Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis

Turner, M. et al. | 2021|  Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis| J Cancer Surviv | https://doi.org/10.1007/s11764-021-01122-7

The reviewers behind this systematic review and meta-analysis set out to describe and quantify stroke incidence in people living with and beyond cancer. To this end they conducted a systematic review (36 articles met the inclusion criteria) and meta-analysis (25 of the included articles calculated hazard ratios for the incidence of stroke; 7 studies were included for individual cancer types). These epidemiological studies comparing stroke incidence between individuals living with and beyond cancer and those without cancer (matched controls, controls from the general population, or using the general reference population of a region or country). They report that stroke incidence is significantly increased after diagnosis of certain cancers. The resulting paper has been published in the Journal of Cancer Survivorship where the reviewers outline their findings in further detail.

Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis [paper]

See also:

MedScape Increased Risk of Stroke in Cancer Patients and Survivors [clinical summary]

Life Special Issue “Prostate Cancer”

Life | nd | Life Special Issue “Prostate Cancer”

The prostate is the largest accessory gland of the male reproductive tract. Together with seminal vesicles and bulbourethral glands, the prostate is responsible for the production of an alkaline fluid that forms part of the seminal fluid. The prostate of men over 40 years of age is commonly affected by several pathologies, like benign prostate hyperplasia and cancer.

Prostate cancer is one of the most frequent cancers among men population worldwide. According to the World Health Organization (WHO), in the year 2018, prostate cancer affected approximately 1.28 million men and was responsible for the death of 358,989 of them. Prostate cancer development is associated with several risk factors, like older age, black ethnicity, a family history of disease, an increased body mass index and obesity. In this way, the risk of prostate cancer development may be reduced through the consumption of a healthy diet full of fruits and vegetables, practice of physical exercise and maintenance of a healthy weight.

Despite several approaches are available for prostate cancer treatment, the number of prostate cancer deaths is continuously increasing, which emphasizes the need to search for new methods for precocious diagnosis and more effective treatment. The animal models, including rodents, have greatly contributed to the study of biopathology, and the prevention and treatment of prostate cancer.

This Special Issue aims to publish original research works, case reports or reviews concerning the diagnosis, treatment and prognosis of prostate cancer, highlighting new advances in this field.  

Articles in this special edition include:

Prostate Cancer Aggressiveness Prediction Using CT Images

Association of Circulating Tumor Cells with Inflammatory and Biomarkers in the Blood of Patients with Metastatic Castration-Resistant Prostate Cancer

Site-Specific and Common Prostate Cancer Metastasis Genes as Suggested by Meta-Analysis of Gene Expression Data

Prostate Cancer Diagnostic Algorithm as a “Road Map” from the First Stratification of the Patient to the Final Treatment Decision

Full details from Life

Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection

Pinato, D. J. et al | 2021 | Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study | Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(21)00573-8

The authors of this study sought to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. In addition, because deferral and modification of systemic anti-cancer therapy has been commonplace during the early phases of the pandemic, they also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection.

Summary

Background

The medium-term and long-term impact of COVID-19 in patients with cancer is not yet known. In this study, we aimed to describe the prevalence of COVID-19 sequelae and their impact on the survival of patients with cancer. We also aimed to describe patterns of resumption and modifications of systemic anti-cancer therapy following recovery from SARS-CoV-2 infection.

Methods

OnCovid is an active European registry study enrolling consecutive patients aged 18 years or older with a history of solid or haematological malignancy and who had a diagnosis of RT-PCR confirmed SARS-CoV-2 infection. For this retrospective study, patients were enrolled from 35 institutions across Belgium, France, Germany, Italy, Spain, and the UK. Patients who were diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, and entered into the registry at the point of data lock (March 1, 2021), were eligible for analysis. The present analysis was focused on COVID-19 survivors who underwent clinical reassessment at each participating institution. We documented prevalence of COVID-19 sequelae and described factors associated with their development and their association with post-COVID-19 survival, which was defined as the interval from post-COVID-19 reassessment to the patients’ death or last follow-up. We also evaluated resumption of systemic anti-cancer therapy in patients treated within 4 weeks of COVID-19 diagnosis. The OnCovid study is registered in ClinicalTrials.gov, NCT04393974.

Findings

2795 patients diagnosed with SARS-CoV-2 infection between Feb 27, 2020, and Feb 14, 2021, were entered into the study by the time of the data lock on March 1, 2021. After the exclusion of ineligible patients, the final study population consisted of 2634 patients. 1557 COVID-19 survivors underwent a formal clinical reassessment after a median of 22·1 months (IQR 8·4–57·8) from cancer diagnosis and 44 days (28–329) from COVID-19 diagnosis. 234 (15·0 per cent) patients reported COVID-19 sequelae, including respiratory symptoms (116 [49·6 per cent]) and residual fatigue (96 [41·0 per cent]). Sequelae were more common in men (vs women; p equal to 0·041), patients aged 65 years or older (vs other age groups; p=0·048), patients with two or more comorbidities (vs one or none; p equal to 0·0006), and patients with a history of smoking (vs no smoking history; p equal to 0·0004). Sequelae were associated with hospitalisation for COVID-19 (p less than 0·0001), complicated COVID-19 (p less than 0·0001), and COVID-19 therapy (p equal to 0·0002). With a median post-COVID-19 follow-up of 128 days (95 per cent CI 113–148), COVID-19 sequelae were associated with an increased risk of death (hazard ratio [HR] 1·80 [95 per cent CI 1·18–2·75]) after adjusting for time to post-COVID-19 reassessment, sex, age, comorbidity burden, tumour characteristics, anticancer therapy, and COVID-19 severity. Among 466 patients on systemic anti-cancer therapy, 70 (15·0 per cent) permanently discontinued therapy, and 178 (38·2 per cent) resumed treatment with a dose or regimen adjustment. Permanent treatment discontinuations were independently associated with an increased risk of death (HR 3·53 [95 per cent CI 1·45–8·59]), but dose or regimen adjustments were not (0·84 [0·35–2·02]).

Interpretation

Sequelae post-COVID-19 affect up to 15% of patients with cancer and adversely affect survival and oncological outcomes after recovery. Adjustments to systemic anti-cancer therapy can be safely pursued in treatment-eligible patients.

Funding

National Institute for Health Research Imperial Biomedical Research Centre and the Cancer Treatment and Research Trust.

Prevalence and impact of COVID-19 sequelae on treatment and survival of patients with cancer who recovered from SARS-CoV-2 infection: evidence from the OnCovid retrospective, multicentre registry study [paper]

Under 16 Cancer Patient Experience Survey 2020 findings

NHS England | October 2021 | Under 16 Cancer Patient Experience Survey 2020

The Under 16 Cancer Patient Experience Survey (U16 CPES) measures experiences of tumour and cancer care in children across England. The 2020 survey was its first iteration and is expected to run annually. The survey captures the experiences of children aged under 16 at the time of their care, and that of their parents or carers.
The survey enables Principal Treatment Centres (PTCs) to compare themselves against others

Image source: under16cancerexperiencesurvey.co.uk Image outlines the report’s executive summary

Image provides a visual summary of the responses to the question on bedside manner and trust in staff

More visual summaries available from the Under 16 Cancer Experience Survey

Under 16 Cancer Patient Experience Survey 2020 [full report from NHS England]

Visual summaries

See also:

Further information about the survey including national results, principal treatment centre results and suporting documents available from Under 16 Cancer Experience Survey

Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework

Maharaj, A.D., et al | 2021| Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework | BMJ Quality & Safety| 30 |792-803.

Abstract

Background Evidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.

Objectives (1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).

Methods Semistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.

Results In total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).

Conclusions The internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.

Interested in reading the full article? Rotherham NHS staff  can request a copy from their Library & Knowledge Service

 

[NICE] People with advanced or metastatic urothelial cancer to get life-extending treatment

NICE | September 2021 | People with advanced or metastatic urothelial cancer to get life-extending treatment

Around 130 people per year with untreated locally advanced or metastatic urothelial cancer will be eligible for a new life-extending treatment after NICE published final draft guidance today (30 September 2021) recommending atezolizumab.

The recommendation comes after additional clinical evidence which showed that people who have atezolizumab are likely to live up to 8 months longer than those who have platinum-containing chemotherapy was collected as part a Cancer Drugs Fund managed access agreement.

Full details available from NICE

NICE People with advanced or metastatic urothelial cancer to get life-extending treatment

NICE Draft guidance on atezolizumab

Building back cancer services in England

IPPR| September 2021 | Building back cancer services in England

The government recently announced a three-year funding plan for the health service. They have said the funding will allow the NHS to aim for highly ambitious activity increases, but there is more to be done to ‘build back batter’ cancer care

The think-tank makes the following recommendations recommend a new three-part cancer pledge for the country.

1. Build capacity: the government should explore ways to build the right level of capacity in the system in the immediate and medium term to enable increases in service activity. This must include plans to expand the workforce and diagnostic capacity.
2. Harness innovation: without innovation, productivity gains the government is better and aspirations set out in the NHS Long Term Plan will difficult to deliver. Improving uptake of technological advances and re-thinking service design will improve survival outcomes and improve productivity.
3. Better prevention: the government should scale its ambitions on prevention
   and reduce demands on the health service. This should inclu

Building back cancer services in England [news release]

Building back cancer services in England [report]

Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials

Wang, L. et al | 2021 | Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials| BMJ | 8 | 374 | n1034. doi: 10.1136/bmj.n1034. PMID: 34497047.

The reviewers of this paper conducted a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the effectiveness and safety of medical cannabis and cannabinoids for chronic pain that addresses these limitations.

Abstract

Objective: To determine the benefits and harms of medical cannabis and cannabinoids for chronic pain.

Design: Systematic review and meta-analysis.

Data sources: MEDLINE, EMBASE, AMED, PsycInfo, CENTRAL, CINAHL, PubMed, Web of Science, Cannabis-Med, Epistemonikos, and trial registries up to January 2021.

Study selection: Randomised clinical trials of medical cannabis or cannabinoids versus any non-cannabis control for chronic pain at ≥1 month follow-up.

Data extraction and synthesis: Paired reviewers independently assessed risk of bias and extracted data. We performed random-effects models meta-analyses and used GRADE to assess the certainty of evidence.

Results: A total of 32 trials with 5 174 adult patients were included, 29 of which compared medical cannabis or cannabinoids with placebo. Medical cannabis was administered orally (n equal to 30) or topically (n equal to 2). Clinical populations included chronic non-cancer pain (n equal to 28) and cancer related pain (n equal to 4). Length of follow-up ranged from 1 to 5.5 months. Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10 per cent (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of -0.50 cm (95% CI -0.75 to -0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of -0.35 cm (-0.55 to -0.14 cm, high certainty)). Medical cannabis taken orally does not improve emotional, role, or social functioning (high certainty). Moderate certainty evidence shows that medical cannabis taken orally probably results in a small increased risk of transient cognitive impairment (RD 2% (0.1% to 6%)), vomiting (RD 3% (0.4% to 6%)), drowsiness (RD 5% (2% to 8%)), impaired attention (RD 3% (1% to 8%)), and nausea (RD 5% (2% to 8%)), but not diarrhoea; while high certainty evidence shows greater increased risk of dizziness (RD 9% (5% to 14%)) for trials with ❤ months follow-up versus RD 28% (18% to 43%) for trials with ≥3 months follow-up; interaction test P=0.003; moderate credibility of subgroup effect).

Conclusions: Moderate to high certainty evidence shows that non-inhaled medical cannabis or cannabinoids results in a small to very small improvement in pain relief, physical functioning, and sleep quality among patients with chronic pain, along with several transient adverse side effects, compared with placebo. The accompanying BMJ Rapid Recommendation provides contextualised guidance based on this body of evidence. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/3pwn2.

Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials [primary paper]

Most Fully Vaccinated Patients With Cancer Have SARS-CoV-2 Antibodies #Covid19RftLks

Slomski A. | 2021| Most Fully Vaccinated Patients With Cancer Have SARS-CoV-2 Antibodies| JAMA | 326| 9| :800. doi:10.1001/jama.2021.14707

This article in the JAMA highlights the findings of a recent study published in JAMA Oncology: Serologic Status and Toxic Effects of the SARS-CoV-2 BNT162b2 Vaccine in Patients Undergoing Treatment for Cancer. The authors of the paper studied patients undergoing cancer treatment who received a COVID-19 mRNA vaccine produced antibodies at a slower rate than people without cancer, but most were seropositive after the second dose. The results, reinforce the recommendation to prioritize patients with cancer for vaccination against SARS-CoV-2.

JAMA Most Fully Vaccinated Patients With Cancer Have SARS-CoV-2 Antibodies

JAMA Oncology Serologic Status and Toxic Effects of the SARS-CoV-2 BNT162b2 Vaccine in Patients Undergoing Treatment for Cancer

#NotOk Filling the gaps in mental health support for young people with cancer

Teenage Cancer Trust | June 2021 | #NotOk Filling the gaps in mental health support for young people with cancer

This report highlights the experiences of young people with cancer in terms of their mental health and their access to psychological support, along with the impact of the Covid-19 pandemic. It includes data collected through insight work with young people, Teenage Cancer Trust frontline staff, and healthcare professionals.

The charity has launched its #NotOK campaign which calls on UK Governments to:

End the postcode lottery by providing guaranteed access to specialist psychologists

Develop and fund a comprehensive blueprint of psychological care for young people with cancer

#NotOk Filling the gaps in mental health support for young people with cancer [report]

Inadequate specialist mental health support risks derailing young cancer patients’ lives, say experts [press release]