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SEER: Breast cancer survivors at increased risk of thyroid cancer
SAN DIEGO – Breast cancer survivors face an increased risk of thyroid cancer, especially within 5 years of their breast cancer diagnosis, according to results from large retrospective analysis.
“The results of this study prompt a greater awareness of the increased risk for thyroid cancer among breast cancer survivors,” Dr. Jennifer H. Kuo said during a press briefing at the meeting of the Endocrine Society.
Although the incidence of breast cancer has been stable in the last 2 decades, “it’s still a leading cause of cancer; it affects one in eight women in this country at some time in their lives,” said Dr. Kuo of the division of GI/endocrine surgery at Columbia University, New York. “With advancements for the treatment of breast cancer, however, survival after breast cancer has greatly improved, now reaching almost 90% at 5 years. What this means is the number of breast cancer survivors in this country is now increasing. These survivors have an 18%-30% risk of developing a second cancer. Most of these second cancers are hormonally mediated, such as ovarian and uterine cancers, but there are some studies that indicate thyroid cancer is also increased.”
To date, she said, the relationship between breast and thyroid cancer has been largely based on findings from single-center studies, which have suggested a possible increase in thyroid cancer incidence after breast cancer. To further explore this relationship, Dr. Kuo and her associates evaluated the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER 9) program to identify individuals diagnosed with breast cancer and/or thyroid cancer between 1973 and 2011. In all, they identified 704,402 patients with breast cancer only, 49,663 with thyroid cancer only, and 1,526 patients who developed thyroid cancer after breast cancer.
The 10-year risk of thyroid cancer in breast cancer survivors, compared with the general population, was highest among those aged 40 years and 50 years (16% and 12%, vs. 0.33% and 0.35%, respectively), and lowest among those 60 years and 70 years old (0.05% and 0.02% vs. 0.33% and 0.27%). Breast cancer survivors developed thyroid cancer a median of 5 years after their primary diagnosis.
Breast cancer survivors who developed thyroid cancer were younger compared with patients who had breast cancer only (a mean of 54 years vs. 61 years, respectively; P less than .001), had smaller breast cancers (a mean of 15 mm vs. 18 mm; P less than .001), a greater percentage of invasive ductal carcinoma (7.6% vs. 5.5%; P = .002), and were more likely to receive adjuvant radiation therapy (48% vs. 44%; P = .009). “This is probably reflective of the surgical treatment that these patients receive,” Dr. Kuo said.
No differences between the two cohorts were noted in terms of estrogen receptor/progesterone receptor positivity or lymph node involvement.
Because breast cancer doesn’t generally develop in younger women, breast cancer survivors in the SEER 9 database who then developed a subsequent thyroid cancer were older, compared with patients who had thyroid cancer only (a mean of 62 vs. 45 years, respectively; P less than .001). In addition, compared with patients who had thyroid cancer only, breast cancer survivors who developed thyroid cancer had smaller thyroid tumors (11 mm vs. 13 mm; P = .004) and less radioactive iodine positivity (46% vs. 37%; P less than .001). They also had a greater percentage of tall cell variant papillary thyroid cancer (.9% vs. .5%; P = .036), oxyphilic variant follicular thyroid cancer (4.3% vs. 2.6%; P less than .001), and anaplastic cancer 1.5% vs. 0.8%; P = .001).
Dr. Kuo plans to investigate if tamoxifen treatment plays a role in increasing the risk of thyroid cancer in breast cancer survivors. She reported having no relevant financial conflicts.
On Twitter @dougbrunk
SAN DIEGO – Breast cancer survivors face an increased risk of thyroid cancer, especially within 5 years of their breast cancer diagnosis, according to results from large retrospective analysis.
“The results of this study prompt a greater awareness of the increased risk for thyroid cancer among breast cancer survivors,” Dr. Jennifer H. Kuo said during a press briefing at the meeting of the Endocrine Society.
Although the incidence of breast cancer has been stable in the last 2 decades, “it’s still a leading cause of cancer; it affects one in eight women in this country at some time in their lives,” said Dr. Kuo of the division of GI/endocrine surgery at Columbia University, New York. “With advancements for the treatment of breast cancer, however, survival after breast cancer has greatly improved, now reaching almost 90% at 5 years. What this means is the number of breast cancer survivors in this country is now increasing. These survivors have an 18%-30% risk of developing a second cancer. Most of these second cancers are hormonally mediated, such as ovarian and uterine cancers, but there are some studies that indicate thyroid cancer is also increased.”
To date, she said, the relationship between breast and thyroid cancer has been largely based on findings from single-center studies, which have suggested a possible increase in thyroid cancer incidence after breast cancer. To further explore this relationship, Dr. Kuo and her associates evaluated the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER 9) program to identify individuals diagnosed with breast cancer and/or thyroid cancer between 1973 and 2011. In all, they identified 704,402 patients with breast cancer only, 49,663 with thyroid cancer only, and 1,526 patients who developed thyroid cancer after breast cancer.
The 10-year risk of thyroid cancer in breast cancer survivors, compared with the general population, was highest among those aged 40 years and 50 years (16% and 12%, vs. 0.33% and 0.35%, respectively), and lowest among those 60 years and 70 years old (0.05% and 0.02% vs. 0.33% and 0.27%). Breast cancer survivors developed thyroid cancer a median of 5 years after their primary diagnosis.
Breast cancer survivors who developed thyroid cancer were younger compared with patients who had breast cancer only (a mean of 54 years vs. 61 years, respectively; P less than .001), had smaller breast cancers (a mean of 15 mm vs. 18 mm; P less than .001), a greater percentage of invasive ductal carcinoma (7.6% vs. 5.5%; P = .002), and were more likely to receive adjuvant radiation therapy (48% vs. 44%; P = .009). “This is probably reflective of the surgical treatment that these patients receive,” Dr. Kuo said.
No differences between the two cohorts were noted in terms of estrogen receptor/progesterone receptor positivity or lymph node involvement.
Because breast cancer doesn’t generally develop in younger women, breast cancer survivors in the SEER 9 database who then developed a subsequent thyroid cancer were older, compared with patients who had thyroid cancer only (a mean of 62 vs. 45 years, respectively; P less than .001). In addition, compared with patients who had thyroid cancer only, breast cancer survivors who developed thyroid cancer had smaller thyroid tumors (11 mm vs. 13 mm; P = .004) and less radioactive iodine positivity (46% vs. 37%; P less than .001). They also had a greater percentage of tall cell variant papillary thyroid cancer (.9% vs. .5%; P = .036), oxyphilic variant follicular thyroid cancer (4.3% vs. 2.6%; P less than .001), and anaplastic cancer 1.5% vs. 0.8%; P = .001).
Dr. Kuo plans to investigate if tamoxifen treatment plays a role in increasing the risk of thyroid cancer in breast cancer survivors. She reported having no relevant financial conflicts.
On Twitter @dougbrunk
SAN DIEGO – Breast cancer survivors face an increased risk of thyroid cancer, especially within 5 years of their breast cancer diagnosis, according to results from large retrospective analysis.
“The results of this study prompt a greater awareness of the increased risk for thyroid cancer among breast cancer survivors,” Dr. Jennifer H. Kuo said during a press briefing at the meeting of the Endocrine Society.
Although the incidence of breast cancer has been stable in the last 2 decades, “it’s still a leading cause of cancer; it affects one in eight women in this country at some time in their lives,” said Dr. Kuo of the division of GI/endocrine surgery at Columbia University, New York. “With advancements for the treatment of breast cancer, however, survival after breast cancer has greatly improved, now reaching almost 90% at 5 years. What this means is the number of breast cancer survivors in this country is now increasing. These survivors have an 18%-30% risk of developing a second cancer. Most of these second cancers are hormonally mediated, such as ovarian and uterine cancers, but there are some studies that indicate thyroid cancer is also increased.”
To date, she said, the relationship between breast and thyroid cancer has been largely based on findings from single-center studies, which have suggested a possible increase in thyroid cancer incidence after breast cancer. To further explore this relationship, Dr. Kuo and her associates evaluated the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER 9) program to identify individuals diagnosed with breast cancer and/or thyroid cancer between 1973 and 2011. In all, they identified 704,402 patients with breast cancer only, 49,663 with thyroid cancer only, and 1,526 patients who developed thyroid cancer after breast cancer.
The 10-year risk of thyroid cancer in breast cancer survivors, compared with the general population, was highest among those aged 40 years and 50 years (16% and 12%, vs. 0.33% and 0.35%, respectively), and lowest among those 60 years and 70 years old (0.05% and 0.02% vs. 0.33% and 0.27%). Breast cancer survivors developed thyroid cancer a median of 5 years after their primary diagnosis.
Breast cancer survivors who developed thyroid cancer were younger compared with patients who had breast cancer only (a mean of 54 years vs. 61 years, respectively; P less than .001), had smaller breast cancers (a mean of 15 mm vs. 18 mm; P less than .001), a greater percentage of invasive ductal carcinoma (7.6% vs. 5.5%; P = .002), and were more likely to receive adjuvant radiation therapy (48% vs. 44%; P = .009). “This is probably reflective of the surgical treatment that these patients receive,” Dr. Kuo said.
No differences between the two cohorts were noted in terms of estrogen receptor/progesterone receptor positivity or lymph node involvement.
Because breast cancer doesn’t generally develop in younger women, breast cancer survivors in the SEER 9 database who then developed a subsequent thyroid cancer were older, compared with patients who had thyroid cancer only (a mean of 62 vs. 45 years, respectively; P less than .001). In addition, compared with patients who had thyroid cancer only, breast cancer survivors who developed thyroid cancer had smaller thyroid tumors (11 mm vs. 13 mm; P = .004) and less radioactive iodine positivity (46% vs. 37%; P less than .001). They also had a greater percentage of tall cell variant papillary thyroid cancer (.9% vs. .5%; P = .036), oxyphilic variant follicular thyroid cancer (4.3% vs. 2.6%; P less than .001), and anaplastic cancer 1.5% vs. 0.8%; P = .001).
Dr. Kuo plans to investigate if tamoxifen treatment plays a role in increasing the risk of thyroid cancer in breast cancer survivors. She reported having no relevant financial conflicts.
On Twitter @dougbrunk
AT ENDO 2015
Key clinical point: The age-specific risk of thyroid cancer is higher among breast cancer survivors, compared with that of the general population.
Major finding: The 10-year risk of thyroid cancer in breast cancer survivors was highest among those aged 40 and 50 years, compared with the general population (16% and 12%, vs. 0.33% and 0.35%, respectively), and lowest among those 60 and 70 years old (0.33% and 0.27% vs. 0.05% and 0.02%).
Data source: A retrospective analysis of the National Cancer Institute’s Surveillance, Epidemiology, and End Results 9 (SEER 9) to identify individuals diagnosed with breast cancer and/or thyroid cancer between 1973 and 2011.
Disclosures: Dr. Kuo reported having no relevant financial conflicts.
FDA approves new antifungal for aspergillosis and mucormycosis
Isavuconazonium sulfate, an azole antifungal drug, has been approved to treat invasive aspergillosis and invasive mucormycosis, “rare but serious infections,” the Food and Drug Administration announced on March 6.
Available in both intravenous and capsule formulations, the drug will be marketed as Cresemba by Astellas Pharma US.
Approval for the aspergillosis indication was based on a study of 516 patients randomized to treatment with isavuconazonium or voriconazole, which is approved for treating invasive aspergillosis and is the standard of care; approval of the mucormycosis indication was based on a single-arm study of 37 patients, which compared treatment results with “the natural disease progression associated with untreated mucormycosis,” according to the FDA statement announcing the approval.
“Both studies showed Cresemba was safe and effective in treating these serious fungal infections,” which most often affect immunocompromised patients, the statement said.
At a meeting in January, the FDA’s Anti-Infective Drugs Advisory Committee recommended approval of both indications, although they were more ambivalent about the mucormycosis indication because of the small amount of data in those patients. One of the manufacturer’s postmarketing commitments is to establish a registry “to collect and analyze clinical efficacy-related outcome data on patients treated with isavuconazonium sulfate who have invasive mucormycosis or infection with non–fumigatus aspergillus species,” according to the FDA’s approval letter.
The most common side effects associated with isavuconazonium include nausea, vomiting, diarrhea, headache, elevated liver chemistry tests, hypokalemia, constipation, dyspnea, cough, peripheral edema and back pain. Serious adverse events include liver problems, infusion reactions and severe allergic and skin reactions. The IV formulation comes in a powder formulation that is reconstituted for intravenous administration, and when administered intravenously, an in-line filter should be used because of the possibility that insoluble particulate may be formed after reconstitution, according to the prescribing information.
Serious adverse events associated with isavuconazonium should be reported to the FDA’s MedWatch program online or at 800-332-0178.
Isavuconazonium sulfate, an azole antifungal drug, has been approved to treat invasive aspergillosis and invasive mucormycosis, “rare but serious infections,” the Food and Drug Administration announced on March 6.
Available in both intravenous and capsule formulations, the drug will be marketed as Cresemba by Astellas Pharma US.
Approval for the aspergillosis indication was based on a study of 516 patients randomized to treatment with isavuconazonium or voriconazole, which is approved for treating invasive aspergillosis and is the standard of care; approval of the mucormycosis indication was based on a single-arm study of 37 patients, which compared treatment results with “the natural disease progression associated with untreated mucormycosis,” according to the FDA statement announcing the approval.
“Both studies showed Cresemba was safe and effective in treating these serious fungal infections,” which most often affect immunocompromised patients, the statement said.
At a meeting in January, the FDA’s Anti-Infective Drugs Advisory Committee recommended approval of both indications, although they were more ambivalent about the mucormycosis indication because of the small amount of data in those patients. One of the manufacturer’s postmarketing commitments is to establish a registry “to collect and analyze clinical efficacy-related outcome data on patients treated with isavuconazonium sulfate who have invasive mucormycosis or infection with non–fumigatus aspergillus species,” according to the FDA’s approval letter.
The most common side effects associated with isavuconazonium include nausea, vomiting, diarrhea, headache, elevated liver chemistry tests, hypokalemia, constipation, dyspnea, cough, peripheral edema and back pain. Serious adverse events include liver problems, infusion reactions and severe allergic and skin reactions. The IV formulation comes in a powder formulation that is reconstituted for intravenous administration, and when administered intravenously, an in-line filter should be used because of the possibility that insoluble particulate may be formed after reconstitution, according to the prescribing information.
Serious adverse events associated with isavuconazonium should be reported to the FDA’s MedWatch program online or at 800-332-0178.
Isavuconazonium sulfate, an azole antifungal drug, has been approved to treat invasive aspergillosis and invasive mucormycosis, “rare but serious infections,” the Food and Drug Administration announced on March 6.
Available in both intravenous and capsule formulations, the drug will be marketed as Cresemba by Astellas Pharma US.
Approval for the aspergillosis indication was based on a study of 516 patients randomized to treatment with isavuconazonium or voriconazole, which is approved for treating invasive aspergillosis and is the standard of care; approval of the mucormycosis indication was based on a single-arm study of 37 patients, which compared treatment results with “the natural disease progression associated with untreated mucormycosis,” according to the FDA statement announcing the approval.
“Both studies showed Cresemba was safe and effective in treating these serious fungal infections,” which most often affect immunocompromised patients, the statement said.
At a meeting in January, the FDA’s Anti-Infective Drugs Advisory Committee recommended approval of both indications, although they were more ambivalent about the mucormycosis indication because of the small amount of data in those patients. One of the manufacturer’s postmarketing commitments is to establish a registry “to collect and analyze clinical efficacy-related outcome data on patients treated with isavuconazonium sulfate who have invasive mucormycosis or infection with non–fumigatus aspergillus species,” according to the FDA’s approval letter.
The most common side effects associated with isavuconazonium include nausea, vomiting, diarrhea, headache, elevated liver chemistry tests, hypokalemia, constipation, dyspnea, cough, peripheral edema and back pain. Serious adverse events include liver problems, infusion reactions and severe allergic and skin reactions. The IV formulation comes in a powder formulation that is reconstituted for intravenous administration, and when administered intravenously, an in-line filter should be used because of the possibility that insoluble particulate may be formed after reconstitution, according to the prescribing information.
Serious adverse events associated with isavuconazonium should be reported to the FDA’s MedWatch program online or at 800-332-0178.
Cancer-Related Anemia
Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.
To read the full article in PDF:
Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.
To read the full article in PDF:
Anemia occurs in more than half of patients with cancer and is associated with worse performance status, quality of life, and survival. Anemia is often attributed to the effects of chemotherapy; however, a 2004 European Cancer Anemia Survey reported that 39% of patients with cancer were anemic prior to starting chemotherapy and the incidence of anemia may be as high as 90% in patients on chemotherapy. The pathogenesis of cancer-related anemia is multifactorial; it can be a direct result of cancer invading the bone marrow, or result from the effects of radiation, chemotherapy-induced anemia, chronic renal disease, and cancer-related inflammation leading to functional iron deficiency anemia.
To read the full article in PDF:
More cancer patients surviving longer, but age-based disparities remain
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
Survival rates overall for cancer patients are higher now than 20 years ago, though younger patients are faring significantly better than older ones for many types of cancer, according to investigators.
The findings were published online Feb. 19 in JAMA Oncology.
Furthermore, racial disparities in survival persist for most cancer sites, wrote Chenjie Zeng and associates at Vanderbilt University, Nashville, Tenn.
Using data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program, the researchers calculated survival rates for just over a million patients diagnosed with cancer of the colon or rectum, breast, prostate, lung, liver, pancreas or ovary over the time span from 1990 to 2009. Survival rates were obtained for each cancer site; results were grouped in 5-year cohorts by diagnosis date, and further broken down by race, sex, and age group (20-49, 50-64, 65-74, and 75-85 years at time of diagnosis).
Hazard ratios for cancer-specific death were obtained by comparing all later 5-year cohorts to the 1990-1994 group. Adjusted HRs for patients aged 50-64 years diagnosed with cancer in 2005-2009 compared with those diagnosed in 1990-1994 were 0.57 for colon or rectal cancer, 0.48 for breast cancer, 0.61 for liver cancer, and 0.32 for prostate cancer. By contrast, the oldest patients (aged 75-85 years) had HRs of 0.88, 0.88, 0.76, and 0.65, respectively, for these cancer sites. Age-related findings were less pronounced for lung and pancreatic cancers, Ms. Zeng and associates said (JAMA Oncology 2015 Feb. 19 [doi:10.1001/jamaoncol.2014.161]).
African Americans had a greater increase in prostate cancer survival than did whites or Asians; ovarian cancer survival, however, was reduced for African Americans but improved among whites over the study period. Overall survival rates were poorer for all cancer sites for African Americans when compared to whites, with racial disparities in screening and care a potential factor.
Some of the age-related survival differences may be attributed to younger patients’ being able to take greater advantage of newer therapies, since the largest age-related survival gap occurred for cancer sites with greater treatment advances (breast, colorectal, and prostate cancers), Ms. Zeng and associates said.
Study limitations included inability to exclude potential confounders such as socioeconomic status, lifestyle choices, and comorbidities, as well as oversampling of urban and foreign-born individuals in the study population, the researchers noted.
FROM JAMA ONCOLOGY
Key clinical point: Cancer survival rates improved less for older than younger patients in a large longitudinal study.
Major finding: All age groups showed improved survival for all cancers with the exception of ovarian cancer, but differences were greater for younger ages.
Data source: Longitudinal analysis of 20 years of data from 1.02 million cancer patients in nine population-based National Cancer Institute registries.
Disclosures: This study was supported by the National Institutes of Health and by funds from Vanderbilt University’s Ingram Professorship and Anne Potter Wilson Chair. Ms. Zeng received support from the Vanderbilt International Scholarship Program. The authors reported no conflicts of interest.
Perceptions about participation in cancer clinical trials in New York state
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Background Clinical trials are valuable in advancing cancer care through the investigation of ways in which to better prevent, detect and diagnose, and/or treat cancer. Recruitment of adults into clinical trials has historically been low.
Objective To survey adult cancer patients who reside in New York state to better understand their participation in and attitudes about clinical trials.
Methods From January 2012-April 2013, we conducted a one-time survey about clinical trials in 8 cancer-treatment or cancer-patient support organizations in the state. Surveys were offered in person and online to adults with a past or current cancer diagnosis. Analysis was limited to adults who resided in the state and provided a self-reported status of previous participation in clinical trials.
Results Of the 1,832 participants who completed the survey, 1,475 were included in the analysis. Our sample represented all regions of the state. Most of the respondents (68.1%) had never participated in a clinical trial. Almost 32% said they had never received information about research studies. Most (84%) felt that patients should be asked to participate in clinical trials, but fewer (70%) were willing to be approached about participation.
Limitations The sample is predominantly white and female and overrepresents breast and hematologic cancers.
Conclusions Increased outreach coupled with a team approach to educate and enroll patients in clinical trials may be the necessary first steps to increase participation in trials and ensure a diverse sample of participants.
Click on the PDF icon at the top of this introduction to read the full article.
Women with self-reported lower-limb lymphedema after treatment for gynecological cancers: are they more likely to self-report psychosocial symptoms and less likely to use services?
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
Click on the PDF icon at the top of this introduction to read the full article.
Background Survivorship for gynecological cancers has increased because of improved screening and treatment. Use of supportive care services after treatment is important to improve patient quality of life.
Objective To assess self-reported lower-limb lymphedema (LLL), depression, anxiety, quality of life, unmet supportive care needs, and service use among gynecological cancer survivors.
Methods In 2010, a population-based, cross-sectional mail survey was conducted among 160 gynecological cancer survivors 5-30 months after their diagnoses (response rate, 53%).
Results Overall, 30% of women self-reported symptoms of LLL, 21% and 24% self-reported symptoms of depression or anxiety, respectively. Women with LLL were more likely to also report symptoms of depression or anxiety, and had higher unmet supportive care needs. Services needed but not used by 10%-15% of women with LLL, anxiety, or depression were those of a lymphedema specialist, pain specialist, and physiotherapist for LLL, and a psychiatrist, psychologist, and pain specialist for anxiety and depression.
Limitations Small sample size, self-reported data, limited generalization to other countries, underrepresentation of older women (age >70 years) and women from non-Caucasian backgrounds.
Conclusions Women with LLL or high distress were less likely to use services they needed.
Funding Cancer Australia
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Sustained antiemetic responses with APF530 (sustained-release granisetron) during multiple cycles of emetogenic chemotherapy
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Click on the PDF icon at the top of this introduction to read the full article.
Click on the PDF icon at the top of this introduction to read the full article.
Study: Few oncology patients demand tests, procedures
Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Dr. Gogineni and colleagues report that few patient-physician encounters at three cancer centers in Philadelphia involved a patient demand, and the majority of demands made were viewed by the physician as clinically appropriate.
Suddenly, the demanding cancer patient looks less like a budget buster and more like an urban myth. In the wake of these findings, the question now deserving of our attention is: Why does the myth of the demanding patient have so much traction?
My new hypothesis is that these findings say more about our own clinical sensibilities than about our patients. The real point of the study by Dr. Gogineni is this: We have to stop blaming patients for being demanding. The myth of the demanding patient is more about our own responses and how lackluster communication skills can contribute to difficult situations that stick in our throats and our memories.
Dr. Anthony L. Back of the Seattle Cancer Care Alliance and the University of Washington in Seattle made these comments in an accompanying editorial (doi:10.1001/jamaoncol.2014.185). He reported no relevant conflicts of interest.
Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Fewer than 1 in 10 oncology patients demand specific tests or procedures, and their physicians do not often concede when such demands are inappropriate, according to a study published Feb. 12 in JAMA Oncology.
Dr. Keerthi Gogineni and her colleagues at the University of Pennsylvania, Philadelphia, interviewed clinicians working in outpatient oncology clinics at three Philadelphia area hospitals regarding patient encounters between October 2013 and June 2014. A total of 34 oncologists, 11 oncology fellows, and 15 nurse practitioners/physician assistants were interviewed. Among the 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were deemed clinically inappropriate by the health providers (JAMA Oncology doi:10.1001/jamaoncol.2014.197).
Of the 440 patient requests, 216 (49%) were for imaging studies; 68 (16%) for palliative treatment of pain, insomnia, or other symptoms; 60 (14%) were for laboratory tests; 23 (5%) were for genetic or chemosensitivity analyses; 30 (7%) were for a clinical trial or experimental treatment; and 16 (3.6%) were for a specific chemotherapy, drug, or biologic agent. (The remaining requests were categorized as “other.”)
Oncology team members agreed to 310 (98%) of the 316 clinically appropriate requests. Of the equivocal ones, they complied with 48 (65%). And among the 50 clinically inappropriate demands or requests, physicians and other providers complied with 7 (14%). Of the total 5,050 patient encounters, clinicians ordered tests or procedures based on improper demands in less than 1% of encounters.
Researchers found no association between patient demands and patient sex, age, race, type of insurance, approximate household income, disease stage, treatment intent, visit type, clinician type, clinician race, or hospital.
Given the rarity of clinically inappropriate demands or requests and that few were complied with, such improper requests are unlikely to add significantly to health care costs, Dr. Gogineni and her colleagues concluded, adding that even requests for clinically appropriate interventions could suggest lack of trust between the doctor and patient and threaten the therapeutic relationship.
Key clinical point: The majority of oncology patients do not demand appropriate care.
Major finding: Among 5,050 patient encounters, patients demanded or requested treatments in 9% of cases. About 72% were clinically appropriate requests, while 11% were rated clinically inappropriate.
Data source: Interviews of 60 oncologists and team member from three Philadelphia area hospitals.
Disclosures: No conflicts of interest were reported.
ASCO endorses ACS guidelines for prostate cancer survivor care
The American Society of Clinical Oncology has endorsed the American Cancer Society Prostate Cancer Survivorship Care Guidelines, a 39-point list with recommendations on continuing care for prostate care survivors, but with a number of qualifying statements and modifications.
The guidelines, developed by a workgroup of 16 multidisciplinary experts specializing in the care of prostate cancer patients and the long-term effects of their treatments, are intended as points of reference for primary care providers, medical oncologists, urologists, and other health care providers.
Areas covered in the guidelines include health promotion, surveillance for recurrence, screening and early detection of second primary cancers, assessment and management of physical and psychosocial long-term and late effects, and care coordination and practice implications.Read the full list of recommendations here: (doi: 10.1200/JCO.2014.60.2557).
The American Society of Clinical Oncology has endorsed the American Cancer Society Prostate Cancer Survivorship Care Guidelines, a 39-point list with recommendations on continuing care for prostate care survivors, but with a number of qualifying statements and modifications.
The guidelines, developed by a workgroup of 16 multidisciplinary experts specializing in the care of prostate cancer patients and the long-term effects of their treatments, are intended as points of reference for primary care providers, medical oncologists, urologists, and other health care providers.
Areas covered in the guidelines include health promotion, surveillance for recurrence, screening and early detection of second primary cancers, assessment and management of physical and psychosocial long-term and late effects, and care coordination and practice implications.Read the full list of recommendations here: (doi: 10.1200/JCO.2014.60.2557).
The American Society of Clinical Oncology has endorsed the American Cancer Society Prostate Cancer Survivorship Care Guidelines, a 39-point list with recommendations on continuing care for prostate care survivors, but with a number of qualifying statements and modifications.
The guidelines, developed by a workgroup of 16 multidisciplinary experts specializing in the care of prostate cancer patients and the long-term effects of their treatments, are intended as points of reference for primary care providers, medical oncologists, urologists, and other health care providers.
Areas covered in the guidelines include health promotion, surveillance for recurrence, screening and early detection of second primary cancers, assessment and management of physical and psychosocial long-term and late effects, and care coordination and practice implications.Read the full list of recommendations here: (doi: 10.1200/JCO.2014.60.2557).
Physical signs indicate impending death in cancer patients
Several physical symptoms may signal upcoming death in advanced cancer patients, said Dr. David Hui and his colleagues in the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center, Houston.
In a study of 357 advanced cancer patients in palliative care, 203 of whom died, eight specific symptoms were associated with death within 3 days. These physical signs were nonreactive pupils (positive likelihood ratio [LR], = 16.7), decreased response to verbal stimuli (LR, 8.3), decreased response to visual stimuli (LR, 6.7), inability to close the eyelids (LR, 13.6), drooping of the nasolabial fold (LR, 8.3), hyperextension of the neck (LR, 7.3), grunting of vocal chords (LR, 11.8), and upper gastrointestinal bleeding (LR, 10.3), the authors reported.
“The use of these bedside physical signs individually or in combination may assist clinicians in making the diagnosis of impending death,” Dr. Hui and his associates wrote.
Read the full article in Cancer at doi:10.1002/cncr.29048.
Several physical symptoms may signal upcoming death in advanced cancer patients, said Dr. David Hui and his colleagues in the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center, Houston.
In a study of 357 advanced cancer patients in palliative care, 203 of whom died, eight specific symptoms were associated with death within 3 days. These physical signs were nonreactive pupils (positive likelihood ratio [LR], = 16.7), decreased response to verbal stimuli (LR, 8.3), decreased response to visual stimuli (LR, 6.7), inability to close the eyelids (LR, 13.6), drooping of the nasolabial fold (LR, 8.3), hyperextension of the neck (LR, 7.3), grunting of vocal chords (LR, 11.8), and upper gastrointestinal bleeding (LR, 10.3), the authors reported.
“The use of these bedside physical signs individually or in combination may assist clinicians in making the diagnosis of impending death,” Dr. Hui and his associates wrote.
Read the full article in Cancer at doi:10.1002/cncr.29048.
Several physical symptoms may signal upcoming death in advanced cancer patients, said Dr. David Hui and his colleagues in the department of palliative care and rehabilitation medicine at the University of Texas MD Anderson Cancer Center, Houston.
In a study of 357 advanced cancer patients in palliative care, 203 of whom died, eight specific symptoms were associated with death within 3 days. These physical signs were nonreactive pupils (positive likelihood ratio [LR], = 16.7), decreased response to verbal stimuli (LR, 8.3), decreased response to visual stimuli (LR, 6.7), inability to close the eyelids (LR, 13.6), drooping of the nasolabial fold (LR, 8.3), hyperextension of the neck (LR, 7.3), grunting of vocal chords (LR, 11.8), and upper gastrointestinal bleeding (LR, 10.3), the authors reported.
“The use of these bedside physical signs individually or in combination may assist clinicians in making the diagnosis of impending death,” Dr. Hui and his associates wrote.
Read the full article in Cancer at doi:10.1002/cncr.29048.