Adolescent and young adult oncology patients: Disparities in access

Alvarez, E. et al. Cancer. Published online: 27 February 2017

Background: Adolescents and young adults (AYAs) ages 15 to 39 years with cancer continue to experience disparate survival outcomes compared with their younger and older counterparts. This may be caused in part by differential access to specialized cancer centers (SCCs), because treatment at SCCs has been associated with improved overall survival. The authors examined social and clinical factors associated with AYA use of SCCs (defined as Children’s Oncology Group-designated or National Cancer Institute-designated centers).

 

Conclusions: Receiving care at an SCC was influenced by insurance, race/ethnicity, geography, and tumor type. Identifying the barriers associated with decreased SCC use is an important first step toward improving outcomes in AYA oncology patients

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Rare Thyroid Malignancies: an Overview for the Oncologist

Spielman, D.B. et al. Clinical Oncology. Published online: 24 February 2017

Image Source: Nephron – Wikimedia // CC BY-SA 3.0

Image shows high magnification micrograph of medullary thyroid carcinoma.

Anaplastic thyroid cancer, medullary thyroid cancer, primary thyroid lymphoma and primary thyroid sarcoma are rare thyroid cancers that comprise 5–10% of all thyroid malignancies. Unlike well-differentiated thyroid cancers, these malignancies have few treatment options and carry a worse prognosis.

The literature surrounding these pathologies is limited, but remains an area of active research. Despite the rarity of these conditions, they remain an important part of the differential diagnosis for any thyroid nodule. Awareness of their presentation, work-up and management is critical for oncologists and head and neck surgeons. The purpose of this article is to provide a broad overview of these malignancies with an emphasis on emerging clinical research and therapies.

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NICE: All patients with colorectal cancer should be tested for genetic condition

Everyone who has colorectal cancer diagnosed should be tested for an inherited genetic condition called Lynch syndrome, new guidance states | BMJ

The National Institute for Health and Care Excellence (NICE) recommends microsatellite instability testing or immunohistochemistry to detect abnormalities that may indicate the syndrome.

Lynch syndrome, the most common cause of hereditary bowel cancer, has also been linked to an increased risk of developing other cancers including womb, ovarian, and stomach. People with the condition who develop colorectal cancer generally do so at a younger age, usually 40-50.

Testing for the condition helps to identify whether the patient’s family are also at increased risk of cancer so that they can be monitored more closely if needed, says NICE. Where these tests show that a person has a risk of the syndrome, the guidance recommends further tests to confirm the diagnosis. Because it is an inherited condition, a positive test can also lead to testing of family members.

Diagnosing Lynch syndrome may also help with the choice of treatment for colorectal cancer—for example, to direct chemotherapy or surgery.

Read the full overview here

Read the full guidance recommendations here

Organisational characteristics, teamwork & service delivery in lung cancer diagnostic assessment programmes

Honein-AbouHaidar, G.N. et al. (2017) BMJ Open. 7:e013965.

Objectives: Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs.

Conclusions: This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.

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Measuring patients’ muscles to predict chemotherapy side effects

Measuring patients’ muscle mass and quality could potentially help doctors better identify patients at high risk for toxic side effects that could require hospitalizations, researchers report | ScienceDaily

Researchers at the University of North Carolina Lineberger Comprehensive Cancer Center report in the journal Clinical Cancer Research that a tool developed at UNC could potentially help doctors better identify patients at high risk for toxic side effects that could require hospitalizations.

Shlomit Strulov Shachar, MD, the study’s first author, said they found that low measures of muscle quality and quantity in patients with early-stage breast cancer were linked to serious side effects and hospitalizations. Based on their findings, the researchers believe measuring muscle composition could be helpful in predicting which patients will experience side effects from chemotherapy, and in determining appropriate drug doses.

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Read the original research abstract here

7 innovative bits of research tech our Cancer Research U are developing

Today is Innovation Day, so CRUK are taking a look at some of the cutting edge technologies that their researchers are using in their efforts to understand and treat cancer | CRUK

• iKnife: an ‘intelligent knife’ to spot cancerous tissue during surgery
• Blood tests to monitor and personalise treatment

• Nanobubbles to re-oxygenate tumours
• Gold nanoparticles
• Infra-red endoscopes to detect cancer earlier
• Gene editing to boost immunotherapies
• New imaging technologies

Read the full blog post here

Quality of life with those with advanced cancer improved through walking

Walking for just 30 minutes three times per week could improve the quality of life for those with advanced cancer, a new study has found | ScienceDaily

Researchers from the University of Surrey collaborated with those form the Florence Nightingale Faculty of Nursing & Midwifery at King’s College London to explore the impact of walking on the quality of life and symptom severity in patients with advanced cancer.

Despite growing evidence of significant health benefits of exercise to cancer patients, physical activity commonly declines considerably during treatment and remains low afterwards. Initiatives in place to promote physical activity for those suffering with cancer are normally supervised and require travel to specialist facilities, placing an additional burden on patients.

Read the full overview here

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Prevalence of cancer chemotherapy-related problems and associated supportive care

Wagland, R. et al. (2016) Supportive Care in Cancer. 24(12) pp. 4901–4911

Purpose: The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.

Conclusion: The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.

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Significant variation in A&E cancer diagnoses across England

Cancer diagnosis in accident and emergency departments are three times more likely in some parts of England than others | HSJ

Public Health England data shared with HSJ shows the number of cancer diagnoses in emergency care, often when a patient has attended for another reason, vary from 11 per cent of all cancer diagnoses in one clinical commissioning area to 33 per cent in another.

The figures indicate which areas are better at detecting cancers at an early stage and in primary care services. The percentage of cancer cases diagnosed during an emergency visit to hospital is recognised as a proxy for the effectiveness of primary care.

The national average according to the most recent available data, for quarter three of 2015-16, is 20 per cent of cancer cases being diagnosed in A&E.

In the same period, South Manchester CCG had the highest rate of 33 per cent, compared to 11 per cent for North Somerset CCG, which was the lowest.

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Reducing Patient Waiting Times for Radiation Therapy and Improving the Treatment Planning Process:

Babshov, V. et al. Clinical Oncology. Published online: 19 February 2017

Highlights

• Modelling of an entire radiotherapy planning process at a cancer treatment facility.
• Bottleneck analysis and resource level impact quantification to reduce waiting times.
• Additional dosimetrist improved the mean waiting time by 6.5%.
• Removing one physicist dramatically worsened the waiting time.
• Applicability and transportability of the model to other facilities.

Read the full abstract here