The prevalence of comorbid cancer and dementia

Findings suggest that dementia is associated with poorer cancer outcomes

Objectives: A comorbid diagnosis of cancer and dementia (cancer–dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer–dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care.

Method: Databases were searched  using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer–dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively.

Results: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer–dementia prevalence rates (range 0.2%–45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer–dementia despite greater health service use.

Conclusions: There is a dearth of good-quality evidence investigating the cancer–dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer–dementia and enable patients, carers and clinicians to make informed cancer-related decisions.

Full reference: L. McWilliams, C et al. | A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care | Aging & Mental Health |  Published online: 18 Jul 2017

The role of hormonal therapy in patients with relapsed high-grade ovarian carcinoma

Hormonal therapy is used as a treatment option in high-grade ovarian carcinoma (HGOC), but the role and choice of treatment remains unclear. Agents used include tamoxifen and aromatase inhibitors | BMC Cancer

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Image source: Haukeland universitetssjukehus – Flickr // CC BY 2.0

Aim: Our aim was to evaluate the efficacy of tamoxifen (T) and letrozole (L) in HGOC in clinical practice and investigate factors influencing clinical outcome.

Methods: A retrospective review of patients with relapsed HGOC treated with either tamoxifen or letrozole at the Royal Marsden Hospital between 2007 and 2012 was performed. The primary endpoint of the study was objective response rate (ORR). Secondary endpoints included CA125 response, clinical benefit rate (CBR) and duration of response. Platinum-sensitivity and ER-status were evaluated as predictors of treatment response.

Results: 97 patients were included (43 T, 54 L); median age 63 years (20–92); 91% high-grade serous; median number of lines of prior chemotherapy 3 (1–8); 60% platinum-resistant, 40% platinum-sensitive; 52% ER + ve, 1% ER-ve, 47% unknown. 14 patients (6 T, 8 L) achieved a partial response, with ORR (RECIST) of 14% (T) and 15% (L). The CBR for ≥3 months was 65% (22/43) for tamoxifen and 56% (22/54) for letrozole. There was no significant difference in ORR (p = 0.99) or CBR (p = 0.14) between tamoxifen and letrozole. 22 patients (23%) had a CA-125 response with hormonal therapy (10 T – 23% and 12 L – 22%). ORR did not differ by platinum sensitivity (p = 0.42); or ER-status (positive vs unknown, p = 0.12). Responders to letrozole had longer durations of response than responders to tamoxifen (26 vs 11.5 months, p = 0.03), but equivalent disease stability duration (9.6 vs 7.2 months respectively, p = 0.11).

Conclusions: Within the constraints of a retrospective study, we identified that patients treated with letrozole had a significantly longer duration of response than those treated with tamoxifen. Treatment with either tamoxifen or letrozole is a rational treatment option for patients with ER + ve HGOC, with equivalent ORR, CBR and disease stability.

Full reference: George, A. et al. (2017) The role of hormonal therapy in patients with relapsed high-grade ovarian carcinoma: a retrospective series of tamoxifen and letrozole. BMC Cancer. 17:456

The Diagnosis and Treatment of Prostate Cancer

This review details recent advances in the diagnosis and treatment of prostate cancer which have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference.

Abstract

Prostate cancer is the most common cancer diagnosis made in men with more than 160 000 new cases each year in the United States. Although it often has an indolent course, prostate cancer remains the third-leading cause of cancer death in men.

When prostate cancer is suspected, tissue biopsy remains the standard of care for diagnosis. However, the identification and characterization of the disease have become increasingly precise through improved risk stratification and advances in magnetic resonance and functional imaging, as well as from the emergence of biomarkers. Multiple management options now exist for men diagnosed with prostate cancer. Active surveillance (the serial monitoring for disease progression with the intent to cure) appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer, particularly those with a prostate-specific antigen level of less than 10 ng/mL and Gleason score 3 + 3 tumors. Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life. For metastatic disease, chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone. New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference. Initial treatment with chemotherapy can improve survival compared with androgen deprivation therapy. Abiraterone, enzalutamide, and other agents can improve outcomes in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Full reference: The Diagnosis and Treatment of Prostate Cancer  | Mark S. Litwin, & Hung-Jui Tan | JAMA. 2017;317(24):2532-2542

New insight into how cancer spreads

Engineers have offered new insight into how cancer cells move based on their ability to sense their environment. The discovery could have a major impact on therapies to prevent the spread of cancer. | Via ScienceDaily

Researchers have found that cells have the ability to sense the stiffness of their environment and their ability to move is dependent upon that environment. These environments range from stiff (bone tissue) to soft (fatty tissue) with a medium stiffness (muscle tissue).

David Odde, a University of Minnesota biomedical engineering professor and Masonic Cancer Center researcher who led the study said “If we can trick cancer cells into believing it is not a good environment for migration, we can prevent the cancer cells from spreading.” The findings have been published in the Journal, Nature Communications

Full story at ScienceDaily

Journal reference: Benjamin L. Bangasser et al.  Shifting the optimal stiffness for cell migration. Nature Communications, 2017; 8

 

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

Cheap blood test could boost prostate cancer treatment

A cheap genetic test costing less than £50 has been developed that could help target treatment for men with advanced prostate cancer and help offset side effects from ineffective treatments | OnMedica

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Cancer researchers across Europe, including doctors from the Institute of Cancer Research (ICR) in London, analysed blood from 265 men with the disease and found those with multiple copies of a particular gene did not respond to abiraterone and enzalutamide – drugs commonly used to treat advanced cases.

About 46,000 men are diagnosed with prostate cancer in the UK every year, one in four of them at an advanced stage. For the study,* published in the journal Annals of Oncology, scientists took blood samples from patients taking part in three different clinical trials.

The team says that more trials are needed but they hope the test could prevent thousands of men undergoing unnecessary treatment and allow more personalised care. The drugs abiraterone and enzalutamide are given to men whose cancer is no longer responding to traditional hormone therapy and has started to spread.

Read the full commentary via OnMedica here

Read the full original research article here

Big data advances breast cancer research by ‘decades’

Big data has brought forward breast cancer research forward by ‘decades’, experts say.

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Scientists have created a ‘map’ linking the shape of breast cancer cells to genes turned on and off, and matched it to real disease outcomes, which could one day help doctors select treatments, according to a study  published in Genome Research.

Cancer Research UK-funded scientists at The Institute of Cancer Research, London, used large sets of data to map out a network of links between cell shape and genes.

By analysing cell shape in millions of images of more than 300,000 breast cancer cells, and data for more than 28,000 different genes, researchers found that cell shape changes, which can be caused by physical pressures on the tumour, are converted into changes in gene activity.

When they then used their maps to analyse thousands of samples taken from women who took part in the Cancer Research UK funded METABRIC study, the researchers discovered that these changes are linked to clinical outcomes for patients.

Read more at OnMedica

Full reference: Heba Z. Sailem & Chris Bakal Identification of clinically predictive metagenes that encode components of a network coupling cell shape to transcription by image-omics
Genome Research. 2017. 27: 196-207