New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis

Evidence from clinical trial populations suggests low-dose aspirin reduces the risk of colorectal cancer (CRC). Part of this reduction in risk might be due to protection against metastatic disease | BMC Cancer

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Image source: Bayer AG – Wikimedia // CC BY-SA 3.0

We investigated the risk of CRC among new-users of low-dose aspirin (75–300 mg), including risk by stage at diagnosis. Using The Health Improvement Network, we conducted a cohort study with nested case–control analysis. Two cohorts (N = 170,336 each) aged 40–89 years from 2000 to 2009 and free of cancer were identified: i) new-users of low-dose aspirin, ii) non-users of low-dose aspirin, at start of follow-up, matched by age, sex and previous primary care practitioner visits. Patients were followed for up to 12 years to identify incident CRC. 10,000 frequency-matched controls were selected by incidence density sampling where the odds ratio is an unbiased estimator of the incidence rate ratio (RR). RRs with 95% confidence intervals were calculated. Low-dose aspirin use was classified ‘as-treated’ independent from baseline exposure status to account for changes in exposure during follow-up.

Patients starting low-dose aspirin therapy have a reduced risk of Stages B–D CRC, suggesting a role for low-dose aspirin in the progression of established CRC; a substantial reduction in the risk of Dukes A CRC may occur after 5 years’ therapy.

Full reference: García Rodríguez, L.A. et al. (2017) New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis: a nested case–control study in UK general practice. BMC Cancer. 17:637

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Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer

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Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Discovery in fight against bowel cancer

New research has discovered how a genomic approach to understanding bowel (colorectal) cancer could improve the prognosis and quality of life for patients.

Bowel cancer is the fourth most common cancer in the UK, with 41,200 people newly diagnosed each year. A number of treatment options are available but mortality rates remain high, with bowel cancer the second most common cause of cancer death in the UK.

Researchers at Queen’s University Belfast, in collaboration with the University of Oxford and the University of Leeds have made a significant advance in the treatment of bowel cancer. The study, which has been published in the journal Nature Communications, has shown how defining precise gene signatures within bowel cancer cells can allow us to develop novel prognostic and predictive markers for bowel cancer and help to drive personalised medicine approaches.

Full story via ScienceDaily

Link to the research:  Dunne, P.D. et al. Cancer-cell intrinsic gene expression signatures overcome intratumoural heterogeneity bias in colorectal cancer patient classification. Nature Communications, 2017

Chance of colon cancer recurrence nearly cut in half in people who eat nuts

Something as simple as eating tree nuts may make a difference in the long-term survival of patients with colon cancer, a new study concludes.American Society of Clinical Oncology (ASCO) | ScienceDaily | 18th May 2017

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An observational study of 826 patients with stage III colon cancer showed that those who consumed two ounces or more of nuts per week had a 42% lower chance of cancer recurrence and 57% lower chance of death than those who did not eat nuts.

A secondary analysis revealed the benefit of nut consumption was limited to tree nuts. Tree nuts include almonds, walnuts, hazelnuts, cashews, and pecans, among others. These findings will be presented at the upcoming 2017 ASCO Annual Meeting in Chicago.

Read more at ScienceDaily

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

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

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

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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.

Read the full article here

NICE: All patients with colorectal cancer should be tested for genetic condition

Everyone who has colorectal cancer diagnosed should be tested for an inherited genetic condition called Lynch syndrome, new guidance states | BMJ

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The National Institute for Health and Care Excellence (NICE) recommends microsatellite instability testing or immunohistochemistry to detect abnormalities that may indicate the syndrome.

Lynch syndrome, the most common cause of hereditary bowel cancer, has also been linked to an increased risk of developing other cancers including womb, ovarian, and stomach. People with the condition who develop colorectal cancer generally do so at a younger age, usually 40-50.

Testing for the condition helps to identify whether the patient’s family are also at increased risk of cancer so that they can be monitored more closely if needed, says NICE. Where these tests show that a person has a risk of the syndrome, the guidance recommends further tests to confirm the diagnosis. Because it is an inherited condition, a positive test can also lead to testing of family members.

Diagnosing Lynch syndrome may also help with the choice of treatment for colorectal cancer—for example, to direct chemotherapy or surgery.

Read the full overview here

Read the full guidance recommendations here