Effect of ultrasonography surveillance in patients with liver cancer

Liver cancer is a growing global public health problem. Ultrasonography is an imaging tool widely used for the early diagnosis of liver cancer | BMJ Open

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Image source: Nephron – Wikimedia // CC SA 3.0

Image shows low magnification micrograph of hepatocellular carcinoma the most common form of primary liver cancer.

Objective: The effect of ultrasonography surveillance (US) on the survival of patients with liver cancer is unknown. Therefore, this study examined the association between survival and US frequency during the 2 years preceding patients’ liver cancer diagnosis.

Methods: This population-based longitudinal study was conducted in Taiwan, a region with high liver cancer incidence, by using the National Health Insurance Research Database. We compared survival between patients who received US three times or more (≥3 group) and less than three times (<3 group) during the 2 years preceding their liver cancer diagnosis, and identified the predictors for the ≥3 group.

Results: This study enrolled 4621 patients with liver cancer who had died between 1997 and 2010. The median survival rate was higher in the ≥3 group (1.42 years) than in the <3 group (0.51 years). Five-year survival probability was also significantly higher in the ≥3 group (14.4%) than in the <3 group (7.7%). The multivariate logistic regression results showed that the three most common positive predictors for receiving three or more US sessions were indications of viral hepatitis, gallbladder diseases and kidney–urinary–bladder diseases; the most common negative predictors for receiving three or more US sessions were male sex and indications of abdominal pain.

Conclusion: Patients with liver cancer who received US three times or more during the 2 years preceding their liver cancer diagnosis exhibited a higher 5-year survival probability.

Full reference: Chiang, J. et al. (2017) Effect of ultrasonography surveillance in patients with liver cancer: a population-based longitudinal study. BMJ Open. 7:e015936

A watch-and-wait approach for locally advanced rectal cancer

Dossa, F. et al. The Lancet Gastroenterology & Hepatology | Published online: 4 May 2017

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Background: A watch-and-wait approach for patients with clinical complete response to neoadjuvant chemoradiation could avoid the morbidity of conventional surgery for rectal cancer. However, the safety of this approach is unclear. We synthesised the evidence for watch-and-wait as a treatment for rectal cancer.

 

Interpretation: Most patients treated by watch-and-wait avoid radical surgery and of those who have regrowth almost all have salvage therapy. Although we detected no significant differences in non-regrowth cancer recurrence or overall survival in patients treated with watch-and-wait versus surgery, few patients have been studied and more prospective studies are needed to confirm long-term safety.

Read the full abstract here

Improving adherence to colorectal cancer surveillance guidelines

Mariko C. et al. (2017) BMC Cancer. 17:106

L0028329 Endoscopy operations. Colour lithograph by Virginia Powell,

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

Background: Colorectal cancer (CRC) survivors are at increased risk of developing the disease again. Surveillance guidelines are aimed at maximising the early detection of recurring or new cancers and pre-cancerous polyps. The frequency and type of surveillance recommended depends on the type of treatment for the initial CRC, the extent of colonoscopic investigation prior to treatment and the results of previous surveillance tests. This paper aimed to test the effect of a paper–based educational intervention to improve adherence to colonoscopy following treatment for colorectal cancer.

Conclusions: Results indicate the paper-based educational intervention is not effective in improving adherence to colorectal cancer surveillance guidelines for colonoscopy.

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Vitamin D3 Prevents Calcium-Induced Progression of Early-Stage Prostate Tumors

Bernichtein, S. et al. Cancer Research. Published online: 15 January 2017

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Active surveillance has emerged as an alternative to immediate treatment for men with low-risk prostate cancer. Accordingly, identification of environmental factors that facilitate progression to more aggressive stages is critical for disease prevention. Although calcium-enriched diets have been speculated to increase prostate cancer risk, their impact on early-stage tumors remains unexplored. In this study, we addressed this issue with a large interventional animal study.

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Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer

Pham, K.N. et al. The Journal of Urology. August 2016. 196 (2).pp. 392–398

Image shows a colour-enhanced electron micrograph of a clump of prostate cancer cells.

Purpose: Active surveillance is an important alternative to definitive therapy for men with low risk prostate cancer. However, the impact of active surveillance on health related quality of life compared to that in men without cancer remains unknown. In this study we evaluated health related quality of life outcomes in men on active surveillance compared to men followed after negative prostate needle biopsy.

Materials and Methods: A prospective study was conducted on men who were enrolled into the Center for Prostate Disease Research Multicenter National Database and underwent prostate needle biopsy for suspicion of prostate cancer between 2007 and 2014. Health related quality of life was assessed at biopsy (baseline) and annually for up to 3 years using SF-36 and EPIC questionnaires. Health related quality of life scores were modeled using generalized estimating equations, adjusting for baseline health related quality of life, and demographic and clinical characteristics.

Results: Of the 1,204 men who met the initial eligibility criteria 420 had a negative prostate needle biopsy (noncancer comparison group). Among the 411 men diagnosed with low risk prostate cancer 89 were on active surveillance. Longitudinal analysis revealed that for most health related quality of life subscales there were no significant differences between the groups in adjusted health related quality of life score trends over time.

Conclusions: In this study most health related quality of life outcomes in patients with low risk prostate cancer on active surveillance did not differ significantly from those of men without prostate cancer. A comparison group of men with a similar risk of prostate cancer detection is critical to clarify the psychological and physical impact of active surveillance.

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Active Surveillance of Prostate Cancer in a Community Practice: How to Measure, Manage, and Improve?

Gaylis, F. et al.Urology. Published online: 12 February 2016

Objective: To measure past active surveillance (AS) adoption rates, institute the best practice, and measure the AS adoption rates following implementation. We report our findings over a 3-year period.

Methods: Patient prostate needle biopsy and treatment data from the period August 2011 to August 2014 were retrieved from an integrated electronic medical records (Allscripts) and stored in a Microsoft Access database for analysis. Structured data were queried using the automated software program WizMD and unstructured data were abstracted by manual review. AS adoption was calculated according to four different selection criteria. Between 2013 and 2014, physicians at Genesis Healthcare Partners (GHP) underwent an educational training program on the University of California, San Diego/GHP AS best practice for managing low-risk prostate cancer patients and were provided report cards on their AS adoption and comparative reporting.

Results: AS adoption increased for the 3 years of the study. AS adoption for all newly diagnosed patients managed at GHP increased from 12.9% to 14.74%. AS adoption for patients with low-risk prostate cancer (as defined by the National Comprehensive Cancer Network) increased from 31.90% to 58.46% from year 1 to year 3 of the study (P < .001), and AS adoption for the most strict (restrictive) criteria increased from 43.75% to 82.61% (P < .001) after the educational and comparative reporting intervention.

Conclusion: These data highlight the potential benefit of physician education and comparative reporting to enhance AS adoption. AS adoption rates vary according to selection criteria used for analysis. Carefully selected outcomes from evidence-based guidelines have the potential to enhance medical quality.

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Exercise could work as treatment for prostate cancer

Cancer Research UK

The PANTERA study, led by Sheffield Hallam University, will focus on 50 men who have the disease, but whose cancer has not spread.

Half of the men in the study will carry out two-and-a-half hours of aerobic exercise every week for 12 months – initially with the support of a qualified trainer and then with free access to local gyms. The other half will be given information about the benefits of exercise for cancer patients but will have no supervised sessions.

Prostate cancer that has not spread is sometimes treated with surgery or radiotherapy. But this can have side-effects so many men opt for active surveillance instead, which involves monitoring the disease. All the men in the PANTERA study are and will remain on active surveillance – and they will also be closely monitored as part of the study itself.

 

Read the full press release via Cancer Research UK