NIHR: Active monitoring in early prostate cancer prevents as many deaths as surgery or radiotherapy, new research shows

NIHR| 4 February 2021| Active monitoring in early prostate cancer prevents as many deaths as surgery or radiotherapy, new research shows

New research indicates that ‘watch and wait’ also known as active monitoring in early prostate cancer prevents as many deaths as surgery or radiotherapy. The experts involved in this trial have observed that at 10-year median follow-up of patients with early prostate cancer, there was no difference in disease-specific mortality between active monitoring, radical prostatectomy and radical radiotherapy treatments, which caused different side-effect profiles.

It stuidied over 82 000 men between the ages of 50 and 69 who agreed to have a PSA test. Some 2664 were diagnosed with localised prostate cancer, and of this group, 1643 agreed to be randomly allocated to surgery, radiotherapy, or active monitoring. Urinary and sexual function was assessed by questionnaires completed by the men.

The results showed that in the ten years following their diagnosis:

• 99% of men were alive in each of the three groups
• compared with active monitoring, surgery and radiotherapy reduced the risk of disease spreading outside the prostate by half
• urinary leakage and sexual function were worst after surgery
• sexual and bowel functions were most affected by radiotherapy
• More than half (55%) men on active monitoring moved to a radical treatment but many (44%) remained disease free and avoided the side effects of treatments.

The study found that overall, quality of life was similar across all groups. Men on active monitoring had an expected gradual decline in their urinary and sexual function over time. The researchers concluded that longer follow-up is needed to determine the most cost-effective treatment for localised prostate cancer over a man’s lifetime.

This is a practice changer for the management of prostate cancer; many academics have called it the Greatest Trial Of all Time. After years of retrospective research with uncontrollable bias, it was the first large randomised controlled trial to compare surgery to radiotherapy and active monitoring for the treatment of localised prostate cancer. It showed no difference in survival in the different treatment groups which is essential news for counselling patients with a new diagnosis of prostate cancer.

Suneil Jain, Professor and Honorary Consultant in Clinical Oncology, Queen’s University of Belfast

(Source: NIHR)

The primary paper Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT

What factors affect quality of life in older patients with cancer?

A new study provides insights on the factors that affect health-related quality of life in older adults with cancer. The findings support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. | Cancer  | Story via ScienceDaily

Abstract

As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear.

Methods

A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey from the Medical Outcomes Study. Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents).

Results

Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue, pain, disturbed sleep, and drowsiness.

Symptoms found to be strongly associated with MCS included fatigue, problems remembering things, disturbed sleep, and lack of appetite.

Conclusions

The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer.

 

Full reference: Maria Pisu et al. | Most impactful factors on the health-related quality of life of a geriatric population with cancer |Cancer |  First publishd 18 December 2017

New quality of life measure for recovering cancer patients

New ‘quality of life metric’, will use questionnaires to measure how well cancer patients are supported after treatment. | NHS England

NHS England are introducing a new approach to drive improvements in after care which includes personalised plans for people with cancer outlining not only their physical needs, but also other support they may need, such as help at home or financial advice.

The latest national survey shows the vast majority of people with cancer are positive about the NHS care they receive, but there is currently no measure to assess how well patients are supported after treatment.

The new ‘quality of life metric’, which is the first of its kind, will use questionnaires to measure how effective this support is and the data will be made available on My NHS – helping patients, the public, clinicians and health service providers see how well their local after cancer care support is doing.

Full story at NHS England

New chemotherapy approach offers breast cancer patients a better quality of life

The chemotherapy drug capecitabine gives patients a better quality of life and is as effective at preventing breast cancer from returning as the alternative regimen called CMF, when given following epirubicin. | ScienceDaily | Cancer Research UK

Around 4,400 patients on the TACT2 clinical trial were treated with the chemotherapy drug epirubicin followed by either capecitabine or CMF, after surgery.

Researchers at The Institute of Cancer Research, London, and the Cancer Research UK Edinburgh Centre found that capecitabine resulted in patients experiencing fewer side effects and having a better quality of life, and it was as effective at preventing cancer’s return as CMF.

Most patients experienced some side effects regardless of the treatment they were given. But those taking CMF were more likely to experience severe side effects including early menopause, nausea, infection, thrombosis, and anemia.

During the trial, patients were followed up after 12, 18 and 24 months, and then yearly for at least 10 years, to see if their cancer had returned and to monitor side effects. More than 85 per cent of patients did not experience their cancer returning for at least five years.

More detail at

• Cancer Research UK
•  ScienceDaily

Link to the research:

Cameron, D., et al.  Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer in the randomised UK TACT2 trial (CRUK/05/19): a multicentre, phase 3, open-label, randomised, controlled trial. The Lancet Oncology.

Breast cancer e-support program vs routine care

Zhu, J. et al. (2017) BMC Cancer. 17:291

Background: Women with breast cancer undergoing chemotherapy suffer from a number of symptoms and report receiving inadequate support from health care professionals. Innovative and easily accessible interventions are lacking. Breast Cancer e-Support is a mobile Application program (App) that provides patients with individually tailored information and a support group of peers and health care professionals. Breast Cancer e-Support aims to promote women’s self-efficacy, social support and symptom management, thus improving their quality of life and psychological well-being.

Discussion: This is the first study of its kind in China to evaluate the use of a mobile application intervention with a rigorous research design and theoretical framework. This study will contribute to evidence regarding the effectiveness of a theory-based mobile application to support women with breast cancer undergoing chemotherapy. The results should provide a better understanding of the role of self-efficacy and social support in reducing symptom distress and of the credibility of using a theoretical framework to develop internet-based interventions. The results will provide evidence to support the implementation of an innovative and easily accessible intervention that enhances health outcomes.

Read the full protocol here

Quality of life with those with advanced cancer improved through walking

Walking for just 30 minutes three times per week could improve the quality of life for those with advanced cancer, a new study has found | ScienceDaily

Researchers from the University of Surrey collaborated with those form the Florence Nightingale Faculty of Nursing & Midwifery at King’s College London to explore the impact of walking on the quality of life and symptom severity in patients with advanced cancer.

Despite growing evidence of significant health benefits of exercise to cancer patients, physical activity commonly declines considerably during treatment and remains low afterwards. Initiatives in place to promote physical activity for those suffering with cancer are normally supervised and require travel to specialist facilities, placing an additional burden on patients.

Read the full overview here

Read the full article here

Prevalence of cancer chemotherapy-related problems and associated supportive care

Wagland, R. et al. (2016) Supportive Care in Cancer. 24(12) pp. 4901–4911

Purpose: The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.

Conclusion: The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.

Read the full abstract here

Key issues affecting quality of life and patient-reported outcomes in prostate cancer

Msaouel P. et al. BMJ Supportive & Palliative Care. Published Online: 6 February 2017

Objective: Evidence-based quality of life (QL) questionnaires require the identification of issues of importance to patients. The primary aim of this study was to inform providers on patient-expressed issues while enhancing the content validity of instruments assessing QL and patient-reported outcomes (PROs) in prostate cancer. The study provided additional psychometric properties for the new PRO and QL instrument, the Prostate Cancer Symptom Scale (PCSS).

Conclusions: This is the largest survey providing patient-expressed background for content validity for QL and PRO measures. The findings of this study should aid development of newer practical questionnaires, such as the PCSS, which can be adapted to electronic platforms enhancing rapid and accurate PRO and QL evaluation.

Read the full article here

Early palliative care improves coping & quality of life for patients with incurable cancers

ScienceDaily | Published online: 7 September 2016.

A randomized clinical trial found that introducing palliative care shortly after a diagnosis of certain metastatic cancers greatly increases a patient’s coping abilities, as well as overall quality of life. Researchers also found that early integration of palliative care results in an increase in discussions about patient end-of-life care preferences.

The findings are part of a growing body of evidence demonstrating the benefits of palliative care on patient quality of life. This study will be presented at the upcoming 2016 Palliative Care in Oncology Symposium in San Francisco.

To explore the effects of early palliative care, researchers randomly assigned 350 patients, who had been recently diagnosed with incurable lung or non-colorectal gastrointestinal cancer, to receive early palliative care integrated with oncology care or oncology care alone.

Read the abstract commentary here

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 source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

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.

Read the abstract here