How big data is being mobilised in the fight against leukaemia

In a project funded by Bloodwise and the Scottish Cancer Foundation, we have created LEUKomics. This online data portal brings together a wealth of CML gene expression data from specialised laboratories across the globe | Lorna Jackson & Lisa Hopcroft for The Conversation

Image source: Paulo Henrique Orlandi Mourao – Wikimedia // CC BY-SA 3.0

Our intention is to eliminate the bottleneck surrounding big data analysis in CML. Each dataset is subjected to manual quality checks, and all the necessary computational processing to extract information on gene expression. This enables immediate access to and interpretation of data that previously would not have been easily accessible to academics or clinicians without training in specialised computational approaches.

Consolidating these data into a single resource also allows large-scale, computationally-intensive research efforts by bioinformaticians (specialists in the analysis of big data in biology). From a computational perspective, the fact that CML is caused by a single mutation makes it an attractive disease model for cancer stem cells. However, existing datasets tend to have small sample numbers, which can limit their potential.

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Targeted Therapy in Thyroid Cancer

Valerio, L. et al. Clinical Oncology | Published online: 18 March 2017

Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows photomicrograph (magnification X25, H & E stain) showing degenerating papillae in papillary carcinoma of the thyroid.

Thyroid cancer typically has a good outcome following standard treatments, which include surgery, radioactive iodine ablation for differentiated tumours and treatment with thyrotropine hormone-suppressive levothyroxine. Thyroid cancers that persist or recur following these therapies have a poorer prognosis. Cytotoxic chemotherapy or external beam radiotherapy has a low efficacy in these patients. ‘Target therapy’ with tyrosine kinase inhibitors (TKIs) represent an important therapeutic option for the treatment of advanced cases of radioiodine refractory (RAI-R) differentiated thyroid cancer (DTC), medullary thyroid cancer (MTC) and possibly for cases of poorly differentiated (PDTC) and anaplastic thyroid cancer (ATC).

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Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy

Pollard, A. et al. (2017) European Journal of Cancer Care. 26(2)

Image source: mindfulness – Flickr // CC BY 2.0

People with head and neck cancer (HNC) experience elevated symptom toxicity and co-morbidity as a result of treatment, which is associated with poorer psychosocial and quality-of-life (QoL) outcomes.

This Phase I study examined whether an individualised mindfulness-based stress reduction (IMBSR) programme could be successfully used with HNC patients undergoing curative treatment.

After controlling for pre-intervention mindfulness, there was an association between higher post-intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings.

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Cost-effectiveness of an exercise programme for patients undergoing adjuvant chemotherapy

May, A.M. et al. (2017) BMJ Open. 7:e012187

Image source: Sancho McCann – Flickr // CC BY 2.0

Objective: Meta-analyses show that exercise interventions during cancer treatment reduce cancer-related fatigue. However, little is known about the cost-effectiveness of such interventions. Here we aim to assess the cost-effectiveness of the 18-week physical activity during cancer treatment (PACT) intervention for patients with breast and colon cancer. The PACT trial showed beneficial effects for fatigue and physical fitness.

 

Results: For colon cancer, the cost-effectiveness analysis showed beneficial effects of the exercise intervention with incremental costs savings of €4321 and QALY improvements of 0.03. 100% of bootstrap simulations indicated that the intervention is dominant (ie, cheaper and more effective). For breast cancer, the results did not indicate that the exercise intervention was cost-effective. Incremental costs were €2912, and the incremental effect was 0.01 QALY. At a Dutch threshold value of €20 000 per QALY, the probability that the intervention is cost-effective was 2%.

Conclusions: Our results suggest that the 18-week exercise programme was cost-effective for colon cancer, but not for breast cancer.

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Developing a model for embedded palliative care in a cancer clinic

DeSanto-Madeya, S. et al. BMJ Supportive & Palliative Care | Published Online: 03 March 2017.

Objectives: Describe the development and key features of a model for embedded palliative care (PC) for patients with advanced kidney cancer or melanoma seen in a cancer clinic.

Conclusions: The initial phase demonstrated acceptability and feasibility of a model for embedded PC for patients and the oncology team. Establishment of specific eligibility criteria and screening to identify eligible patients in the model phase led to an increased uptake of PC for patients with advanced kidney cancer and melanoma in a cancer clinic.

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Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue

Mustian, K.M. et al. JAMA Oncology | Published online: 2 March 2017

Question: Which of the 4 most commonly recommended treatments for cancer-related-fatigue—exercise, psychological, the combination of exercise and psychological, and pharmaceutical—is the most effective?

Findings: This meta-analysis of 113 unique studies (11 525 unique participants) found that exercise and psychological interventions and the combination of both reduce cancer-related fatigue during and after cancer treatment. Reduction was not due to time, attention, or education. In contrast, pharmaceutical interventions do not improve cancer-related fatigue to the same magnitude.

Meaning: Clinicians should prescribe exercise and/or psychological interventions as first-line treatments for cancer-related fatigue.

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Sexual well-being in cancer and palliative care

Gleeson, A.et al. BMJ Supportive & Palliative Care | Published Online: 2 March 2017

Objectives: The aims of this study were twofold. First, to determine the current practice of healthcare professionals (HCPs) working with cancer and palliative care patients in primary and secondary care settings in relation to sexual well-being. Second, to determine the education requirements of HCPs regarding the management of sexual well-being concerns of cancer/palliative care patients.

 

Conclusions: This survey identified that sexual well-being in cancer and palliative care patients is not routinely assessed with the majority of respondents stating that further support and training would be beneficial. The results of this questionnaire will be used to inform and develop sexual well-being training for HCPs working with cancer and palliative care patients.

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Understanding GP attitudes to cancer preventing drugs

A study by Cancer Research UK concludes that GPs want more support when offering drugs that lower the risk of certain cancers. It finds that GPs are more comfortable to discuss drugs, and more willing to prescribe or recommend drugs when they are supported by secondary care clinicians. Cancer Research UK

Understanding GP attitudes to cancer preventing drugs is aimed at increasing understanding GP attitudes towards offering the use of tamoxifen and aspirin to lower the risk of cancer, or prevent cancer. This is an area where there is little research around clinician attitudes and knowledge.

The study surveyed 1,007 GPs from across the UK. It found nearly half of GPs were unaware of the potential benefits of tamoxifen to prevent breast cancer among women with a clear family history of the disease who are therefore at higher risk.

The study also showed that more needs to be done to promote the evidence and guidance on chemoprevention. The research suggests that ensuring evidence based chemoprevention is routinely discussed with and offered to the people who may benefit should be a priority across the UK.

Executive summary: Understanding GP Attitudes to Cancer Preventing Drugs 

Full report: Understanding GP Attitudes to Cancer Preventing Drugs

Obesity linked to heightened risk of certain cancers

Obesity is strongly linked to the risk of developing certain major cancers, according to a re-analysis of research published in The BMJ | OnMedica | BMJ

Links between obesity and cancer risk are strongest for 11 cancers related to digestive organs and hormones, says the review. Obesity could also be linked to other cancers, but the quality of the evidence is not sufficiently strong to draw those conclusions yet.

Obesity prevalence has more than doubled over the past 40 years, and the evidence to date suggests that it is linked to a heightened risk of developing particular cancers, but methodological flaws in some published studies have weakened the strength of the associations found.

To better gauge the quality of the evidence and the strength of these associations, the researchers comprehensively reviewed published studies looking at obesity and cancer risk.

From among 204 reviews that analysed obesity measurements, such as body mass index (BMI), weight gain, and waist circumference, and the risk of 36 cancers, 95 included continuous measures of obesity.

Only 13% of the associations for nine cancers were based on strong evidence, meaning the results were statistically significant and excluded bias.

Strong associations were found in studies that looked at heightened risk of oesophageal, bone marrow, colon (in men), rectal (in men), biliary tract system, pancreatic, endometrial (in premenopausal women), and kidney cancers.

Read more via OnMedica

Link to the research: Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. BMJ 2017;356:j477. DOI: 10.1136/bmj.j477