Grey Horizon blog posts will resume the week of January 3rd; Happy Holidays

To all Grey Horizon readers, 

Thank you for supporting the blog this past year.  Postings will resume the week of week of January 3, 2023.  

Merry Christmas and Happy Holidays!  

  

Travel time for breast cancer screening remains long for many women

 A new study conducted by the American Cancer Society and recently published in the Journal of the National Cancer Institute indicates that location of a mammography facility is associated with lower breast cancer rates particularly among women living in rural areas. According to senior scientist Dr. Daniel Wiese, "mammography is widely available in the United States but barriers, such as long drive times, are likely influencing a women's decision to get screened."  Dr. Wise further emphasizes the importance of programs aimed at removing barriers "so women can access this potentially life-saving screening."  

To read more about this study, click here. 

Source mentioned: 

Wiese D, Islami F, Henry KA. Changes in geographic accessibility to mammography by state and rural-urban status, United States, 2006-2022. J Natl Cancer Inst. 2022 Dec 14:djac217. doi: 10.1093/jnci/djac217. Epub ahead of print. PMID: 36515214.

 

Alternate approach to World Health Organization (WHO) analgesic ladder for cancer pain management

Results of a recent randomized parallel group study conducted at the Edinburgh Cancer Research Institute in the UK unveiled a new 2-step option for cancer main management which is more cost-effective than the standard 3-step analgesic ladder approach created decades ago by the World Health Organization (WHO).  The authors of this study, led by Professor Marie T. Fallon state that study findings will be of particular interest "in low- and middle-income countries where weak opioids are expensive and switching complicated."  Further, the study, the first of its kind to access the WHO analgesic ladder from a cost-effectiveness perspective, brought forth several findings, including that the 3-step approach (direct to strong opioid) did not results in fast pain relief that the 2-step (weak opioid approach).  

To read more about this study, click here. 

Sources mentioned: 

Fallon M, Dierberger K, Leng M, et al. An international, open-label, randomised trial comparing a two-step approach versus the standard three-step approach of the WHO analgesic ladder in patients with cancer. Annals of Oncology 2022;33(12):1296-1303.

Bramati PS, Bruera E. The end of the second step of the World Health Organization analgesic ladder? Annals of Oncology 2022;33(12):1212-1213.

Adjuvant pembrolizumab improves quality of life in patients with high-risk resected melanoma

 Results of the SWOG S1404 phase III randomized clinical trial were recently published in JAMA Oncology.  According to trial, "pembrolizumab provides superior clinical and patient-reported quality-of-life outcomes compared to standard care with adjuvant ipilimumab or high-dose interferon for high-risk resected melanoma."  Conducted on 1303 patients, with a variety of genders and racial backgrounds, the SWIG S1404 trial emphasized the important of physicians discussing quality-of-life issues with patients "when making shared decisions regarding the risks and benefits of adjuvant treatment in resected melanoma."  

Source mentioned: Unger JM, Darke A, Othus M, et al. Effectiveness of Adjuvant Pembrolizumab vs High-Dose Interferon or Ipilimumab for Quality-of-Life Outcomes in Patients With Resected Melanoma A Secondary Analysis of the SWOG S1404 Randomized Clinical Trial. JAMA Oncology; Published online 23 November 2022. doi:10.1001/jamaoncol.2022.5486

Press Release: Ethnic diversity and disparities in access to genetic testing impact prostate cancer development and treatment

A press release from the European Society of Medical Oncology (ESMO) discusses the importance and need for "ethnically diverse prostate cancer genomics data and accessible genetic testing."   According to Dr. Rodrigo Dienstmann, an oncologist with joint appointments at the Grupo Oncoclinicas in Sao Paulo Brazil as well as the Vall d'Hebron Institute of Oncology in Barcelona, Spain, predisposition to prostate cancer does vary across ethnicities, particularly in men of African and Caribbean descent, who are at increased risk: "such race-related differences can condition the behaviour of the disease and its treatment, yet our current knowledge of prostate cancer genomics is largely limited to data from Europe and the USA, in which Asian and other non-Caucasian ethnicities are scarcely represented." 

To learn more about this press release, click here.  

Geriatric assessment intervention reduces patient-reported symptom toxicities in older patients with advanced cancer

 Findings from GAP70+, the first study to "systematically describe baseline symptom burden as measured by the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) in older adults with advanced cancer" was recently published in the Journal of Clinical Oncology. 

According to the GAO70+ study, more than 25% of new cancer diagnoses occur in older patients, however this demographic is often now well-represented in clinical trials, which limits understanding of the various treatment options available.  

To read more about this study, click here. 

Source mentioned: Culakova E, Mohile SG, Peppone L, et al. Effects of a Geriatric Assessment Intervention on Patient-Reported Symptomatic Toxicity in Older Adults With Advanced Cancer. JCO; Published online 10 November. DOI: 10.1200/JCO.22.00738

New study shows cancer mortality higher among American Indian and Alaska Native individuals

 A new study recently released by the American Cancer Society indicates that "cancer mortality among American Indian and Alaska Native individuals is 18% higher than among White individuals despite similar cancer incidence."  The study is the first U.S. nationwide mortality data that has been published for this demographic and explains that the "disparity is driven by common cancers that are receptive to early detection."  Thus, breast and prostate cancer incidence rates are 15% and 12% lower, but 7% and 31% higher mortality rates.  Further, mortality rates for infection-related cancers, including liver, stomach, cervix, and kidney, were twice the rate among American Indian and Alaska Native groups compared to White individuals. 

To read more about this study, click here. 

Source mentioned:  Kratzer TB, Jemal A, Miller KD, et al. Cancer statistics for American Indian and Alaska Native individuals, 2022: Including increasing disparities in early-onset colorectal cancer. CA Cancer J Clin. 2022;1‐27. https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21757

New study shows recently diagnosed adult cancer survivors at higher risk for bone fractures

 A new study conducted by the American Cancer Society indicates that adult cancer survivors, especially those diagnosed within 5 years and/or treated with chemotherapy, "have an increased risk for bone fractures, specifically pelvic and vertebral fractures, compared to older adults without cancer." These findings were further correlated with levels of physical activity and smoking status; active adults had a lower risk of bone fractures, whereas smoking among survivors lead to an increased risk of bone issues. The study, conducted on 92,431 participants over 20 years (1997-2017) unveiled 12,943 with bone fractures.  

To read more about this study, click here. 

Evaluation of primary and secondary prevention of oral cancer

 A special report produced by the International Agency for Research on Cancer (IARC) on the primary and secondary prevention of oral cancer has determined that "cessation of tobacco smoking, alcohol consumption and areca nut use will contribute to significant reductions in the risk of oral cancer." Cancer of the lip and oral cavity is the 16th cause of mortality worldwide, with "a wide range of genetic, environmental, and behavioural factors" all contributing to oral cancer risk.  

To read more about this report, click here. 

Source mentioned: Bouvard V, Nethan ST, Singh D, at al. IARC Perspective on Oral Cancer Prevention. NEJM; Published online 18 October 2022. DOI: 10.1056/NEJMsr2210097

Long-term clinical benefit with nivolumab and ipilimubab extends beyond treatment discontinuation in patients with metastatic NCSLC, regardless of PD-L1 expression

According to a 5-year follow-up of the CheckMate 227 trial, nivolumab and ipilimumab "continued to demonstrate long-term, durable clinical benefit for previously untreated patients with metastatic non-small cell lung cancer (NSCLC) versus chemotherapy, regardless of tumour PD-L1 expression."   Following a 5-year survival rate of 24% for nivolumab and ipilimumab in PD-L1, the authors of CheckMate 227 concluded that this is the "first phase III study to report 5-year clinical outcomes with a first-line combination of ICIs for patients with metastatic NSLSC." 

To read more about CheckMate 227, click here. 

Source mentioned: Brahmer JR, Lee J-S, Ciuleanu T-E, et al. Five-Year Survival Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small Cell Lung Cancer in CheckMate 227. JCO; Published online 12 October 2022. DOI: 10.1200/JCO.22.01503

Long-term follow-up confirms pembrolizumab and pembrolizumab-chemotherapy as effective first-line treatment options for recurrent or metastatic HNSCC

 A recently published follow-up study of the first-line pembrolizumab and pembrolizumab-chemotherapy KEYNOTE-048 trial "continued to demonstrate overall survival benefit compared with cetuximab-chemotherapy" in head and neck cancer patients.  A 4-year follow-up period noted a survival plateau of 20% for patients administered pembrolizumab alone, and a 30% survival rate for those patients receiving a pembrolizumab-chemotherapy combination.  However, study authors did observe more favourable side effects in patients receive pembrolizumab alone without additional chemotherapy.  

To read more about this study, click here. 

Sources mentioned:  

Harrington KJ, Burtness B, Greil R, et al. Pembrolizumab With or Without Chemotherapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Updated Results of the Phase III KEYNOTE-048 Study. JCO; Published online 11 October 2022. DOI: 10.1200/JCO.21.02508 

Ho AL. Immunotherapy, Chemotherapy, or Both: Options for First-Line Therapy for Patients With Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. JCO; Published online 12 October 2022. DOI: 10.1200/JCO.22.01408

Modest effectiveness of screening colonoscopy for the prevention of colorectal cancer: the NordICC study

 Results from the Nordic-European Initiative on Colorectal Cancer (NordICC) were recently unveiled at the United European Gastroenterology Week held in Vienna from October 8-11, 2022. Authors of the NordICC study state that "colonoscopy is considered to be more effective than sigmoidoscopy, but colonoscopy has not been adopted in many parts of the world, partly because evidence from randomized studies regarding the benefits is lacking."  The authors further emphasized that findings were significant in the 84,85 participants in NordICC (28,220 in the invited group, 11,843 of whom underwent screening, along with 56,365 participants in the usual-care group: "during a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group." 

To read more about this study, click here.  

Sources mentioned: 

Bretthauer M, Løberg M, Wieszczy P, et al., for the NordICC Study Group. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. NEJM; Published online 9 October 2022. DOI: 10.1056/NEJMoa2208375

Dominitz JA, Robertson DJ. Understanding the Results of a Randomized Trial of Screening Colonoscopy. NEJM; Published online 9 October 2022. DOI: 10.1056/NEJMe2211595

Cancer survivors delaying care due to transportation barriers use ER more; have highest risks for all-cause and cancer-specific mortality

 New findings unveiled by the American Cancer Society indicates that lack of transportation is a contributing factor in delayed care for cancer survivors and subsequent visits to the emergency room. Led by Dr. Xuesong Han, scientific director of health services research at the American Cancer Society, 30,000 cancer survivors and 500,000 adults with no cancer history were observed from 2000-2018.  The study revealed that "2.8% if cancer survivors and 1.7% if adults without a cancer history reported delays in care due to transportation barriers."   The study authors thus emphasized the need to "mitigate transportation barriers in vulnerable cancer survivor communities." 

To read more about this study, click here.