Advancing Care, Advancing Years: Improving Cancer Treatment and Care for an Ageing Population 

Cancer Research UK | June 2018 | Advancing Care, Advancing Years: Improving Cancer Treatment and Care for an Ageing Population 

A new report presents the findings of  research commissioned by Cancer Research UK (CRUK) and conducted by the University of Birmingham’s Health Services Management Centre and ICF International, which sought to understand the specific needs of older patients, and to explore the process of clinical decision-making for older people with cancer across the UK.

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This research involved a literature review, clinical observations at eight case study sites, interviews with 15 national decision-makers and 80 health professionals, and three UK-wide surveys (of primary care professionals, secondary care professionals and older people affected by cancer). The direction of the research was also informed by engagement with a group of older people affected by cancer, and by extensive engagement and interviews with national policymakers.

This research involved a literature review, clinical observations at eight case study sites, interviews with 15 national decision-makers and 80 health professionals, and three UK-wide surveys (of primary care professionals, secondary care professionals and older people affected by cancer). The direction of the research was also informed by engagement with a group of older people affected by cancer, and by extensive engagement and interviews with national policymakers.

The report is available from CRUK 

Prostate cancer ultrasound treatment as effective as surgery or radiotherapy

Using high energy ultrasound beams to destroy prostate cancer tumours may be as effective as surgery or radiotherapy, but with fewer side effects | European Urology | via ScienceDaily

A new study, carried out at six hospitals across the UK, tracked 625 men with prostate cancer who received a type of treatment called high-intensity focused ultrasound (HIFU).

The research, published in the journal European Urology, is the largest ever study of HIFU treatment used to target prostate tumours. The treatment is similar to a ‘lumpectomy’ for other cancers — where doctors remove only tumour cells, leaving as much healthy tissue as possible.

The findings, from a number of institutions including Imperial College London and University College London, found that after five years the cancer survival rate from HIFU was 100 per cent. Approximately, 1 in 10 men needed further treatment. The cancer survival rate from surgery and radiotherapy is also 100 per cent at five years.

The research also showed the risk of side effects of HIFU, such as urinary incontinence and erectile dysfunction, were lower than other treatment options, at 2 per cent and 15 per cent respectively.

Full story at ScienceDaily

Journal reference: Guillaumier, S. et al. | A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer |European Urology, 2018

Hypnosis may help reduce distress of cancer treatment in children

University of Exeter | June 2018 | Hypnosis may help reduce distress of cancer treatment in children

A team at the University of Exeter have worked alongside Devon Integrated Children’s Service to explore ways of  reducing anxiety in children having treatment for cancer without using drugs. According to the authors of the study almost fifty per cent of children with cancer experience clinically significant emotional distress. This can cause additional anguish for the child and for their families and have a long-lasting impact on mental health. As well as looking at the evidence available on hypnosis, the team also reviewed evidence on listening to music, virtual reality and cognitive behavioural therapy. They found much of the research about whether or not these strategies reduced children’s distress to be  contradictory.

Now, the team report  that hypnosis can reduce the distress associated with injections and other needle procedures, such as extracting bone marrow and giving chemotherapy. Earlier research had found that procedures like these are often more anxiety-inducing for children and young people than the cancer itself.
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Tamsin Ford, Professor of Child and Adolescent Psychiatry at the University of Exeter Medical School, said: “Hypnosis is inexpensive to deliver, and our research found that it was the technique that was most studied, and showed promise in reducing children’s anxiety about the many medical procedures they have to endure. We now need high quality trials to be sure whether hypnosis should be adopted in clinics.”(Source: University of Exeter)

An article based on the research’s findings has been published in the journal Psychooncology

Abstract

OBJECTIVE:

Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP.

METHODS:

Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen’s d) and 95% confidence intervals. All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool.

RESULTS:

Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual . Evidence from nonhypnosis interventions was equivocal, with some promising individual studies. There was high risk of bias across included studies limiting confidence in some positive effects.

CONCLUSIONS:

Evidence suggests promise for hypnosis interventions to reduce procedural anxiety in CYP undergoing cancer treatment. These results largely emerge from one research group, therefore wider research is required. Promising evidence for individual nonhypnosis interventions must be evaluated through rigorously conducted randomised controlled trials.

Full reference:

Nunns, M., Mayhew, D., Ford, T, Rogers, M., Curle, C., Logan, S., Moore, D.|2018| Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: A systematic review and meta-analysis| Psychooncology2018 Apr 30|  doi: 10.1002/pon.4749. [Epub ahead of print]

 

Research supports less chemotherapy after bowel cancer surgery

NIHR | June 2018 | Research supports less chemotherapy after bowel cancer surgery

New research funded by the NIHR shows that patients with bowel cancer may only need half of the number of sessions of chemotherapy than they currently receive. The international clinical research trial indicates that people with bowel cancer who are currently given 6 months of chemotherapy may only need three months of treatment (Source: NIHR).
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The full story is available at NIHR 

Background

6 months of oxaliplatin-containing chemotherapy is usually given as adjuvant treatment for stage 3 colorectal cancer. We investigated whether 3 months of oxaliplatin-containing chemotherapy would be non-inferior to the usual 6 months of treatment.

Methods

The SCOT study was an international, randomised, phase 3, non-inferiority trial done at 244 centres. Patients aged 18 years or older with high-risk stage II and stage III colorectal cancer underwent central randomisation with minimisation for centre, choice of regimen, sex, disease site, N stage, T stage, and the starting dose of capecitabine. Patients were assigned (1:1) to receive 3 months or 6 months of adjuvant oxaliplatin-containing chemotherapy. The chemotherapy regimens could consist of CAPOX (capecitabine and oxaliplatin) or FOLFOX (bolus and infused fluorouracil with oxaliplatin). The regimen was selected before randomisation in accordance with choices of the patient and treating physician. The primary study endpoint was disease-free survival and the non-inferiority margin was a hazard ratio of 1·13. The primary analysis was done in the intention-to-treat population and safety was assessed in patients who started study treatment. This trial is registered with ISRCTN, number ISRCTN59757862, and follow-up is continuing.

Findings

6088 patients underwent randomisation between March 27, 2008, and Nov 29, 2013. The intended treatment was FOLFOX in 1981 patients and CAPOX in 4107 patients. 3044 patients were assigned to 3 month group and 3044 were assigned to 6 month group. Nine patients in the 3 month group and 14 patients in the 6 month group did not consent for their data to be used, leaving 3035 patients in the 3 month group and 3030 patients in the 6 month group for the intention-to-treat analyses. At the cutoff date for analysis, there had been 1482 disease-free survival events, with 740 in the 3 month group and 742 in the 6 month group. 3 year disease-free survival was 76·7%  for the 3 month group and 77·1%  for the 6 month group, giving a hazard ratio of 1·006 (0·909–1·114, test for non-inferiority p=0·012), significantly below the non-inferiority margin. Peripheral neuropathy of grade 2 or worse was more common in the 6 month group (237 [58%] of 409 patients for the subset with safety data) than in the 3 month group (103 [25%] of 420) and was long-lasting and associated with worse quality of life. 1098 serious adverse events were reported (492 reports in the 3 month group and 606 reports in the 6 month group) and 32 treatment-related deaths occurred (16 in each group).

Interpretation

In the whole study population, 3 months of oxaliplatin-containing adjuvant chemotherapy was non-inferior to 6 months of the same therapy for patients with high-risk stage II and stage III colorectal cancer and was associated with reduced toxicity and improved quality of life. Despite the fact the study was underpowered, these data suggest that a shorter duration leads to similar survival outcomes with better quality of life and thus might represent a new standard of care.

The findings have now been published in the journal Lancet Oncology where the article can now be downloaded

Full reference:

Iveson, Timothy J et al.| 2018| 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial|The Lancet Oncology | Vol. 19| Issue 4| P.  562 – 578

Promising new ovarian cancer treatment could soon be available on the NHS

Ovarian Cancer Action | June 2018 |Promising new ovarian cancer treatment could soon be available on the NHS

The National Institute for Health and Care Excellence (NICE) has issued draft guidance on a promising new ovarian cancer drug, niraparib, advising that it is a suitable candidate for use in the Cancer Drugs Fund (CDF) (Ovarian Cancer Action). 

Ovarian cancer is the fifth most common cause of cancer death in women and has the highest mortality rate of all gynaecological cancers. Five-year survival in England and Wales is also among the lowest in Europe – well below the European average. While these figures are bleak, it is exciting to think that niraparib could provide a much-needed new option for many women with the disease.

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“We are pleased that the NICE committee has recognised the high unmet need in ovarian cancer treatment,” said Katherine Taylor, Chief Executive of Ovarian Cancer Action. “Every day matters for patients and their families and we hope that the CDF submission is successful and will deliver access to many women in England and Wales as soon as possible. We also look forward to a review by the Scottish Medicines Consortium (SMC) later this year.”

Source: Ovarian Cancer Action

Related:

NICE Niraparib for ovarian cancer [ID1041]

In the media:

The Independent Ovarian cancer ‘game changer’ drug which holds back disease’s return gets first NHS fund approval

Sky News Niraparib drug: Daily pill available on NHS for first time is ‘milestone’ in ovarian cancer treatment

Express Ovarian cancer – ‘game changing’ new drug puts patient’s tumour into remission

Cancers should be recategorised based on tumour types, not location, say American researchers

Liu, J.,  et al | 2018 | An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics | Cell | 73 | Vol. 2| P. 400-416| e11 | Doi: 10.1016/j.cell.2018.02.052. 

Researchers in the US argue that based on the findings of a study that looked at 33 cancer types in more than 10,000 patients, cancers should in future be categorised according to similarities in tumour types; rather than where they are first formed. The researchers suggest they could reclassified into clusters that shared molecules.

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Abstract

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale.

Highlights:

  • Generation of TCGA Clinical Data Resource for 11,160 patients over 33 cancer types
  • Analysis of clinical outcome endpoints with usage recommendations for each cancer
  • Demonstration of data validity and utility for large-scale translational research

 

In the media: BBC News  Reclassify cancers to improve treatment, researchers say

The full article is available from The Cell 

New Cancer Drugs Fund benefiting thousands of patients and releasing £140million for the NHS

Since the Cancer Drugs Fund (CDF) opened in July 2016,  nearly 15,700 patients have benefited from 52 drugs treating 81 different types of cancer. Of these patients, around 5,000 have received treatment sooner than they would have under the previous system.

AS NHS England has also secured discounts on on eight of the treatments previously funded via the old CDF this is expected to generate savings for the NHS of around £140m over the next five years.

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The new system means the National Institute for Health and Care Excellence (NICE) appraisal process now starts much earlier for newly referred drugs, with the aim of publishing draft guidance before drugs receive their licence, and then final guidance to be issued within 90 days of that.

Patients also benefit from new cancer drugs at least four months earlier under the reformed CDF than was previously the case.  All cancer treatments recommended by NICE, whether for routine commissioning or the CDF are now available to patients as soon as positive draft guidance is published by NICE.

 

Further information can be found at  NHS England