Advance Care Planning and Attainment of Cancer Patients’ End-of-Life Preferences: Relatives’ Perspective

Am J Hosp Palliat Care. 2023 Mar;40(3):322-328

Purpose

The purpose of this study is to determine which element of advance care planning (ACP) – an advance directives (AD) document or an end-of-life discussion between patient and family (DwF), if any—improves the likelihood of cancer patients’ attaining their preferences regarding treatments in the last month of life and dying in the place they prefer.

Methods

First-degree relatives of deceased cancer patients, interviewed by telephone, were asked if the treatments the patients received in their last month of life and their place of death corresponded to the patients’ preferences. Nominal logistic regression analyses were conducted in search of significant association between having an AD document and/or conducting a DwF and patients’ treatment and place of death in accordance with their preferences.

Results

491 deceased patients were included in the study. Their average age was 68; 52% were women. According to 32% of the relatives, the patients’ treatment in the last month of life was aligned with their preferences and 55% said the patients had died in their preferred place. Only 16.5% had an AD document, 58.5% only discussed their treatment preferences with relatives, and 25% did neither. DwF and ability to speak until last week of life were significantly related to receiving treatment consistent with patients’ preferences. Dying where the patient prefers is significantly associated with having an AD and a DwF, with an AD yielding higher odds.

Conclusion

A multifaceted interconnection exists between the two elements of ACP in attaining cancer patients’ wishes and abetting better end of life care.

Further information – Advance Care Planning and Attainment of Cancer Patients’ End-of-Life Preferences: Relatives’ Perspective

Two new personalised immunotherapy treatments for aggressive forms of blood cancer recommended for the Cancer Drugs Fund

NICE – 27th April 2023

Hundreds of people with aggressive forms of blood cancer are set to benefit after two personalised immunotherapy (CAR-T) treatments were today (Thursday, 27 April) recommended by NICE for the Cancer Drugs Fund (CDF).  

CAR-T therapy is a treatment in which a person’s own immune system cells (T-cells) are altered in a laboratory to attach to and kill cancer cells. The two treatments are both given as a one-off treatment straight into the blood stream. 

The treatments could benefit up to 600 people in total each year in England. 

1. Axicabtagene ciloleucel (Yescarta, Kite) is recommended in final draft guidance as a CAR-T (chimeric antigen receptor) therapy for adults with diffuse large B‑cell lymphoma (DLBCL) that returns within a year of, or is resistant to, first-line chemoimmunotherapy. 
2. Brexucabtagene autoleucel (Tecartus, Kite) is also recommended to go into the CDF in final draft guidance for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people aged 26 and over. 

Further information – Two new personalised immunotherapy treatments for aggressive forms of blood cancer recommended for the Cancer Drugs Fund

Read the final draft guidance for axicabtagene ciloleucel for treating relapsed or refractory diffuse large B-cell lymphoma after one systemic treatment here. 

The final draft guidance for brexucabtagene autoleucel for treating relapsed or refractory B-cell acute lymphoblastic leukaemia in people 26 years and over is also on the NICE website. 

Working together to improve access to clinical trials and biobanking for teenagers and young adults with cancer

ECMC Network

This roadmap sets out how we can improve access to clinical trials, and therefore outcomes, for
teenagers and young adults. It has been developed with and for the cancer research community.
Patients, survivors, parents, and families were central in creating this roadmap, and will continue
to be as we move forward. All future work that develops from this roadmap should be relevant,
impactful, and truly serving the needs of people affected by cancer.

Roadmap – Working together to improve access to clinical trials and biobanking for teenagers and young adults with cancer

Trolley Trends: Shifting the nation towards healthier shopping

On behalf of Cancer Research UK, British Heart Foundation and Diabetes UK, March 2023

It is widely accepted that within the UK the consumption of saturated fat, sugar, salt and
calories is too high. Diets which are high in fat, salt, and/or sugar (HFSS) and/or calories
increase the risk of obesity and overweight as well as other risk factors for a range of
health conditions, including heart and circulatory diseases, type 2 diabetes and some
cancers.
Cancer Research UK, British Heart Foundation and Diabetes UK partnered with the major
UK retailer Tesco in 2018, with the aim of ‘Helping you to live healthier’. The four-way UK
health partnership aims to inspire, empower and support Tesco colleagues, customers,
and their families to shift towards a healthier diet to reduce the risk of cancer, heart and
circulatory diseases, and type 2 diabetes.
In March 2022, the three charities independently commissioned YouGov to conduct
research to explore attitudes and behaviours around healthy eating and food shopping. As
part of the health partnership, Tesco provided a sample of anonymised customer Clubcard
data which also allowed YouGov to explore actual purchasing behaviours.
This research delivered insights that underpinned a policy discussion authored by the
three charities, with recommendations for how supermarkets and government can
positively impact the supermarket environment to make a healthy diet more available,
affordable, appealing and accessible to all.

Read the Report – Trolley Trends: Shifting the nation towards healthier shopping

Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update

Journal of Clinical Oncology – 19th April 2023

PURPOSE – To update the American Society of Clinical Oncology guideline on the management of anxiety and depression in adult cancer survivors.

METHODS – A multidisciplinary expert panel convened to update the guideline. A systematic review of evidence published from 2013-2021 was conducted.

RESULTS – The evidence base consisted of 17 systematic reviews ± meta analyses (nine for psychosocial interventions, four for physical exercise, three for mindfulness-based stress reduction [MBSR], and one for pharmacologic interventions), and an additional 44 randomized controlled trials. Psychological, educational, and psychosocial interventions led to improvements in depression and anxiety. Evidence for pharmacologic management of depression and anxiety in cancer survivors was inconsistent. The lack of inclusion of survivors from minoritized groups was noted and identified as an important consideration to provide high-quality care for ethnic minority populations.

RECOMMENDATIONS – It is recommended to use a stepped-care model, that is, provide the most effective and least resource-intensive intervention based on symptom severity. All oncology patients should be offered education regarding depression and anxiety. For patients with moderate symptoms of depression, clinicians should offer cognitive behavior therapy (CBT), behavioral activation (BA), MBSR, structured physical activity, or empirically supported psychosocial interventions. For patients with moderate symptoms of anxiety, clinicians should offer CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions. For patients with severe symptoms of depression or anxiety, clinicians should offer cognitive therapy, BA, CBT, MBSR, or interpersonal therapy. Treating clinicians may offer a pharmacologic regimen for depression or anxiety for patients who do not have access to first-line treatment, prefer pharmacotherapy, have previously responded well to pharmacotherapy, or have not improved following first-line psychological or behavioral management.

Further information – Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update

National Lung Cancer Audit (NLCA) – State of the nation report 2023

HQIP –  Published: 12 Apr 2023

The National Lung Cancer Audit (NLCA) has published a State of the Nation Report 2023. Based on patients diagnosed with lung cancer in England during 2021, and in Wales in 2020-2021, it summarises the performance of lung cancer services on a set of performance indicators and patient outcomes.

The report found that the number of patients diagnosed in England in 2021 has recovered to pre- pandemic levels, with 34,478 patients diagnosed with lung cancer (compared to 31,371 in 2020 and 33,091 in 2019). It also found that the Covid-19 pandemic had an impact on the number of patients diagnosed in Wales, which fell from 2,240 in 2019 to 2,067 in 2020 (with a subsequent recovery in 2021 to 2,244).

Other key findings for England include:The proportion of patients with stage I/II PS 0–2 non-small cell lung cancer (NSCLC) undergoing curative-intent treatment in England has increased from 73% in 2020 to 79% in 2021, andThe proportion of patients with NSCLC stage IIIB-IV and PS 0-1 receiving systemic anti-cancer therapy in England has increased from 55% in 2020 to 61% in 2021.

For Wales, there was a reduction in the number of patients with NSCLC undergoing surgery or treatment with curative-intent, compared with 2019 – and, by 2021, the number of patients undergoing these treatments had not recovered to 2019 pre- pandemic levels.

Read the Report – National Lung Cancer Audit (NLCA) – State of the nation report 2023

How TRACERx is helping us predict lung cancer’s next move

Cancer Research UK – 12th April 2023

Since 2014, TRACERx has been collecting comprehensive genomic and clinical data from people with NSCLC, from their point of diagnosis throughout their treatment, to unpick the complexities of lung cancer and aid the design of new, targeted lung cancer treatments.

Today, researchers based at the Francis Crick Institute have published 7 papers in the journals Nature and Nature Medicine, detailing new results from TRACERx.

Each of these papers is revealing the secrets of how lung cancer can evolve, spread and resist treatment, from how the visual characteristics of lung tumour cells may indicate a person’s prognosis to how DNA from ancient viruses can be reactivated in tumours to accelerate their growth.

Further information – How TRACERx is helping us predict lung cancer’s next move

Background Research – Al Bakir, M., Huebner, A., Martínez-Ruiz, C. et al. The evolution of non-small cell lung cancer metastases in TRACERx. Nature (2023). https://doi.org/10.1038/s41586-023-05729-x

NICE final draft guidance recommends olaparib for early breast cancer and metastatic prostate cancer following new commercial deals

NICE – 6th April 2023

Ground-breaking commercial deals for anti-cancer medicine olaparib have paved the way for hundreds to benefit in final draft guidance published today (6 April 2023) by NICE that recommends it for some types of early breast cancer and advanced prostate cancer.

The deals negotiated by NHS England and company AstraZeneca have enabled NICE to recommend olaparib as a clinically and cost-effective option:

• for adults with HER2-negative, high-risk early breast cancer who have inherited faults in their BRCA1 or BRCA2 genes, after surgery and chemotherapy
• and for adults with previously treated hormone-relapsed metastatic prostate cancer who have the same BRCA mutations.

Further information – NICE final draft guidance recommends olaparib for early breast cancer and metastatic prostate cancer following new commercial deals

Read the draft guidance on olaparib for adjuvant treatment of high-risk HER2-negative, BRCA-positive early breast cancer after chemotherapy here: