Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

Huang, B., et al | 2021| Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk| British Journal of Sports Medicine|  Published Online First: 29 June 2021. doi: 10.1136/bjsports-2021-104046

The authors of this study investigated the joint association of physical activity (PA) and a novel comprehensive sleep score with all-cause and subtype-specific CVD and cancer mortality risks. They report that among middle-aged UK adults without obstructive sleep apnoea history or class III obesity, PA at levels at or above the WHO guideline (600 metabolic equivalent task mins/week) threshold eliminated most of the deleterious associations of poor sleep with mortality.

Abstract

Objectives Although both physical inactivity and poor sleep are deleteriously associated with mortality, the joint effects of these two behaviours remain unknown. This study aimed to investigate the joint association of physical activity (PA) and sleep with all-cause and cause-specific mortality risks.

Methods 380 055 participants aged 55.9 (8.1) years (55 per cent women) from the UK Biobank were included. Baseline PA levels were categorised as high, medium, low and no moderate-to-vigorous PA (MVPA) based on current public health guidelines. We categorised sleep into healthy, intermediate and poor with an established composited sleep score of chronotype, sleep duration, insomnia, snoring and daytime sleepiness. We derived 12 PA–sleep combinations, accordingly. Mortality risks were ascertained to May 2020 for all-cause, total cardiovascular disease (CVD), CVD subtypes (coronary heart disease, haemorrhagic stroke, ischaemic stroke), as well as total cancer and lung cancer.

Results After an average follow-up of 11.1 years, sleep scores showed dose-response associations with all-cause, total CVD and ischaemic stroke mortality. Compared with high PA-healthy sleep group (reference), the no MVPA-poor sleep group had the highest mortality risks for all-cause (HR (95 per cent CIs), (1.57 (1.35 to 1.82)), total CVD (1.67 (1.27 to 2.19)), total cancer (1.45 (1.18 to 1.77)) and lung cancer (1.91 (1.30 to 2.81))). The deleterious associations of poor sleep with all outcomes, except for stroke, was amplified with lower PA.

Conclusion The detrimental associations of poor sleep with all-cause and cause-specific mortality risks are exacerbated by low PA, suggesting likely synergistic effects. Our study supports the need to target both behaviours in research and clinical practice.

Full paper Sleep and physical activity in relation to all-cause, cardiovascular disease and cancer mortality risk

[NICE Technology Appraisal Guidance] Pembrolizumab for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency

NICE |  June 2021 | Pembrolizumab for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency

Evidence-based recommendations on pembrolizumab (Keytruda) for treating metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency in adults.

Pembrolizumab for untreated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency

Breast cancer screening: women with poor mental health are less likely to attend appointments

NIHR | 21 June 2021| Breast cancer screening: women with poor mental health are less likely to attend appointments

This Alert from National Institute for Health Research (NIHR) highlights the findings of recent research that looked at resaons why women chose not to attend breast screening appointments. This research was conducted in Northern Ireland and included nearly 60 000 women between the ages of 50 and 70. They were all eligible for routine NHS screening for breast cancer. One in ten of the sample reported poor mental health. This group was almost a quarter (23 per cent) less likely to attend breast screening than women without mental health problems.

In the last decade evidence suggests that women who live in less affluent or urban areas, and those who are not married, are less likely to attend screening.

The researchers used data from the Northern Ireland Longitudinal Study includes data on one in four (28 per cent) of the Northern Ireland population. It includes women’s responses to questions on mental health in the 2011 Northern Ireland Census. The authors linked this information to women’s records on breast cancer screening. 

Their investigation into the factors that impacted on a woman’s likelihood not to attend a screening appointment were:

• women with mental illness were less likely to attend screening than women who did not report mental health conditions
• not being married or living in an urban area were each linked to a similar reduction (23 per cent less) in attendance
• the effect of social deprivation was greater, and women in this group were 34 per cent less likely to attend breast screening
• mental health had an impact across all groups of women, regardless of social deprivation, urban living or marital status.

The authors of the study call for health services to explore targeted interventions, such as more frequent appointment reminders. This could encourage women with mental illness to attend screening appointments. 

[Abstract] Does poor mental health explain socio-demographic gradients in breast cancer screening uptake? A population-based study.

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[NICE Draft guidance] Nivolumab with ipilimumab for previously treated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency [ID1332]

NICE | Nivolumab with ipilimumab for previously treated metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency [ID1332] | Expected publication date: 21 July 2021

NICE has today (14 June 2021)published final draft guidance recommending nivolumab plus ipilimumab for people with metastatic colorectal cancer with high microsatellite instability or mismatch repair deficiency

Draft guidance available from NICE

Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial

Sahgal, A. et al | 2021| Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial | The Lancet Oncology | DOI:https://doi.org/10.1016/S1470-2045(21)00196-0

Summary

Background

Conventional external beam radiotherapy is the standard palliative treatment for spinal metastases; however, complete response rates for pain are as low as 10–20%. Stereotactic body radiotherapy delivers high-dose, ablative radiotherapy. We aimed to compare complete response rates for pain after stereotactic body radiotherapy or conventional external beam radiotherapy in patients with painful spinal metastasis.

Methods

This open-label, multicentre, randomised, controlled, phase 2/3 trial was done at 13 hospitals in Canada and five hospitals in Australia. Patients were eligible if they were aged 18 years and older, and had painful (defined as ≥2 points with the Brief Pain Inventory) MRI-confirmed spinal metastasis, no more than three consecutive vertebral segments to be included in the treatment volume, an Eastern Cooperative Oncology Group performance status of 0–2, a Spinal Instability Neoplasia Score of less than 12, and no neurologically symptomatic spinal cord or cauda equina compression. Patients were randomly assigned (1:1) with a web-based, computer-generated allocation sequence to receive either stereotactic body radiotherapy at a dose of 24 Gy in two daily fractions or conventional external beam radiotherapy at a dose of 20 Gy in five daily fractions using standard techniques. Treatment assignment was done centrally by use of a minimisation method to achieve balance for the stratification factors of radiosensitivity, the presence or absence of mass-type tumour (extraosseous or epidural disease extension, or both) on imaging, and centre. The primary endpoint was the proportion of patients with a complete response for pain at 3 months after radiotherapy. The primary endpoint was analysed in the intention-to-treat population and all safety and quality assurance analyses were done in the as-treated population (ie, all patients who received at least one fraction of radiotherapy). The trial is registered with ClinicalTrials.gov, NCT02512965.

Findings

Between Jan 4, 2016, and Sept 27, 2019, 229 patients were enrolled and randomly assigned to receive conventional external beam radiotherapy (n equal to 115) or stereotactic body radiotherapy (n equal to 114). All 229 patients were included in the intention-to-treat analysis. The median follow-up was 6·7 months (IQR 6·3–6·9). At 3 months, 40 (35 per cent) of 114 patients in the stereotactic body radiotherapy group, and 16 (14 per cent ) of 115 patients in the conventional external beam radiotherapy group had a complete response for pain (risk ratio 1·33, 95 per cent CI 1·14–1·55; p equal to 0·0002). This significant difference was maintained in multivariable-adjusted analyses (odds ratio 3·47, 95 per cent CI 1·77–6·80; p equal to 0·0003). The most common grade 3–4 adverse event was grade 3 pain (five [4 per cent] of 115 patients in the conventional external beam radiotherapy group vs five (5 per cent) of 110 patients in the stereotactic body radiotherapy group). No treatment-related deaths were observed.

Interpretation

Stereotactic body radiotherapy at a dose of 24 Gy in two daily fractions was superior to conventional external beam radiotherapy at a dose of 20 Gy in five daily fractions in improving the complete response rate for pain. These results suggest that use of conformal, image-guided, stereotactically dose-escalated radiotherapy is appropriate in the palliative setting for symptom control for selected patients with painful spinal metastases, and an increased awareness of the need for specialised and multidisciplinary involvement in the delivery of end-of-life care is needed.

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Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

Baydoun, M. et al | 2021 | Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice | https://doi.org/10.2147/PPA.S267064

This systematic review aims to evaluate adherence to home practice in studies evaluating the effects of MBI programs on psychological distress outcomes in cancer patients. The purpose of the review was to :

1. To evaluate the extent to which cancer patients report completing formal (meditation, body scan, yoga) and/or informal (doing everyday activities mindfully) home practice exercises assigned within the context of MBIs.
2. To identify factors influencing adherence to mindfulness home practice among cancer patients.
3. To evaluate the relationship between the amount of home practice and intervention effects on psychological distress.

Abstract

Background

 Although mindfulness-based interventions (MBIs) have demonstrated efficacy for alleviating psychological distress in cancer survivors, little is known about the extent to which participants adhere to assigned home practice. The purpose of this systematic review was to summarize and appraise the literature on rates and correlates of adherence to mindfulness home practice among cancer survivors.

Methods
Four databases (PubMed, Psychology and Behavioral Sciences, PsycInfo, and CINAHL) were searched for studies published before October 15, 2020. Articles were included if they evaluated the benefits of an MBI program for adults with cancer.

Results

 Twenty-one studies (N equal to 1811 participants) meeting the inclusion criteria were identified (randomized controlled trials (n equal to 13), non-randomized controlled designs (n equal to 2), single-group studies (n eqaul to 6)). The pooled adherence rate for participants’ home practice was 60 per cent of the assigned amount, which equated to 27 min per day during the intervention period. There was some evidence for a relationship between home practice of mindfulness techniques and improvements in mood, stress, anxiety, depression, and fear of cancer recurrence (correlation coefficients ranged from 0.33 to 0.67). Factors including marital status, mood disturbance at baseline, intervention modality, and personality traits were evaluated in relation to adherence to home practice, but the current literature was inadequate to evaluate whether a relationship exists.

Conclusion

Adherence to mindfulness home practice among cancer survivors is suboptimal, and most of the correlates of adherence studied to date are non-modifiable. More research is warranted to scrutinize the role of home practice in mindfulness-based interventions, including assessment of modifiable factors influencing adherence to improve benefits for this population.

Systematic review Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

Cancer Summit Catch Up With Cancer – The Way Forward

All Party Parliamentary Group | June 2021 | Cancer Summit Catch Up With Cancer – The Way Forward

The All Party Parliamentary Group investigate the scale of the Covid-induced cancer crisis and listen to solutions proposed by front line staff and professionals. Experts from medical colleges, charities, leading oncologists, medical industry bodies and input from frontline workforce were consulted by the APPG as part of roundtable and consultation, and from these responses the APPG reports that the UK went into the pandemic with the worst cancer survival rates amongst high income countries; which was due to:
a. Persistent underinvestment
b. The imposition of bureaucratic blocks to progress

As part of this engagement with learned bodies, two underlying themes were identified:

• there is a desperate need for investment in cancer services and new ways of working. That the implementation of the solutions to the crisis require a national strategy, political
• oversight and planning at the highest levels

As part of the roundtable, experts were asked about the scale of the cancer backlog and how best to tackle it. The 6 points relate to pre-pandemic cancer services, workforce, investment, a new cancer recovery plan and long-term plan, pathways and systems, IT infrastructure and data sharing.

• The AAPG’s report also makes 7 recommendations

Cancer Summit [full report]

See also:

The Lancet Oncology UK Government urged to recognise post-COVID-19 cancer backlog

[NICE Technology Appraisal Guidance] Atezolizumab monotherapy for untreated advanced non-small-cell lung cancer

NICE |  02 June 2021 | Atezolizumab monotherapy for untreated advanced non-small-cell lung cancer

NICE has published its final guidance today , in which they’ve recommended atezolizumab as an option for some people with untreated metastatic non-small-cell lung cancer:

Evidence-based recommendations on atezolizumab (Tecentriq) for treating advanced non-small-cell lung cancer in adults. A table of NHS England interim treatment options gives possible alternative treatment options for use during the COVID-19 pandemic to reduce infection risk. This may affect decisions on using atezolizumab. See the COVID-19 rapid guideline: delivery of systemic anticancer treatments for more details.

Full details are available from NICE