Data show fewer new cancer research projects were funded during the Covid-19 pandemic #Covid19RftLks

Institute of Cancer Research | March 2022 | Data show fewer new cancer research projects were funded during the Covid-19 pandemic

New figures from the National Cancer Research Institute (NCRI) show that fewer new cancer research projects were funded in 2020/21. This is the first time NCRI’s cancer research funding database has shown a drop in funding caused by the Covid-19 pandemic.

Full details are available from the Institute of Cancer Research

In the news:

The Guardian UK cancer research studies fell 32% in first year of Covid, say charities

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.

If you’d like access to this paper, please request it from the Library

New oncology collaboration established to drive forward translational cancer research

NIHR | February 2021 | New oncology collaboration established to drive forward translational cancer research

The National Institute for Health Research has announced the NIHR Oncology Translational Research Collaboration (TRC), it unites leading cancer researchers from across the NIHR’s Biomedical Research Centres (BRC) to drive forward innovative research in key areas including early diagnosis, surgery, immunotherapy and radiotherapy. Through working in partnership, the Oncology TRC will be able to carry out research that requires real collaborative effort, and would not be possible by centres working alone. It will also complement research undertaken by other cancer research networks.

Full details about the TRC are available from NIHR

To find out more about the Oncology TRC, visit its page on the NIHR website or contact nocri@nihr.ac.uk to find out how you can work with the collaboration. 

NIHR: How radiotherapy research has helped safe and effective treatment for cancer patients throughout the COVID-19 pandemic #covid19rftlks #worldcancerday

NIHR | 4 February 2021| How radiotherapy research has helped safe and effective treatment for cancer patients throughout the COVID-19 pandemic

Today 4 February 2021 is World Cancer Day, the NIHR highlights how thanks to radiotherapy research, patients with breast cancer can continue to receive safe and effective treatment in a reduced number of visits to hospital, helping to keep them safe from Covid-19 (@NIHRResearch).

In this piece Professor John Wadsley explains how, research that demonstrates a week’s treatment of radiotherapy is as safe and effective as undergoing a course of more treatments over a period of three weeks, was used to inform treatment for patients with breast cancer during the first wave of the pandemic.

Radiotherapy treatment usually requires multiple visits to hospital, typically five days a week for three to seven weeks. At the onset of the pandemic there were major concerns about the safety of bringing potentially vulnerable patients into hospital for so many visits, and the capacity within radiotherapy departments to continue delivering treatments due to staff sickness or having to isolate.

Researchers from the FAST- Forward trial, wherein more than 4000 patients from 97 UK hospitals over 2.5 years, each allocated to one of three treatment groups – the standard 15 treatment schedule or one of two, had already tested whether a course of five treatments over one week was as safe and effective. Patients in all groups were carefully followed up to check for any evidence of cancer recurrence and for any late side effects from the treatment. The findings from the FAST- Forward trial are published in The Lancet

The full article can be read from NIHR Research

Related:

University of Leeds Dramatic changes to radiotherapy treatments due to COVID-19

University of Leeds: ‘First of its kind’ lung cancer trial

University of Leeds | November 2020| ‘First of its kind’ lung cancer trial

Scientists from the UK universities of Leeds, Newcastle, Manchester and Glasgow have been awarded funding of £900,000 by Cancer Research UK; the CONCORDE trial will explore the use of new drugs alongside standard radiotherapy in the hope of improving survival for people with advanced non-small cell lung cancer (NSCLC).

The team of researchers hope that the new drugs will make radiotherapy more effective, increase its ability to eradicate tumour cells and potentially offer new hope to lung cancer patients (Source: University of Leeds)

Full details of the trial are available from the Leeds press release

NIHR: More precise classification of risk in prostate cancer reveals a huge variation in treatment

NIHR | September 2020 |More precise classification of risk in prostate cancer reveals a huge variation in treatment

A new study identifies huge variation in the treatment of prostate cancer in English hospitals. in some hospitals, almost all are offered radiotherapy or surgery. In other hospitals, they are much more likely to be monitored with active surveillance and spared the possible effects of treatment. The researchers included more than 60000 men diagnosed with prostate cancer in almost 130 English hospitals between 2014 and 2017.

Current NICE guidelines classify prostate cancers in three tiers: low, intermediate or high risk. These are broad tiers, and not all men in the intermediate group are at the same risk of their cancer spreading. Therefore, some can potentially avoid treatment.

The Cambridge Prognostic Group (CPG) classification splits both intermediate- and high-risk groups in two, giving five tiers in total. Intermediate-risk cancers are divided into tumours with favourable and unfavourable outlooks. This study uses the CPG classification, categorising the patients into its’ five risk groups.

As expected, men in the low-risk group were least likely to have been treated with surgery or radiotherapy and most likely to have been on active surveillance. Men in the higher risk groups were most likely to have had surgery or radiotherapy. Variation between different hospitals’ approaches is not obvious in the broad intermediate category used by NICE. But when the researchers used the more detailed, five-tier CPG classification, they were able to consider those with favourable and unfavourable outlooks separately.

They found huge variations between hospitals in the treatments offered to men with intermediate-risk cancer. This was especially true for men with favourable intermediate-risk cancer. In some hospitals, less than a quarter of these men (23%) had surgery or radiotherapy. In others, almost all (97%) had surgery or radiotherapy. This suggests there is little agreement between hospitals in how these men should be managed.

NICE issued guidelines in 2019 which used the traditional three groupings of low-, intermediate- and high-risk prostate cancer. The guidelines do not divide intermediate-risk cancers into favourable and unfavourable groups. NICE recommends that men with intermediate-risk cancers should be offered surgery or radiotherapy.

Despite growing evidence in favour of active surveillance for favourable intermediate-risk prostate cancer, this approach is not recommended by NICE as initial treatment. But the guidelines state that it can be considered for men who choose not to have immediate radical treatment.

This work suggests that some men who received treatment for prostate cancer could have been managed with active surveillance. This piece of research also underlines how differences in treatment practices in men with intermediate-risk disease (CPG2 and CPG3) and in men with high-risk disease (CPG4 and CPGP5) that are not visible when using the traditional three-tiered risk classification (Source: NIHR).

Full alert available from NIHR

Read the published paper Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation from BMC Medicine

BMJ: CT screening in former or current smokers can significantly reduce mortality by almost a quarter

Mayor, S. |2020| Lung cancer: CT screening in former or current smokers significantly reduces mortality, study finds| BMJ  |368 |doi: https://doi.org/10.1136/bmj.m347

The findings of a large randomised controlled trial, now published in the NEJM, demonstrate that regular computed tomographic (CT) screening in current and former smokers reduces lung cancer mortality by around a quarter at 10 years.

The NELSON study included more than 13 000 men and 2 500 women aged between 50 and 74 from the Netherlands and Belgium. All of the subjects were current or former smokers, with a median smoking history of 38.0 pack years (interquartile range 29.7 pack years to 49.5 pack years) among male participants. Less than half  (44.9%) of the men in the study were former smokers.

Results showed that deaths from lung cancer were nearly a quarter (24%)  lower after 10 years of follow-up in men undergoing regular CT screening than in those not screened . Lung cancer deaths decreased from 3.3 deaths per 1000 person years in the control group to 2.5 deaths per 1000 person years in men who were screened (Source: Mayor, 2020).

Abstract

BACKGROUND

There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.

METHODS

A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.

RESULTS

Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.

CONCLUSIONS

In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580. opens in new tab.)

Interested in this study? Ask the Library & Knowledge Service to provide you with a copy here

 

Testicular cancer: one cycle of chemo just as effective

Cullen, M., et al |2020|The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis|European Urology|

European Urology has published a paper based on a study that looked at the efficacy of one cycle of chemotherapy for patients with testicular cancer rather than two.  While standard treatment in Europe involves two cycles of chemotherapy the researchers of this trial  show that one cycle has few adverse effects and comparable outcomes
to those seen with two cycles. 

Abstract
Background: Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2 ), and cisplatin (BE360P) chemotherapy, or surveillance.
Objective: To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P.
Design, setting, and participants: A total of 246 patients with vascular invasion–positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study.
Intervention: One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1–3, and cisplatin 50 mg/m2 on days 1–2, plus antibacterial and granulocyte colony stimulating factor prophylaxis.
Outcome measurements and statistical analysis: The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of 5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr.
Results and limitations: The median follow-up was 49 mo (interquartile range 37–60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3–
3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3–4 febrile neutropenia occurred in 6.8% of participants.
Conclusions: BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population.
Patient summary: Removing the testicle fails to cure many patients with high-risk primary testicular cancer  since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes
to those seen with two cycles

 

The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of  Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in 
High-risk, Stage 1 Nonseminomatous or Combined Germ Cell
Tumours of the Testis

In then news:

BBC News Testicular cancer: ‘Kinder’ chemotherapy is ‘just as effective’

Manchester research: One dose of radiotherapy as effective as five doses for cancer in the spine

University of Manchester| December  2019 | One dose of radiotherapy as effective as five doses for cancer in the spine 

A study conducted by a team of researchers from the Universities of Manchester and University College London aimed to test whether administering just one dose (single-fraction) of radiotherapy could be used instead of five doses (multi-fraction) which requires several hospital visits. The findings of the SCORAD randomised clinical trial, now published in JAMA, indicate that one dose of radiotherapy should be used instead of five doses for most patients with spinal canal compression, this finding is supported by all of the other statistical criteria and multiple patient outcomes.

The lead trial investigator, Professor Peter Hoskin (University of Manchester, Mount Vernon Cancer Centre (NHS), said: “In the UK, NICE guidelines do not currently stipulate a standard treatment regimen, though most patients with spinal canal compression or other metastatic bone disease are given several fractions.

“We believe our findings, which show equal clinical effectiveness for single-dose radiotherapy, provide strong evidence for NICE guidelines, and those in other countries, to be changed to stipulate a one-dose one-visit approach, reducing unnecessary discomfort for end of life cancer patients without compromising efficacy” (Source: University of Manchester).

Key points 

Question  Is treatment with a single dose of radiotherapy noninferior to multifraction radiotherapy delivered over 5 days among patients with metastatic cancer who have spinal canal compression?

Findings  In a clinical trial of 686 patients, the percentage who were ambulatory at 8 weeks was 69.3% in the single-fraction group vs 72.7% in the multifraction radiotherapy group. The lower CI limit for the risk difference (−11.5%) did not meet the predefined noninferiority margin of −11.0%.

Meaning  Treatment with single-fraction radiotherapy did not meet the criterion for noninferiority compared with multifraction radiotherapy for ambulatory response rate at 8 weeks, but consideration should be given to the extent to which the lower bound of the CI overlapped with the noninferiority margin.

See also:

University of Manchester One dose of radiotherapy as effective as five doses for cancer in the spine

University College London One dose of radiotherapy as effective as five doses for cancer in the spine

Full reference:

Hoskin, P.J., et al.|2019| Effect of Single-Fraction vs Multifraction Radiotherapy on Ambulatory Status Among Patients With Spinal Canal Compression From Metastatic Cancer: The SCORAD Randomized Clinical Trial | JAMA|322| 21| P. 2084–2094 |doi:https://doi.org/10.1001/jama.2019.17913

The full article is available from JAMA

Abstract

Importance  Malignant spinal canal compression, a major complication of metastatic cancer, is managed with radiotherapy to maintain mobility and relieve pain, although there is no standard radiotherapy regimen.

Objective  To evaluate whether single-fraction radiotherapy is noninferior to 5 fractions of radiotherapy.

Design, Setting, and Participants  Multicenter noninferiority randomized clinical trial conducted in 42 UK and 5 Australian radiotherapy centers. Eligible patients (n = 686) had metastatic cancer with spinal cord or cauda equina compression, life expectancy greater than 8 weeks, and no previous radiotherapy to the same area. Patients were recruited between February 2008 and April 2016, with final follow-up in September 2017.

Interventions  Patients were randomized to receive external beam single-fraction 8-Gy radiotherapy (n = 345) or 20 Gy of radiotherapy in 5 fractions over 5 consecutive days (n = 341).

Main Outcomes and Measures  The primary end point was ambulatory status at week 8, based on a 4-point scale and classified as grade 1 (ambulatory without the use of aids and grade 5 of 5 muscle power) or grade 2 (ambulatory using aids or grade 4 of 5 muscle power). The noninferiority margin for the difference in ambulatory status was −11%. Secondary end points included ambulatory status at weeks 1, 4, and 12 and overall survival.

Results  Among 686 randomized patients (median [interquartile range] age, 70 [64-77] years; 503 (73%) men; 44% had prostate cancer, 19% had lung cancer, and 12% had breast cancer), 342 (49.8%) were analyzed for the primary end point (255 patients died before the 8-week assessment). Ambulatory status grade 1 or 2 at week 8 was achieved by 115 of 166 (69.3%) patients in the single-fraction group vs 128 of 176 (72.7%) in the multifraction group. The difference in ambulatory status grade 1 or 2 in the single-fraction vs multifraction group was −0.4% at week 1, −0.7%; P value for noninferiority = .01) at week 4, and 4.1%; P value for noninferiority = .002) at week 12. Overall survival rates at 12 weeks were 50% in the single-fraction group vs 55% in the multifraction group. Of the 11 other secondary end points that were analyzed, the between-group differences were not statistically significant or did not meet noninferiority criterion.

Conclusions and Relevance  Among patients with malignant metastatic solid tumors and spinal canal compression, a single radiotherapy dose, compared with a multifraction dose delivered over 5 days, did not meet the criterion for noninferiority for the primary outcome (ambulatory at 8 weeks). However, the extent to which the lower bound of the CI overlapped with the noninferiority margin should be considered when interpreting the clinical importance of this finding.

Trial Registration  ISRCTN Identifiers: ISRCTN97555949 and ISRCTN97108008

The full paper is available from JAMA 

 

Cancer survivors have raised heart risk, reports a US population-based study of cardiovascular disease mortality risk patients with cancer

Sturgeon, K.M , et al | 2019| A population-based study of cardiovascular disease mortality risk in US cancer patients| European Heart Journal| ehz766| https://doi.org/10.1093/eurheartj/ehz766

The European Heart Journal has published research that looked at three million US patients, across 28  types of  cancers, over a period of  40 years, the experts behind this analysis found that more than one-tenth of patients died from cardiovascular diseases. The research highlights the incidence of cardiovascular disease (CVD)  in patients diagnosed with breast, prostate, or bladder cancer.  The team also observed that from the point of cancer diagnosis onward patients with cancer (all sites) are at elevated risk of dying from CVDs compared to the general US population (Source: Sturgeon, et al. 2019).

 

The journal article is available in full from The European Heart Journal

Abstract

Aims

 

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

 

Methods and results

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973–2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at less than 35 years of age. Further, CVD mortality risk is highest  within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

Conclusion

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

 

In the news:

BBC News Cancer survivors ‘have higher heart risk’