-Analysis

Mocellin, S et al. (2017) Journal of the National Cancer Institute. 109(3) – published online ahead of print

vitamin-1276833_960_720Background: Vitamin B6 is involved in many biochemical reactions and might play a role in carcinogenesis. We summarized the evidence linking vitamin B6 to cancer risk.

Methods: We conducted a systematic review of both observational and intervention studies investigating the relationship between vitamin B6 intake or blood levels of its bioactive form pyridoxal-5′-phosphate (PLP) and the risk of any type of cancer. Random-effects meta-analysis was used to calculate pooled relative risks (RRs) and their 95% confidence intervals (CIs) across studies for high vs low categories of vitamin intake or PLP levels. We also performed a random-effects dose-response meta-analysis.

Results: We identified 121 observational studies (participants, n = 1 924 506; cases, n = 96,436) and nine randomized controlled trials (RCTs; participants, n = 34 911; cases, n = 2539) considering 19 tumor sites. High intake of dietary (food only) vitamin B6 was statistically significantly associated with lower risk of all cancers (relative risk [RR] = 0.78, 95% CI = 0.73 to 0.84) and specific tumors, with special regard to gastrointestinal carcinomas (RR = 0.68, 95% CI = 0.61 to 0.75). An inverse association was also observed between high PLP levels and the risk of all cancers (RR = 0.66, 95% CI = 0.58 to 0.76) and single tumor sites, the most consistent results being those for gastrointestinal tumors (RR = 0.56, 95% CI = 0.48 to 0.65). There was a statistically significant inverse linear relationship between cancer risk and both vitamin B6 dietary intake and PLP levels. When total (food and supplements) intake was considered, the associations were weaker or null. Findings from RCTs did not support a protective effect of vitamin B6 against cancer, although this evidence was graded as low level.

Conclusions: Epidemiological evidence supports the potential of vitamin B6 as a cancer risk reduction agent and the role of PLP as a cancer screening biomarker, especially for gastrointestinal tumors. However, inconsistent findings from total intake and intervention studies suggest that vitamin B6 might also be an indicator of other dietary protective micronutrients.

Read the abstract here

Radiotherapy gets the investment it needs

Samuel, E. Cancer Research UK – Science Blog. Published online: 25 October 2016

NHS Refresh

Today NHS England announced that it will invest £130m over the next couple of years in new radiotherapy machines.

This is great news. Especially when research has shown that for some types of cancer, more advanced radiotherapy techniques – which the newer machines can provide – are what patients need.

It was around 4 years ago that we first raised the issue that England’s radiotherapy machines were becoming out of date and needed to be replaced. A point we’ve raised time and time again since.

So we were pleased when support for buying new machines featured in England’s cancer strategy, published last year.

And it’s fantastic that the NHS is now dedicating money to this unsung hero of cancer treatment.

Read the full blog post here


Commissioning groups’ performance on cancer care in England

Edwards, N. (2016) BMJ355:i5554


It doesn’t look good, but CCGs are only one part of the pathway

NHS England, the body responsible for overseeing local clinical commissioning groups (CCGs), recently published information on how these groups are performing on cancer care. The results were not good. Almost nine out of 10 CCGs were failing (180/209) with only 14% (29) doing well or better.

But beyond the headline figures, these results tell us more about the mess that remains following the 2012 Health and Social Care Act and about how policy makers are running out of ideas on how to make change happen.

The measures cover four indicators. On average CCGs had 50% of cancers diagnosed at stage 1 or 2—showing improvement, but some way from the 2020 target of 62% specified by the independent cancer task force that informed NHS England’s strategy. Only three CCGs came close, with the worst performing CCGs managing just over 30%.

Average one year survival for all cancers is just under 70%, but with a spread of 10 percentage points between the best and worst performing CCGs (64% to 74%). The survival target for 2020 is 75%. Patient experience was high compared with hospital services more generally, at 88%, but varies widely (67% to 96%).

Read the full editorial here

Cancer Awareness Measures (CAM) survey: perceived barriers to seeing GPs

Forty per cent of people say that having to talk through their symptoms with doctors’ receptionists could put them off going to their GP, according to research. | Science Daily |  Journal of Public Health


Analysis of the Cancer Awareness Measure (CAM) published in the Journal of Public Health found that the most commonly perceived barriers to seeing a GP were finding it difficult to get an appointment with a particular doctor (42 per cent), or at a convenient time (42 per cent), and disliking having to talk to GP receptionists about symptoms (40 percent).

The survey of almost 2,000 people in Great Britain,also found that women were more likely to report these barriers.

Those from a lower socio-economic background were more likely to report a number of possible ’emotional’ barriers like worrying about what the GP might find, having tests and talking about symptoms. They were also more likely to say they would be put off going to their GP if they couldn’t see a particular doctor.

Across all groups, not wanting to be seen as someone who makes a fuss was a commonly perceived barrier to seeking help (35 per cent).

Read more via Cancer Research UK

Full reference: Moffat, J. et. al.  Identifying anticipated barriers to help-seeking to promote earlier diagnosis of cancer in Great Britain. Journal of Public Health DOI: 10.1016/j.puhe.2016.08.012


Nivolumab for Recurrent Squamous-Cell Carcinoma of the Head and Neck

Ferris, R.L. New England Journal of Medicine. Published online: 9 October 2016

N0009269 Cancer of the tongue
Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows photomicrograph of squamous cell carcinoma of the tongue.

Background: Patients with recurrent or metastatic squamous-cell carcinoma of the head and neck after platinum chemotherapy have a very poor prognosis and limited therapeutic options. Nivolumab, an anti–programmed death 1 (PD-1) monoclonal antibody, was assessed as treatment for this condition.

Methods: In this randomized, open-label, phase 3 trial, we assigned, in a 2:1 ratio, 361 patients with recurrent squamous-cell carcinoma of the head and neck whose disease had progressed within 6 months after platinum-based chemotherapy to receive nivolumab (at a dose of 3 mg per kilogram of body weight) every 2 weeks or standard, single-agent systemic therapy (methotrexate, docetaxel, or cetuximab). The primary end point was overall survival. Additional end points included progression-free survival, rate of objective response, safety, and patient-reported quality of life.

Results: The median overall survival was 7.5 months (95% confidence interval [CI], 5.5 to 9.1) in the nivolumab group versus 5.1 months (95% CI, 4.0 to 6.0) in the group that received standard therapy. Overall survival was significantly longer with nivolumab than with standard therapy (hazard ratio for death, 0.70; 97.73% CI, 0.51 to 0.96; P=0.01), and the estimates of the 1-year survival rate were approximately 19 percentage points higher with nivolumab than with standard therapy (36.0% vs. 16.6%). The median progression-free survival was 2.0 months (95% CI, 1.9 to 2.1) with nivolumab versus 2.3 months (95% CI, 1.9 to 3.1) with standard therapy (hazard ratio for disease progression or death, 0.89; 95% CI, 0.70 to 1.13; P=0.32). The rate of progression-free survival at 6 months was 19.7% with nivolumab versus 9.9% with standard therapy. The response rate was 13.3% in the nivolumab group versus 5.8% in the standard-therapy group. Treatment-related adverse events of grade 3 or 4 occurred in 13.1% of the patients in the nivolumab group versus 35.1% of those in the standard-therapy group. Physical, role, and social functioning was stable in the nivolumab group, whereas it was meaningfully worse in the standard-therapy group.

Conclusions: Among patients with platinum-refractory, recurrent squamous-cell carcinoma of the head and neck, treatment with nivolumab resulted in longer overall survival than treatment with standard, single-agent therapy.

Read the full article here

New tool for cancer patients measures the stress of expenses

ScienceDaily. Published online: October 7 2016

For many patients, the uncertainty and stress that can come with cancer treatment is compounded by what is now known as “financial toxicity,” the anxiety and distress that follow health care and medication expenses, often compounded by reduced ability to work.

In the October 5, 2016, issue of the journal Cancer, a team of specialists demonstrates how a survey can measure a patient’s risk for, and ability to tolerate, financial stress.

With data from 233 patients going through treatment for advanced cancers, the researchers showed that the COST (COmprehensive Score for financial Toxicity) questionnaire identified patients at financial distress, which was found to be a “clinically relevant patient-centered measure.”

“As expected, we found a strong association between a patient’s use of health care resources and his or her sense of financial toxicity,” said the study’s lead author Jonas de Souza, MD, MBA, a head-and-neck cancer specialist and health services researcher at the University of Chicago Medicine. “This is something we need to look for, to recognize early and make sure it does not become a barrier to care.”

More than two admissions to the hospital, for example, had a significant impact on a patient’s sense of financial toxicity. “This is reasonable,” de Souza said. “Hospital care is much more expensive than office-based care. We now know that it also impacts a patient’s self-reported financial feelings.”

Read the full commentary here

Read the original research article here

Assessment and management of malnutrition in patients with lung cancer

Donald, M & Borthwick, D. (2016) Cancer Nursing Practice. 15(8) pp. 27-31

B0007208 Lung cancer cells
Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0
Image shows scanning electron micrograph of lung cancer cells.
Malnutrition is common in patients with cancer and is a major cause of morbidity and mortality. Many patients with lung cancer have multiple disease-related symptoms, which, along with the effect of treatment and the psychological distress of diagnosis, are likely to affect their nutritional status and overall quality of life.

This article outlines the consequences of malnutrition in patients with lung cancer and the effect of treatment options on nutritional status. It explores identification and management of malnutrition in patients, including the early use of nutritional screening and the provision of nutritional support such as dietary counselling and modification, oral nutritional supplements, and enteral and parenteral nutrition. A nutritional care pathway is outlined, which aims to help nurses and other healthcare professionals adopt an evidence-based, best practice approach to nutritional care for patients with lung cancer. The importance of the lung cancer clinical nurse specialist in nutritional screening and support is highlighted.

Read the abstract here