Patient & Survivor Care

Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.

Click on the PDF icon at the top of this introduction to read the full article.

Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.

Click on the PDF icon at the top of this introduction to read the full article.

Nonislet cell tumor-induced hypoglycemia (NICTH), also known as Doege-Potter syndrome, is a rare paraneoplastic syndrome seen in association with various nonpancreatic tumors, benign and malignant, and comprising mesenchymal, vascular, or epithelial cell types. We report a case of recurrent life-threatening hypoglycemia from a large pelvic solitary fibrous tumor.

Click on the PDF icon at the top of this introduction to read the full article.

In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.

Click on the PDF icon at the top of this introduction to read the full article.

In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.

Click on the PDF icon at the top of this introduction to read the full article.

In the opinion of most, precision medicine is the future of cancer therapeutics. By producing response rates well into double digits, and substantially extending progression-free and overall survival, the molecular testing of tumors to select optimal treatment may be a way to justify the high cost of new and emerging therapeutics. The road to this future will likely be long and winding, however, with a string of incremental successes amid inevitable disappointments. Our patients will walk this road with us, agreeing to testing and treatment when those tests come back positive for an eligible mutation.

Click on the PDF icon at the top of this introduction to read the full article.

A cancer survivorship care plan increased the information patients received yet failed to increase patient satisfaction with cancer care. Moreover, patients who received care plans experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those who did not, according to a study published online Aug. 24 in Journal of Clinical Oncology.

BakiBG/ThinkStock.com

The Institute of Medicine and other groups recommend survivorship care plans (SCPs) for all cancer survivors to help them deal with the challenges they face after diagnosis. Yet few studies have examined SCPs’ effectiveness. To do so, researchers performed what they described as the first pragmatic, cluster-randomized longitudinal trial comparing an automatically generated SCP against usual care in routine clinical practice.

The study involved 221 women with newly diagnosed endometrial cancer treated at 12 medical centers in the Netherlands. Six of the hospitals were randomly assigned to provide usual care (102 patients) and six to provide SCPs (119 patients) immediately after initial surgery, with updated SCPs offered 6 and 12 months later, said Kim A. H. Nicolaije of Tilburg University and the Comprehensive Cancer Center the Netherlands, Eindhoven, and her associates.

Usual care included verbal and written information about diagnosis and treatment, the recovery period, signs of recurrence, and hospital contacts; no additional information was given during follow-up, except for referrals when indicated.

The SCP entailed a treatment summary tailored to each patient’s diagnostic test results, tumor stage and grade, comorbidities, and evolving complications. It addressed possible short- and long-term effects of the cancer and its treatments on physical, social, and sexual life; signs of recurrence and secondary tumors; services such as rehabilitation, psychosocial support, and supportive care; and contact information for hospital personnel and outside specialists.

At follow-up, participants in the SCP group said they’d received more information about their disease, its treatments, other services available to them, different places where they could seek care, and ways they could help themselves get well, compared with the usual-care group. Yet there were no significant differences between the two study groups in several measures of satisfaction with the information provided or with the care itself. Furthermore, patients in the SCP group said they experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those in the usual-care group.

The SCPs called for including patients’ primary care physicians in the plans while usual care did not, and patients in the SCP group reported having more cancer-related contact with their primary-care physicians than those in the usual-care group. Yet this increased contact did not lead to better patient satisfaction, Ms. Nicolaije and her associates said (J Clin Oncol 2015 Aug 24. doi:10.1200/JCO.2014.60.3399).

It is unclear whether these effects are harmful or beneficial for patients. “One could argue that receiving an SCP raises patients’ awareness of cancer-related symptoms and empowers them to find the necessary support,” even if they don’t recognize this as a benefit, the investigators added.

The Dutch Cancer Society supported the study. Ms. Nicolaije reported having no conflicts of interest; a coauthor reported receiving research funding and reimbursement for expenses from Janssen Pharmaceuticals.

A cancer survivorship care plan increased the information patients received yet failed to increase patient satisfaction with cancer care. Moreover, patients who received care plans experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those who did not, according to a study published online Aug. 24 in Journal of Clinical Oncology.

BakiBG/ThinkStock.com

The Institute of Medicine and other groups recommend survivorship care plans (SCPs) for all cancer survivors to help them deal with the challenges they face after diagnosis. Yet few studies have examined SCPs’ effectiveness. To do so, researchers performed what they described as the first pragmatic, cluster-randomized longitudinal trial comparing an automatically generated SCP against usual care in routine clinical practice.

The study involved 221 women with newly diagnosed endometrial cancer treated at 12 medical centers in the Netherlands. Six of the hospitals were randomly assigned to provide usual care (102 patients) and six to provide SCPs (119 patients) immediately after initial surgery, with updated SCPs offered 6 and 12 months later, said Kim A. H. Nicolaije of Tilburg University and the Comprehensive Cancer Center the Netherlands, Eindhoven, and her associates.

Usual care included verbal and written information about diagnosis and treatment, the recovery period, signs of recurrence, and hospital contacts; no additional information was given during follow-up, except for referrals when indicated.

The SCP entailed a treatment summary tailored to each patient’s diagnostic test results, tumor stage and grade, comorbidities, and evolving complications. It addressed possible short- and long-term effects of the cancer and its treatments on physical, social, and sexual life; signs of recurrence and secondary tumors; services such as rehabilitation, psychosocial support, and supportive care; and contact information for hospital personnel and outside specialists.

At follow-up, participants in the SCP group said they’d received more information about their disease, its treatments, other services available to them, different places where they could seek care, and ways they could help themselves get well, compared with the usual-care group. Yet there were no significant differences between the two study groups in several measures of satisfaction with the information provided or with the care itself. Furthermore, patients in the SCP group said they experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those in the usual-care group.

The SCPs called for including patients’ primary care physicians in the plans while usual care did not, and patients in the SCP group reported having more cancer-related contact with their primary-care physicians than those in the usual-care group. Yet this increased contact did not lead to better patient satisfaction, Ms. Nicolaije and her associates said (J Clin Oncol 2015 Aug 24. doi:10.1200/JCO.2014.60.3399).

It is unclear whether these effects are harmful or beneficial for patients. “One could argue that receiving an SCP raises patients’ awareness of cancer-related symptoms and empowers them to find the necessary support,” even if they don’t recognize this as a benefit, the investigators added.

The Dutch Cancer Society supported the study. Ms. Nicolaije reported having no conflicts of interest; a coauthor reported receiving research funding and reimbursement for expenses from Janssen Pharmaceuticals.

A cancer survivorship care plan increased the information patients received yet failed to increase patient satisfaction with cancer care. Moreover, patients who received care plans experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those who did not, according to a study published online Aug. 24 in Journal of Clinical Oncology.

BakiBG/ThinkStock.com

The Institute of Medicine and other groups recommend survivorship care plans (SCPs) for all cancer survivors to help them deal with the challenges they face after diagnosis. Yet few studies have examined SCPs’ effectiveness. To do so, researchers performed what they described as the first pragmatic, cluster-randomized longitudinal trial comparing an automatically generated SCP against usual care in routine clinical practice.

The study involved 221 women with newly diagnosed endometrial cancer treated at 12 medical centers in the Netherlands. Six of the hospitals were randomly assigned to provide usual care (102 patients) and six to provide SCPs (119 patients) immediately after initial surgery, with updated SCPs offered 6 and 12 months later, said Kim A. H. Nicolaije of Tilburg University and the Comprehensive Cancer Center the Netherlands, Eindhoven, and her associates.

Usual care included verbal and written information about diagnosis and treatment, the recovery period, signs of recurrence, and hospital contacts; no additional information was given during follow-up, except for referrals when indicated.

The SCP entailed a treatment summary tailored to each patient’s diagnostic test results, tumor stage and grade, comorbidities, and evolving complications. It addressed possible short- and long-term effects of the cancer and its treatments on physical, social, and sexual life; signs of recurrence and secondary tumors; services such as rehabilitation, psychosocial support, and supportive care; and contact information for hospital personnel and outside specialists.

At follow-up, participants in the SCP group said they’d received more information about their disease, its treatments, other services available to them, different places where they could seek care, and ways they could help themselves get well, compared with the usual-care group. Yet there were no significant differences between the two study groups in several measures of satisfaction with the information provided or with the care itself. Furthermore, patients in the SCP group said they experienced more symptoms, were more concerned about their illness, and were more affected emotionally than were those in the usual-care group.

The SCPs called for including patients’ primary care physicians in the plans while usual care did not, and patients in the SCP group reported having more cancer-related contact with their primary-care physicians than those in the usual-care group. Yet this increased contact did not lead to better patient satisfaction, Ms. Nicolaije and her associates said (J Clin Oncol 2015 Aug 24. doi:10.1200/JCO.2014.60.3399).

It is unclear whether these effects are harmful or beneficial for patients. “One could argue that receiving an SCP raises patients’ awareness of cancer-related symptoms and empowers them to find the necessary support,” even if they don’t recognize this as a benefit, the investigators added.

The Dutch Cancer Society supported the study. Ms. Nicolaije reported having no conflicts of interest; a coauthor reported receiving research funding and reimbursement for expenses from Janssen Pharmaceuticals.

With the race to develop cancer immunotherapies escalating and new agents appearing in the clinic, oncologists’ decision-making toolbox will need to evolve.

“As immunotherapeutics become increasingly available to patients, clinicians face a major challenge in the evaluation of these novel drugs – the accurate determination of clinical efficacy,” physician-scientists recently wrote in a commentary published online in the Journal of Clinical Oncology.

Response evaluation criteria in solid tumors (RECIST) have typically driven oncologists’ decision making. Patients undergo scans and radiographic measurements to determine the extent of change in tumor size. Scan, treat, repeat is a mantra for advanced cancer patients, so much so some patients have sought to trademark the phrase for T-shirts. And significant tumor growth has traditionally signaled treatment failure.

But although some patients have responded to immune-targeted treatment with tumor shrinkage or stable disease that would be consistent with existing RECIST criteria, distinct immune-related patterns of response are also emerging, including pseudoprogression, said Dr. Victoria L. Chiou and Dr. Mauricio Burotto, both medical oncology fellows at the National Cancer Institute, in their commentary (Jour Clin Onc. 2015 Aug 10. doi: 10.1200/JCO.2015.61.6870).

Investigators first addressed this issue by proposing immune response criteria in 2009, based on data from ipilimumab phase II trials in patients with advanced melanoma. Dr. Jedd D. Wolchok of Memorial Sloan Kettering Cancer Center, New York, and his associates expanded on RECIST by adding two additional patterns of response: response after an increase in total tumor burden and response in the presence of new lesions. All patterns of response were associated with favorable survival, Dr. Wolchok and associates said (Clin Cancer Res 2009 Dec 1. doi: 10.1158/1078-0432.CCR-09-1624).

Subsequent trials in patients with advanced melanoma have confirmed that a subset of patients who are responders using immune response criteria would have been misclassified using RECIST alone.

In a study of patients with metastatic melanoma treated with nivolumab, 10% experienced distinct immune-related responses, according to Dr. Chiou and Dr. Burotto. In another study of patients with advanced melanoma, this one evaluating anti–PD-1 monoclonal antibody pembrolizumab, 6.7% of patients of the patients experienced pseudoprogression, and overall, 12% of patients were classified as responders or as having stable disease by immune response criteria but would have been classified as having progressive disease by RECIST.

It is time to expand on those first immune response criteria, Dr. Chiou and Dr. Burotto conclude. “Five years after the introduction of the immune response criteria, it is necessary to fully characterize the patterns of immune-related phenomena, to understand these patterns across multiple solid tumor types, and to evaluate how these guidelines are used in current clinical practice,” they wrote.

The Food and Drug Administration agrees. Though guidelines for industry were published in 2011 regarding cancer vaccines, there is no specific guidance on approval criteria for other cancer immunotherapies such as checkpoint inhibitors, Dr. Gideon Blumenthal, team leader in the FDA’s Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, said in an interview.

“However, the FDA is actively looking at other metrics of response beyond conventional RECIST criteria, both to help industry in early ‘go/no-go’ decision making, as well as for helping in the design of later stages of trial design and to help inform approval decisions,” he said.

The FDA is interested in investigating internal data sets of immunotherapy trials, and in collaborating with external stakeholders to determine what the optimal endpoints for cancer immunotherapies will be. Median PFS and PFS hazard ratios do not appear to capture the overall survival benefit that patients derive from immunotherapies, particularly in early lung cancer trials with which he is most familiar, Dr. Blumenthal said.

“Overall survival remains the gold standard endpoint in oncology as it is a direct measure of clinical benefit and less subject to bias, but as more effective therapies come on line and patients live longer, overall survival will become more challenging to detect,” he said.

[email protected]

On Twitter @NikolaidesLaura

With the race to develop cancer immunotherapies escalating and new agents appearing in the clinic, oncologists’ decision-making toolbox will need to evolve.

“As immunotherapeutics become increasingly available to patients, clinicians face a major challenge in the evaluation of these novel drugs – the accurate determination of clinical efficacy,” physician-scientists recently wrote in a commentary published online in the Journal of Clinical Oncology.

Response evaluation criteria in solid tumors (RECIST) have typically driven oncologists’ decision making. Patients undergo scans and radiographic measurements to determine the extent of change in tumor size. Scan, treat, repeat is a mantra for advanced cancer patients, so much so some patients have sought to trademark the phrase for T-shirts. And significant tumor growth has traditionally signaled treatment failure.

But although some patients have responded to immune-targeted treatment with tumor shrinkage or stable disease that would be consistent with existing RECIST criteria, distinct immune-related patterns of response are also emerging, including pseudoprogression, said Dr. Victoria L. Chiou and Dr. Mauricio Burotto, both medical oncology fellows at the National Cancer Institute, in their commentary (Jour Clin Onc. 2015 Aug 10. doi: 10.1200/JCO.2015.61.6870).

Investigators first addressed this issue by proposing immune response criteria in 2009, based on data from ipilimumab phase II trials in patients with advanced melanoma. Dr. Jedd D. Wolchok of Memorial Sloan Kettering Cancer Center, New York, and his associates expanded on RECIST by adding two additional patterns of response: response after an increase in total tumor burden and response in the presence of new lesions. All patterns of response were associated with favorable survival, Dr. Wolchok and associates said (Clin Cancer Res 2009 Dec 1. doi: 10.1158/1078-0432.CCR-09-1624).

Subsequent trials in patients with advanced melanoma have confirmed that a subset of patients who are responders using immune response criteria would have been misclassified using RECIST alone.

In a study of patients with metastatic melanoma treated with nivolumab, 10% experienced distinct immune-related responses, according to Dr. Chiou and Dr. Burotto. In another study of patients with advanced melanoma, this one evaluating anti–PD-1 monoclonal antibody pembrolizumab, 6.7% of patients of the patients experienced pseudoprogression, and overall, 12% of patients were classified as responders or as having stable disease by immune response criteria but would have been classified as having progressive disease by RECIST.

It is time to expand on those first immune response criteria, Dr. Chiou and Dr. Burotto conclude. “Five years after the introduction of the immune response criteria, it is necessary to fully characterize the patterns of immune-related phenomena, to understand these patterns across multiple solid tumor types, and to evaluate how these guidelines are used in current clinical practice,” they wrote.

The Food and Drug Administration agrees. Though guidelines for industry were published in 2011 regarding cancer vaccines, there is no specific guidance on approval criteria for other cancer immunotherapies such as checkpoint inhibitors, Dr. Gideon Blumenthal, team leader in the FDA’s Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, said in an interview.

“However, the FDA is actively looking at other metrics of response beyond conventional RECIST criteria, both to help industry in early ‘go/no-go’ decision making, as well as for helping in the design of later stages of trial design and to help inform approval decisions,” he said.

The FDA is interested in investigating internal data sets of immunotherapy trials, and in collaborating with external stakeholders to determine what the optimal endpoints for cancer immunotherapies will be. Median PFS and PFS hazard ratios do not appear to capture the overall survival benefit that patients derive from immunotherapies, particularly in early lung cancer trials with which he is most familiar, Dr. Blumenthal said.

“Overall survival remains the gold standard endpoint in oncology as it is a direct measure of clinical benefit and less subject to bias, but as more effective therapies come on line and patients live longer, overall survival will become more challenging to detect,” he said.

[email protected]

On Twitter @NikolaidesLaura

With the race to develop cancer immunotherapies escalating and new agents appearing in the clinic, oncologists’ decision-making toolbox will need to evolve.

“As immunotherapeutics become increasingly available to patients, clinicians face a major challenge in the evaluation of these novel drugs – the accurate determination of clinical efficacy,” physician-scientists recently wrote in a commentary published online in the Journal of Clinical Oncology.

Response evaluation criteria in solid tumors (RECIST) have typically driven oncologists’ decision making. Patients undergo scans and radiographic measurements to determine the extent of change in tumor size. Scan, treat, repeat is a mantra for advanced cancer patients, so much so some patients have sought to trademark the phrase for T-shirts. And significant tumor growth has traditionally signaled treatment failure.

But although some patients have responded to immune-targeted treatment with tumor shrinkage or stable disease that would be consistent with existing RECIST criteria, distinct immune-related patterns of response are also emerging, including pseudoprogression, said Dr. Victoria L. Chiou and Dr. Mauricio Burotto, both medical oncology fellows at the National Cancer Institute, in their commentary (Jour Clin Onc. 2015 Aug 10. doi: 10.1200/JCO.2015.61.6870).

Investigators first addressed this issue by proposing immune response criteria in 2009, based on data from ipilimumab phase II trials in patients with advanced melanoma. Dr. Jedd D. Wolchok of Memorial Sloan Kettering Cancer Center, New York, and his associates expanded on RECIST by adding two additional patterns of response: response after an increase in total tumor burden and response in the presence of new lesions. All patterns of response were associated with favorable survival, Dr. Wolchok and associates said (Clin Cancer Res 2009 Dec 1. doi: 10.1158/1078-0432.CCR-09-1624).

Subsequent trials in patients with advanced melanoma have confirmed that a subset of patients who are responders using immune response criteria would have been misclassified using RECIST alone.

In a study of patients with metastatic melanoma treated with nivolumab, 10% experienced distinct immune-related responses, according to Dr. Chiou and Dr. Burotto. In another study of patients with advanced melanoma, this one evaluating anti–PD-1 monoclonal antibody pembrolizumab, 6.7% of patients of the patients experienced pseudoprogression, and overall, 12% of patients were classified as responders or as having stable disease by immune response criteria but would have been classified as having progressive disease by RECIST.

It is time to expand on those first immune response criteria, Dr. Chiou and Dr. Burotto conclude. “Five years after the introduction of the immune response criteria, it is necessary to fully characterize the patterns of immune-related phenomena, to understand these patterns across multiple solid tumor types, and to evaluate how these guidelines are used in current clinical practice,” they wrote.

The Food and Drug Administration agrees. Though guidelines for industry were published in 2011 regarding cancer vaccines, there is no specific guidance on approval criteria for other cancer immunotherapies such as checkpoint inhibitors, Dr. Gideon Blumenthal, team leader in the FDA’s Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, said in an interview.

“However, the FDA is actively looking at other metrics of response beyond conventional RECIST criteria, both to help industry in early ‘go/no-go’ decision making, as well as for helping in the design of later stages of trial design and to help inform approval decisions,” he said.

The FDA is interested in investigating internal data sets of immunotherapy trials, and in collaborating with external stakeholders to determine what the optimal endpoints for cancer immunotherapies will be. Median PFS and PFS hazard ratios do not appear to capture the overall survival benefit that patients derive from immunotherapies, particularly in early lung cancer trials with which he is most familiar, Dr. Blumenthal said.

“Overall survival remains the gold standard endpoint in oncology as it is a direct measure of clinical benefit and less subject to bias, but as more effective therapies come on line and patients live longer, overall survival will become more challenging to detect,” he said.

[email protected]

On Twitter @NikolaidesLaura

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

WASHINGTON – Cancer survivors are almost twice as likely to be taking medication for anxiety, depression, or both, compared with people who have never had cancer, according to investigators from the Centers for Disease Control and Prevention.

Data from a national survey of more than 48,000 adults show that 15.1% of cancer survivors reported taking drugs for anxiety, and 14% reported taking depression medications, compared with 8.7% and 7.9%, respectively, of adults who never had a cancer diagnosis, reported Nikki A. Hawkins, Ph.D., a behavioral scientist in the CDC’s division of cancer prevention and control.

“We do know that there is a large population of cancer survivors in the U.S. taking these medications for anxiety and depression, which likely reflects the elevated emotional burden on this population,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

Dr. Hawkins and her colleagues examined data from the National Health Interview Survey, a nationwide sample of approximately 35,000 U.S. households containing information on about 87,500 people.

The survey asks whether adult participants ever had cancer, the type, and their age at diagnosis, and includes questions about health behaviors such as smoking, as well as access to health care and utilization of preventive and screening services such as human-papillomavirus vaccination and Pap smear for cervical cancer prevention/detection, mammography for breast cancer screening, and fecal occult blood testing, sigmoidoscopy, or colonoscopy for colorectal cancer screening.

Since 2010, a subset of survey participants has been asked questions about functioning and disability, including physical domains (vision, hearing, mobility, etc.), and affect, including whether they take medications for depression and/or “for feeling worried, nervous, or anxious.”

The investigators included those who took part in the survey from 2010 through 2013, including 3,184 cancer survivors and 44,997 controls (no cancer diagnosis).

Sites of most recent cancer diagnoses include breast (in women), prostate, skin (melanoma), cervix, colorectal, hematologic, ovary/uterus, and other.

In all, 15% of patients had been diagnosed within the past 2 years, 29% from 2 to 5 years, 21% from 6 to 10 years, and 36% 11 or more years (numbers exceed 100% because of rounding).

Nearly twice as many cancer survivors reported taking medication for depression or anxiety, compared with the controls: 18% of survivors reported taking either of the medications, compared with 10.4% of controls. This translates into an estimate for the overall U.S. population of 2,383,954 cancer survivors taking medication for either anxiety or depression, Dr. Hawkins said.

Factors predictive of depression or anxiety medication use among cancer survivors included being female, white, non-Hispanic, age younger than 65 years, having never been married, lower levels of education, having a usual place for medical care, and a having a higher number of chronic health conditions.

With the exception of levels of education, the same factors were also predictive of anxiety and/or medication use among controls, the investigators found.

The study was limited by the use of self-reported survey data, and lack of information on the onset or duration of medication use, specific medications taken, or use of other nonpharmacologic therapies for anxiety or depression, Dr. Hawkins acknowledged.

Nonetheless, “these estimates can serve as a benchmark for medication use among the U.S. cancer survivor population, and moving forward, it will be important to look at the duration and onset of use to see exactly when the increase in medication happens and why it happens at that time,” she said.

Patients treated with ipilimumab for metastatic melanoma should be prepared for immune-related adverse effects, and physicians should expect to treat them early and aggressively, according to a report published online Aug. 17 in Journal of Clinical Oncology.

Severe immune-related adverse effects such as diarrhea, hepatitis, and hypophysitis were common in a retrospective analysis of the medical records of 298 patients treated during a 27-month period at Memorial Sloan Kettering Cancer Center, New York. Corticosteroids were not adequate to control symptoms in a substantial number of cases, and additional systemic immunosuppressive therapy was required, said Dr. Troy Z. Horvat of Memorial Sloan Kettering and his associates.

From their institutional experience, the investigators suspected that the incidence of clinically significant adverse effects of ipilimumab was higher than has been previously reported and higher than would be expected just by counting the number of events qualifying as grade 3 or higher by National Cancer Institute criteria. They also suspected that the need for immunosuppressive therapy was greater than generally expected. Previous studies showed adverse event rates ranging from 6% to 19%, and did not give any information regarding corticosteroid use.

Their analysis confirmed these suspicions, showing that 31% of patients developed grade 3, 4, or 5 adverse effects and 35% required corticosteroid therapy. This is more than twice the rate of grade 3 or higher toxicity reported in clinical trials of ipilimumab. Adverse effects included diarrhea (50 patients), which led to bowel perforation in 3 patients; hepatitis (22 patients); dermatitis (21 patients); endocrinopathies (14); hypophysitis (6); uveitis (2); pneumonitis (1); seizure (1); arthritis (1); and hearing loss (1). These effects were severe enough to cause 19% of patients to discontinue ipilimumab.

About one-third of the patients who received systemic corticosteroids – 10% of the total study population – required additional immunotherapy, including infliximab, mycophenolate, or adalimumab, Dr. Horvat and his associates said (J Clin Oncol 2015 Aug 17 [doi:10.1200/JCO.2015.60.8448]).

This study’s higher rates of adverse events, of corticosteroid therapy, and of further immunosuppressive therapy are likely attributable to the treatment team’s considerable experience with ipilimumab in real-world patients. As clinicians gain such experience, they become more familiar with associated adverse events, allowing earlier identification and intervention, the investigators said.

“In our experience, if improvement in ipilimumab-related adverse effects is not evident early in the treatment with high-dose systemic corticosteroids, more prolonged treatment rarely leads to benefit, and patients usually end up requiring infliximab anyway. ... We believe the overall risk-to-benefit ratio favors the early use of infliximab rather than prolonged treatment with corticosteroids,” they noted.

The median overall survival and median time to treatment failure were not affected by either the occurrence of adverse events or the use of corticosteroids. Overall, 12% of these patients achieved long-term disease control and didn’t require further melanoma treatment. Based on their findings and those of another research group, “we believe that patients and physicians should not be concerned that ipilimumab-related adverse events requiring systemic immunosuppression will compromise the therapeutic benefit,” Dr. Horvat and his associates said.

Patients treated with ipilimumab for metastatic melanoma should be prepared for immune-related adverse effects, and physicians should expect to treat them early and aggressively, according to a report published online Aug. 17 in Journal of Clinical Oncology.

Severe immune-related adverse effects such as diarrhea, hepatitis, and hypophysitis were common in a retrospective analysis of the medical records of 298 patients treated during a 27-month period at Memorial Sloan Kettering Cancer Center, New York. Corticosteroids were not adequate to control symptoms in a substantial number of cases, and additional systemic immunosuppressive therapy was required, said Dr. Troy Z. Horvat of Memorial Sloan Kettering and his associates.

From their institutional experience, the investigators suspected that the incidence of clinically significant adverse effects of ipilimumab was higher than has been previously reported and higher than would be expected just by counting the number of events qualifying as grade 3 or higher by National Cancer Institute criteria. They also suspected that the need for immunosuppressive therapy was greater than generally expected. Previous studies showed adverse event rates ranging from 6% to 19%, and did not give any information regarding corticosteroid use.

Their analysis confirmed these suspicions, showing that 31% of patients developed grade 3, 4, or 5 adverse effects and 35% required corticosteroid therapy. This is more than twice the rate of grade 3 or higher toxicity reported in clinical trials of ipilimumab. Adverse effects included diarrhea (50 patients), which led to bowel perforation in 3 patients; hepatitis (22 patients); dermatitis (21 patients); endocrinopathies (14); hypophysitis (6); uveitis (2); pneumonitis (1); seizure (1); arthritis (1); and hearing loss (1). These effects were severe enough to cause 19% of patients to discontinue ipilimumab.

About one-third of the patients who received systemic corticosteroids – 10% of the total study population – required additional immunotherapy, including infliximab, mycophenolate, or adalimumab, Dr. Horvat and his associates said (J Clin Oncol 2015 Aug 17 [doi:10.1200/JCO.2015.60.8448]).

This study’s higher rates of adverse events, of corticosteroid therapy, and of further immunosuppressive therapy are likely attributable to the treatment team’s considerable experience with ipilimumab in real-world patients. As clinicians gain such experience, they become more familiar with associated adverse events, allowing earlier identification and intervention, the investigators said.

“In our experience, if improvement in ipilimumab-related adverse effects is not evident early in the treatment with high-dose systemic corticosteroids, more prolonged treatment rarely leads to benefit, and patients usually end up requiring infliximab anyway. ... We believe the overall risk-to-benefit ratio favors the early use of infliximab rather than prolonged treatment with corticosteroids,” they noted.

The median overall survival and median time to treatment failure were not affected by either the occurrence of adverse events or the use of corticosteroids. Overall, 12% of these patients achieved long-term disease control and didn’t require further melanoma treatment. Based on their findings and those of another research group, “we believe that patients and physicians should not be concerned that ipilimumab-related adverse events requiring systemic immunosuppression will compromise the therapeutic benefit,” Dr. Horvat and his associates said.

Patients treated with ipilimumab for metastatic melanoma should be prepared for immune-related adverse effects, and physicians should expect to treat them early and aggressively, according to a report published online Aug. 17 in Journal of Clinical Oncology.

Severe immune-related adverse effects such as diarrhea, hepatitis, and hypophysitis were common in a retrospective analysis of the medical records of 298 patients treated during a 27-month period at Memorial Sloan Kettering Cancer Center, New York. Corticosteroids were not adequate to control symptoms in a substantial number of cases, and additional systemic immunosuppressive therapy was required, said Dr. Troy Z. Horvat of Memorial Sloan Kettering and his associates.

From their institutional experience, the investigators suspected that the incidence of clinically significant adverse effects of ipilimumab was higher than has been previously reported and higher than would be expected just by counting the number of events qualifying as grade 3 or higher by National Cancer Institute criteria. They also suspected that the need for immunosuppressive therapy was greater than generally expected. Previous studies showed adverse event rates ranging from 6% to 19%, and did not give any information regarding corticosteroid use.

Their analysis confirmed these suspicions, showing that 31% of patients developed grade 3, 4, or 5 adverse effects and 35% required corticosteroid therapy. This is more than twice the rate of grade 3 or higher toxicity reported in clinical trials of ipilimumab. Adverse effects included diarrhea (50 patients), which led to bowel perforation in 3 patients; hepatitis (22 patients); dermatitis (21 patients); endocrinopathies (14); hypophysitis (6); uveitis (2); pneumonitis (1); seizure (1); arthritis (1); and hearing loss (1). These effects were severe enough to cause 19% of patients to discontinue ipilimumab.

About one-third of the patients who received systemic corticosteroids – 10% of the total study population – required additional immunotherapy, including infliximab, mycophenolate, or adalimumab, Dr. Horvat and his associates said (J Clin Oncol 2015 Aug 17 [doi:10.1200/JCO.2015.60.8448]).

This study’s higher rates of adverse events, of corticosteroid therapy, and of further immunosuppressive therapy are likely attributable to the treatment team’s considerable experience with ipilimumab in real-world patients. As clinicians gain such experience, they become more familiar with associated adverse events, allowing earlier identification and intervention, the investigators said.

“In our experience, if improvement in ipilimumab-related adverse effects is not evident early in the treatment with high-dose systemic corticosteroids, more prolonged treatment rarely leads to benefit, and patients usually end up requiring infliximab anyway. ... We believe the overall risk-to-benefit ratio favors the early use of infliximab rather than prolonged treatment with corticosteroids,” they noted.

The median overall survival and median time to treatment failure were not affected by either the occurrence of adverse events or the use of corticosteroids. Overall, 12% of these patients achieved long-term disease control and didn’t require further melanoma treatment. Based on their findings and those of another research group, “we believe that patients and physicians should not be concerned that ipilimumab-related adverse events requiring systemic immunosuppression will compromise the therapeutic benefit,” Dr. Horvat and his associates said.

A group-based behavioral weight loss program supplemented with personal contact and support was effective in helping overweight or obese breast cancer survivors lose a clinically meaningful amount of weight, investigators reported online Aug. 17 in the Journal of Clinical Oncology.

“Women who have been diagnosed and treated for breast cancer often have special issues and problems, such as treatment-related adverse effects, fatigue, and depression, that can complicate weight management efforts,” wrote Cheryl L. Rock, Ph.D., of the University of California, San Diego, Moores Cancer Center in La Jolla, and her colleagues.

©kaspiic/thinkstockphotos.com

The results from this trial demonstrate that weight loss, even though it was modest, and increased physical activity can be achieved in this population and suggest that these issues can be overcome, the authors noted.

The multicenter trial included 692 overweight or obese breast cancer survivors who were randomly assigned to either the intervention group – which included a cognitive-behavioral weight loss program with telephone counseling and tailored newsletters to support initial weight loss and subsequent maintenance – or a control group with a less intensive intervention (J Clin Oncol. 2015 Aug. 17 doi: 10.1200/JCO.2015.61.1095).

At 6 months, the mean weight loss in the intervention group was 5.9%; at 12 months, the weight loss held steady and was maintained at 6%. In the control group, weight loss was 1.3% at 6 months and 1.5% at 12 months.

At 18 months, the women in the intervention group were 4.7% below their baseline weight, and at 24 months they weighed 3.7% less than at entry into the study. Those in the control group were 1.3% below baseline weight at 18 months and 1.1% below at 24 months.

The weight loss intervention was more effective among women older than 55 years than in younger women, who may need counseling and resources beyond that offered in this study, to achieve sufficient weight loss, Dr. Rock and her associates added.

The study was supported by the National Cancer Institute and by a grant from the National Center for Research Resources, a component of the NIH, and NIH Roadmap for Medical Research. Dr. Rock reported research funding from Jenny Craig and Nestle USA, and several of the coauthors reported financial relationships with various corporations.

A group-based behavioral weight loss program supplemented with personal contact and support was effective in helping overweight or obese breast cancer survivors lose a clinically meaningful amount of weight, investigators reported online Aug. 17 in the Journal of Clinical Oncology.

“Women who have been diagnosed and treated for breast cancer often have special issues and problems, such as treatment-related adverse effects, fatigue, and depression, that can complicate weight management efforts,” wrote Cheryl L. Rock, Ph.D., of the University of California, San Diego, Moores Cancer Center in La Jolla, and her colleagues.

©kaspiic/thinkstockphotos.com

The results from this trial demonstrate that weight loss, even though it was modest, and increased physical activity can be achieved in this population and suggest that these issues can be overcome, the authors noted.

The multicenter trial included 692 overweight or obese breast cancer survivors who were randomly assigned to either the intervention group – which included a cognitive-behavioral weight loss program with telephone counseling and tailored newsletters to support initial weight loss and subsequent maintenance – or a control group with a less intensive intervention (J Clin Oncol. 2015 Aug. 17 doi: 10.1200/JCO.2015.61.1095).

At 6 months, the mean weight loss in the intervention group was 5.9%; at 12 months, the weight loss held steady and was maintained at 6%. In the control group, weight loss was 1.3% at 6 months and 1.5% at 12 months.

At 18 months, the women in the intervention group were 4.7% below their baseline weight, and at 24 months they weighed 3.7% less than at entry into the study. Those in the control group were 1.3% below baseline weight at 18 months and 1.1% below at 24 months.

The weight loss intervention was more effective among women older than 55 years than in younger women, who may need counseling and resources beyond that offered in this study, to achieve sufficient weight loss, Dr. Rock and her associates added.

The study was supported by the National Cancer Institute and by a grant from the National Center for Research Resources, a component of the NIH, and NIH Roadmap for Medical Research. Dr. Rock reported research funding from Jenny Craig and Nestle USA, and several of the coauthors reported financial relationships with various corporations.

A group-based behavioral weight loss program supplemented with personal contact and support was effective in helping overweight or obese breast cancer survivors lose a clinically meaningful amount of weight, investigators reported online Aug. 17 in the Journal of Clinical Oncology.

“Women who have been diagnosed and treated for breast cancer often have special issues and problems, such as treatment-related adverse effects, fatigue, and depression, that can complicate weight management efforts,” wrote Cheryl L. Rock, Ph.D., of the University of California, San Diego, Moores Cancer Center in La Jolla, and her colleagues.

©kaspiic/thinkstockphotos.com

The results from this trial demonstrate that weight loss, even though it was modest, and increased physical activity can be achieved in this population and suggest that these issues can be overcome, the authors noted.

The multicenter trial included 692 overweight or obese breast cancer survivors who were randomly assigned to either the intervention group – which included a cognitive-behavioral weight loss program with telephone counseling and tailored newsletters to support initial weight loss and subsequent maintenance – or a control group with a less intensive intervention (J Clin Oncol. 2015 Aug. 17 doi: 10.1200/JCO.2015.61.1095).

At 6 months, the mean weight loss in the intervention group was 5.9%; at 12 months, the weight loss held steady and was maintained at 6%. In the control group, weight loss was 1.3% at 6 months and 1.5% at 12 months.

At 18 months, the women in the intervention group were 4.7% below their baseline weight, and at 24 months they weighed 3.7% less than at entry into the study. Those in the control group were 1.3% below baseline weight at 18 months and 1.1% below at 24 months.

The weight loss intervention was more effective among women older than 55 years than in younger women, who may need counseling and resources beyond that offered in this study, to achieve sufficient weight loss, Dr. Rock and her associates added.

The study was supported by the National Cancer Institute and by a grant from the National Center for Research Resources, a component of the NIH, and NIH Roadmap for Medical Research. Dr. Rock reported research funding from Jenny Craig and Nestle USA, and several of the coauthors reported financial relationships with various corporations.