Food, housing, transportation insecurity associated with disparities in cancer care and patient outcomes

 A series of three papers discussing housing, transportation, and food insecurity among cancer patients were recently published in the Journal of the National Cancer Institute (JNCI).  Researchers "summarized existing evidence related to disparities in cancer care and patient outcomes, as well as identifying promising interventions and research opportunities to inform policy and improve health equity."  

To read more about these studies and the programs that have been developed to combat inequities regarding access to cancer care, click here. 

Sources mentioned:  

Sanchez JI, Adjei BA, Randhawa G, Medel J, Doose M, Oh A, Jacobsen PB. National Cancer Institute-funded Social Risk Research in Cancer Care Delivery: Opportunities for Future Research. J Natl Cancer Inst. 2022 Sep 8:djac171. doi: 10.1093/jnci/djac171. Epub ahead of print. PMID: 36073952.

Graboyes EM, Chaiyachati KH, Sisto Gall J, Johnson W, Krishnan JA, McManus SS, Thompson L, Shulman LN, Yabroff KR. Addressing Transportation Insecurity Among Patients With Cancer. J Natl Cancer Inst. 2022 Sep 21:djac134. doi: 10.1093/jnci/djac134. Epub ahead of print. PMID: 36130286.

Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst. 2022 Sep 21:djac136. doi: 10.1093/jnci/djac136. Epub ahead of print. PMID: 36130291.

New study shows sugar-sweetened drinks increase risk of cancer mortality

A recent study conducted by the American Cancer Society indicates that drinking 2 or more sugar-sweetened beverages on a daily basis results in a 5% "increased risk of death from an obesity-related cancer, including gastrointestinal, postmenopausal breast, endometrial, and kidney cancer." The study, conducted on 900,000 cancer-free participants who provided information on their consumption of sugar and artificially sweetened beverages found a direct correlation between sugar consumption and known cancer risk factors including weight gain and obesity.  According to lead author of this study Dr. Marjorie McCullough, artificial sweetener use is increasing and thought to be relatively safe, however more research on use of artificial sweeteners and cancer risk is needed. 

To read more about this study, click here. 

Early cancer detection with blood test may change cancer screening paradigms

New data from a study conducted in France suggests that multi-cancer early detection (MCED) tests (currently in development) have the ability to determine common cancer signals from over 50 different types of cancer.  Known as PATHFINDER, the MCED test "detected a cancer signal in 1.4% of 6621 people aged 50 years and over who were not known to have cancer, and cancer was confirmed in 38% of those with a positive test. Of 6290 people who were cancer free, 99.1% received a negative test result." 

To read more about this study, click here. 

Sources mentioned:  

Abstract 903O ‘A prospective study of a multi-cancer early detection blood test’ will be presented by Deb Schrag during the proffered paper session “Basic science and translational research” on Sunday, 11 September, 16:30 to 18:00 CEST in Orléans Auditorium. Annals of Oncology, Volume 33 Supplement 7, September 2022

Swanton C, Neal RD, Johnson PWM et al. NHS-Galleri Trial Design: Equitable study recruitment tactics for targeted population-level screening with a multi-cancer early detection (MCED) test. J Clin Oncol 2022; 40(16) suppl. 

Blog postings will resume week of September 12th

 To all Grey Horizon readers, 

Please note that blog postings will resume the week of September 12, 2022. 

Thank you, take care, and stay well.  

TIL densities association with disease-free survival differs by primary tumour sidedness in stage III colon cancer

 Findings from a recently completed phase 2 study by NCCTG N0147 alliance researchers "found significantly higher tumour infiltrating lymphocyte (TIL) densities in right- versus left-sided colon cancers."  Following an extensive analysis and dichotomy of 1532 colon cancer patients, the study authors concluded that TILs "were second only to N stage for prediction of DFS [disease-free survival] and their relative contribution was substantially greater (16-fold) in right - vs. left-sided tumours." 

To read more about this study, click here.  

Source mentioned: Saberzadeh-Ardestani B, Foster NR, Lee HE, et al. Association of Tumor-infiltrating Lymphocytes (TILs) with Survival Depends on Primary Tumor Sidedness in Stage III Colon Cancers (NCCTG N0147) [Alliance]. Annals of Oncology; Published online 10 August 2022.

Teclistamab results in a high rate of deep and durable response in patients with triple-class-exposed relapsed or refractory myeloma

 Researchers at the Memorial Sloan Kettering Cancer Center in New York recently released findings of a phase I/II study of patients with relapsed or refractory multiple myeloma who received a "once-weekly subcutaneous dose of a bispecific antibody, teclistamab that mediates T-cell activation and subsequent lysis of myeloma cells expressing B-cell maturation antigen (BCMA)."  Of the 165 patients who were administered teclistamab, 65 patients (39.4%) had a complete response or better after a follow-up period of 14.1 months.

To read more about this study, click here.   

Sources mentioned:  Moreau P, Garfall AL, van de Donk NWCJ, et al. Teclistamab in Relapsed or Refractory Multiple Myeloma. N Engl J Med 2022;387:495-505.

Mailankody S, Landgren O. T-Cell Engagers — Modern Immune-Based Therapies for Multiple Myeloma. N Engl J Med 2022;387:558-561.

Study on frequent aspirin use supports reduction in ovarian cancer risk

A study recently published in the Journal of Clinical Oncology indicates that frequent aspirin use is associated with reduction in ovarian cancer risk.  Further, secondary analyses of RCTs observing administration of aspirin for cardiovascular disease prevention "have noted a decreased risk of female reproductive cancers with at least 3 years of aspirin use."  While study authors point out that the ovarian cancer individual cases diagnosed in the study populations were not robust enough to draw definitive conclusions,  "meta-analyses and pooled analyses of cohort and case-control studies have found that aspirin may reduce ovarian cancer risk by 10%-20%, particularly when used frequently (e.g. daily or almost daily)."   

To learn more about this study, click here. 

Source mentioned: Hurwitz LM, Townsend MK, Jordan SJ, et al. Modification of the Association Between Frequent Aspirin Use and Ovarian Cancer Risk: A Meta-Analysis Using Individual-Level Data From Two Ovarian Cancer Consortia. JCO; Published online 22 July 2022. DOI: 10.1200/JCO.21.01900

Older age and smoking most important risk factors for developing any type of cancer

 A recently completed study by the American Cancer Society as identified older age and smoking as "the two most important risk factors associated with a relative and absolute five-year risk of developing any cancer."  The cohort study, comprising 429,991 participants across the USA with no prior history of cancer were followed; within a 5-year period, 15,226 of these participants were diagnosed with cancer.  In addition, risk factors including alcohol intake, family history of cancer, read meet consumption and physical inactivity contributed to an "absolute five-year risk as high as 29% in men and 25% in women." 

To learn more about this study, click here. 

Blog postings will resume week of August 8th

To all Grey Horizon readers, 

Please note that blog postings will resume the week of August 8, 2022. 

Thank you, take care, and stay well.  

Anticancer drugs in the adjuvant setting have considerable costs, raising questions of sustainability

A recently released cross-sectional analysis of approved anticancer drugs by the U.S. Food and Drug Administration (FDA) over a 4 year period (January 2018 - March 2022), determined that "the price of anticancer drugs is on an upward trajectory" worldwide, "with forecasts of global oncology therapeutic sales reaching $250 billion U.S. by 2024."   The authors of this cross-sectional analysis further emphasis the importance of estimating the cost per event averted in adjuvant therapies.  While only 11 approvals were analyzed, "the median cost per event averted of drugs in the adjuvant setting was $1 610 000 US, with...the median cost of a complete adjuvant treatment" totaled $158 000 US per patient. 

To read more about this analysis, click here.  

Source mentioned: Mousavi I, Olivier T, Prasad V. Cost per Event Averted in Cancer Trials in the Adjuvant Setting From 2018 to 2022. JAMA Netw Open 2022;5(6):e2216058.

Only a quarter of phase III studies demonstrated improved quality of life in advanced cancer setting

 A recently completed retrospective cohort study published by the Division of Cancer Care and Epidemiology at the Cancer Research Institute in Queen's University (Kingston, Ontario) indicated that nearly 50% of anticancer drug studies "demonstrated improved PFS [progression-free survival] (but) showed no improves in OS [overall survival] or QOL [quality of life]."  Led by Dr. Bishal Gyawali, the study authors further mentioned that studies with negative QOL results are either published after considerable delay or not at all, however "focusing on non-curative settings only is a strength rather than a limitation of the analysis because the risk-benefit thresholds are different in curative settings." 

To read more about this study, click here. 

Source mentioned: Samuel JN, Booth CM, Eisenhauer E, et al. Association of Quality-of-Life Outcomes in Cancer Drug Trials With Survival Outcomes and Drug Class. JAMA Oncol 2022;8(6):879-886.

Electronic symptom monitoring with PROs improves patient-reported physical function, symptom control and HRQOL

 Results from the PRO-TECT randomized controlled trial, conducted in 52 community oncology practices was recently published in JAMA.  The purpose of PRO-TECT was to "determine whether electronic monitoring of symptoms by patients undergoing treatment for metastatic cancer improves survival, quality of life outcomes and other outcomes compared with usual care."  Following enrollment of 1191 adult metastatic cancer patients, patients in the PRO group "had significantly greater odds of experiencing clinical meaningful benefits versus usual care for physical function", with an improvement of at least 5 points in 7.7% of patients studied. 

To read more about the PRO-TECT trial, click here. 

Source mentioned: Basch E, Schrag D, Henson S, et al. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer A Randomized Clinical Trial. JAMA 2022;327(24):2413-2422.

Some patients with NSCLC (non-small cell lung cancer) may respond poorly to COVID-19 MRNA vaccines

 A recently completed study from the Emory University School of Medicine in Atlanta, Georgia, determined that 25% of patients with non-small cell lung cancer (NSCLC) experienced a negative antibody response after receiving COVID-19 mRNA vaccines.  Study lead Professor Rafi Ahmed further emphasized that his team "did not find a correlation with the type of cancer treatment and the magnitude of the antibody response."  In addition, further research is required as the Emory University study was small, comprised of 82 patients with NSCLC and 53 heathy volunteers.

To read more about this study click here.  

Source mentioned: Valanparambil RM, Carlisle J, Linderman SL, et al. Antibody Response to COVID-19 mRNA Vaccine in Patients With Lung Cancer After Primary Immunization and Booster: Reactivity to the SARS-CoV-2 WT Virus and Omicron Variant. JCO; Published online 27 June 2022. DOI: 10.1200/JCO.21.02986

Age and frailty should be considered independently when evaluating potential risk for side effects among older adults treated with ICIS

 Researchers at the Princess Margaret Cancer Centre in Toronto recently released the findings of a population-level retrospective cohort study aimed at evaluating "the impact of age and frailty among older adults on use of acute care and immune-related adverse events (irAE) associated hospitalizations."  According to Dr. Lawson Eng of the Division of Medical Oncology and Hematology at the Princess Margaret Cancer Centre, older age carried a lower risk of being hospitalized due to irAE, particularly those over the age of 80, which constituted 18% of the 2737 patients who participated in the study.  The study concluded that age and frailty are significant associated factors which "may need to be considered independently when evaluating their use [in] influencing risk of toxicity among older adults receiving ICIs." 

To read more about this study, click here. 

Source mentioned: Eng L, Sutradhar R, Kaliwal Y, et al. Impact of age and frailty on acute care use during immune checkpoint inhibitor (ICI) treatment: A population-based study. J Clin Oncol 2022; 40 (suppl 16; abstr 12002). DOI: 10.1200/JCO.2022.40.16_suppl.12002

New trial alert: Marathon of Hope Cancer Centres Network Study for Ontario (MOHCCN-O)

 The Marathon of Hope Cancer Centres Network (MOHCCN), is presently recruiting cancer patients for its new study focusing on "evolving technologies such as genomics and artificial intelligence to study cancer so that the right treatment can be given to the right patient, at the right time."  Sponsored by the University Health Network in Toronto, and involving a collaboration between the Princess Margaret Hospital, the Ontario Institute for Cancer Research, and the Terry Fox Research Institute, this observational study,  over a 5-year period, aims to develop standard practices "to create a unique shareable dataset of molecular imaging, clinical, and health outcome information on Canadian cancer cases." 

To learn more about this trial and the MOHCCN, click here. 

Study shows public perception of e-cigarettes vs. cigarettes harms changed sharply during EVALID epidemic and COVID-19

 A new study conducted by the American Cancer Society indicates that perceptions by adults of "electronic or e-cigarettes as being more harmful than cigarettes...more than doubled between 2019-2020."  This perception coincides with results from the EVALI study, which focused on lung injury associated with e-cigarettes or vaping.  According to principal scientist Dr. Priti Bandi, all tobacco products, including e-cigarettes are harmful to one's health,  and "there is a need for behavioral interventions to encourage individuals to be informed consumers of available scientific findings and appreciate that while no tobacco product is safe, there are inherent differences between relative and absolute harms between tobacco products that can influence behavior."  

To read more about this study, click here. 

Study finds COVID-19 pandemic reduced breast, cervical, colorectal cancer screenings by millions in 2020

New statistics recently released by the American Cancer Society indicate that screening for breast cancer as dropped 6% (2.13 million), while screening for cervical cancer is done by 11% (4.47 million) in the United States.  Believed to be the first study to evaluate the impact of the COVID-19 pandemic using population-based data, the findings further revealed a 17% drop among Hispanic women undergoing cervical cancer screening, while 27% fewer Asian/Pacific women attended breast cancer screening, "the largest drop for any race."   

To read more about this study, click here. 

Incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing in young adults

 Epidemiological data regarding the incidence of 12 types of cancer among young adults was recently published in the British Journal of Cancer, June 2022.  According to the authors, "the incidence of colorectal, breast, kidney, pancreatic, and uterine cancers is increasing...whilst the incidence of lung, laryngeal, and bladder cancers is decreasing."  Further, the authors concluded that young adults with cancer are more likely to experience diagnostic delays, cautioning that "even when referred, younger patients may be referred through a less urgent route...[which] may results in cancer progressing to a less curable stage." While young adults are susceptible to lifestyle risk factors, namely obesity and smoking, the authors further emphasize that these preventable risk factors must be addressed early on. 

To read more about this study, click here. 

Source mentioned: di Martino E, Smith L, Bradley SH, et al. Incidence trends for twelve cancers in younger adults—a rapid review. Br J Cancer 2022;126:1374–1386. DOI: https://doi.org/10.1038/s41416-022-01704-x

Blog postings will resume week of May 30, 2022

  To all Grey Horizon readers, 

Please note that blog postings will resume the week of May 30, 2022. 

Thank you, take care, and stay well.  

Cancer care in war zones: what have we learnt?

 A recent clinical practice perspective interview by the European Society of Medical Oncology (ESMO), with Professor Richard Sullivan, from the Conflict and Health Research Group at King's College in London, UK, emphasizes the impact of cancer care in war zones for the global oncology community.  Discussion topics include challenges caring for refugees with cancer, coordinating cancer care support amongst different agencies, and the impact of the current conflict in Ukraine on cancer care in the future. 

To read the complete interview, click here.  

Webinar: survivorship needs for people living with advanced and metastatic Cancers

 A recent webinar by Dr. Michelle Mollica, Senior Advisor at the National Cancer Institute's (NCI) Office of Cancer Survivorship, discusses efforts by the NCI on "understanding and addressing the survivorship needs for the growing population of survivors who are living with advanced and metastatic cancers." Dr. Mollica's presentation includes discussions on managing symptoms, psychosocial support, health care delivery and behaviours. 

Fore more information and to view the webinar, click here. 

Increased risk of cancer in early life among individuals with autism spectrum disorders

Results from a recently completed population-based cohort study at the Karolinska Institutet in Sweden determined that "individuals with autism spectrum disorders, when present with comorbid intellectual disability and/or birth defects, were at a higher risk of cancer in early life."  With a focus on autism spectrum patients diagnosed with cancer before age 30, the study concluded that "autism spectrum disorders alone...without comorbid intellectual disability or birth defects...was not associated with an increased risk of any cancer."   

To read more about this study, click here. 

Study mentioned: Liu Q, Yin W, Meijjsen JJ, et al. Cancer risk in individuals with autism spectrum disorder. Annals of Oncology; Published online 13 April 2022. DOI: https://doi.org/10.1016/j.annonc.2022.04.006

First study examining mental illness and self-harm events across 26 cancer types

 Recently published findings in Nature Medicine studied risk of unnatural death following self-harm amongst 459,542 cancer patients diagnosed with 26 different types of cancer.  Due to psychological distress and depression experienced by cancer patients, the study authors concluded that the self-harm "prevalence ratio is higher among younger individuals, as they are more likely to be referred for specialized psychosocial cancer care."  In particular, the study further revealed the patients with co-occurring were mostly likely to cause self-harm to themselves during the first 12 months of a cancer diagnosis. 

To read more about this study, click here.  

Source mentioned: Chang WH, Lai AG. Cumulative burden of psychiatric disorders and self-harm across 26 adult cancers. Nature Medicine; Published online 28 March 2022. DOI: https://doi.org/10.1038/s41591-022-01740-3

NGS is effective in identifying actionable genetic alterations for investigational targeted therapies in paediatric and young adult patients with refractory cancers

A recent study published by the Texas Children's Cancer and Hematology Center recently published findings regarding "the feasibility of a nationwide screening and centralized testing Protocol to select patients with tumours harbouring actionable alterations for enrolment in clinical studies of molecularly targeted therapies."   Following completed testing for 94.7% of tumours, actionable alternations were detected in 31.5% of the first 1,000 tumours screened, with "treatment arm assignment and enrolment occurring in 28.4% and 13.1% of patients." 

To read more about this study, click here. 

Source mentioned: Parsons DW, Janeway KA, Patton DR, et al. Actionable Tumor Alterations and Treatment Protocol Enrollment of Pediatric and Young Adult Patients With Refractory Cancers in the National Cancer Institute–Children's Oncology Group Pediatric MATCH Trial. JCO; Published online 30 March 2022. DOI: 10.1200/JCO.21.02838

Children of patients with cancer more likely to experience medical financial hardship and emotional and educational challenges following parental diagnosis

 A new study conducted by researchers at the American Cancer Society indicates that children "living in families with a history of parental cancer were more likely to face financial, emotional, and educational challenges."  According to Dr. Zhiyuan Zheng, lead author of the study, 3.4% of children between 5-17 are living in families with a parental history of cancer.  As a result, these children may miss school and may be less likely to receive medical care due to lack of family financial resources.  Further, the study states that these children "were particularly vulnerable and began to experience psychosocial and behavioral challenges that often went unaddressed." 

To read more about this study, click here. 

Source mentioned: Zheng Z, Zhao J, Nogueira L, Han X, Fan Q, Yabroff KR. Associations of Parental Cancer With School Absenteeism, Medical Care Unaffordability, Health Care Use, and Mental Health Among Children. JAMA Pediatr. Published online April 11, 2022. doi:10.1001/jamapediatrics.2022.0494

 

Benefit of adjuvant capecitabine after curative resection of biliary tract cancer maintained with a long-term analysis

Results from BILAP, a 5-year study on survival data conducted at the UCL Cancer Institute in London, U.L. confirmed "the benefit of capecitabine as adjuvant therapy after surgical resection of biliary tract cancer...and should be considered as the standard of care."   Conducted between March 15 2006 - December 4, 2014 on 447 patients (of whom 223 were assigned to the capecitabine group for curative intent), indicated a period of 24.3 months for median recurrence-free survival for patients prescribed capecitabine compared to 17.4 months for those in the observation group.  

To read more about the BILAP study, click here. 

Source mentioned: Bridgewater J, Fletcher P, Palmer DH, et al. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. Journal of Clinical Oncology; Published online 22 March 2022. DOI: 10.1200/JCO.21.02568

Tumour budding demonstrates independent prognostic value for disease-free and overall survival in patients with stage III colon cancer

 Joint research conducted in Paris at the Department of Pathology, Sorbonne University, and the Department of Oncology, Georges Pompidou Hospital, indicates that the use of tumour budding as a prognostic biomarker in colon cancer could influence disease-free and overall survival for patients diagnosed at stage III.  Defined as "a single cancer cell of up to four cancer cells at the tumour invasive margin", tumour budding was applied to 1,048 stage III colon cancer patients in the joint Paris post-hoc study.  While the study authors acknowledge that further research is required, their findings do support the notion that "tumour budding seems to provide additional and clinically relevant prognostic information beside risk groups and Immunoscore." 

To learn more about this study, click here. 

Source mentioned: Basile D, Broudin C, Emile JF, et al. Tumor budding is an independent prognostic factor in stage III colon cancer patients: A post-hoc analysis of the IDEA-France phase III trial (PRODIGE-GERCOR). Annals of Oncology; Published online 16 March 2022. DOI: https://doi.org/10.1016/j.annonc.2022.03.002

COVID-19 & cancer: future of the pandemic [YouTube video presentation]

Dr. Otis Brawley, a renowned cancer control expert from Johns Hopkins University recently held a question and answer session discussing "the current state of the COVID-19 pandemic and what cancer survivors need to know going forward to best protect themselves."  Dr. Brawley's research is focused on cancer screening strategies and lifestyle reduction programs, including "striving to close racial, economic, and social disparities in the prevention, detection, and treatment of cancer in the United States and worldwide." 

To view the complete session, click here. 

Survivors of childhood, adolescent, and young adult cancer not at increased risk of testing positive for COVID-19, nor for serious sequelae when contracting infection

A recent study conducted in Ontario explored population-based registries to identify all 5-year survivors of childhood cancer between 0-17 years of age, as well as 6 common cancers afflicting young adults between 15-21 years old.  Findings indicated that "survivors were not at increased risk of receiving a positive COVID-19 test...and were more likely to be fully vaccinated."  Further, there was no increased risk to survivors in the emergency department or who needed to be admitted, and "no survivor experienced intensive care unit admission or died after COVID-19 infection. 

To read more about this study, click here. 

Source mentioned: Gupta S, Sutradhar R, Alexander S, et al. Risk of COVID-19 Infections and of Severe Complications Among Survivors of Childhood, Adolescent, and Young Adult Cancer: A Population-Based Study in Ontario, Canada. JCO; Published online 28 February 2022. DOI: 10.1200/JCO.21.02592

Humoral response to the third dose of the MRNA-based COVID-19 vaccine in a large cohort of patients with cancer

 A recently published letter to the editor in Annals of Oncology, authored by Dr. Vincenzo Di Noia from the Regina Elena National Cancer Institute in Rome, Italy, "described the serological response to the third dose of the BNT162b2 mENA COVID-19 vaccine in a large cohort of patients with cancer."  407 patients received a third dose of BN1162b3 between September - November 2021.  366 (89.9%) of patients were on active anticancer treatment 28 days before BNT162b2 was administered.  Median age of patients was 67, with breast (28.5%) and lung (19.9%) identified as the most common cancer types.  402 (98.8%) of patients studied "had a positive serological status after the third vaccine dose." 

To read more about this study, click here. 

Study mentioned: Di Noia V, Pimpinelli F, Renna D, et al. Potentiation of humoral response to BNT162b2 vaccine after the third dose in patients with solid cancer. Annals of Oncology; Published online 21 February 2022. doi: https://doi.org/10.1016/j.annonc.2022.02.006