Recent findings point to new approaches that improve patient outcomes and quality of life during and after treatment. These include ways to ease treatment for people with blood cancers, to mitigate hearing loss in children undergoing intensive chemotherapy, to lessen repeated testing of people who have had surgery for colorectal cancer, and to better inform people about the risks of alternative medicine.
Palliative Interventions Beneficial Among Patients Undergoing Potentially Curative Treatment of Blood Cancer
Building on prior research showing the benefits of early initiation of supportive care, including palliative care, in patients with advanced cancer, a new study, SHEILD (ClinicalTrials.gov identifier: NCT02207322),55 looked at the approach in 160 people with hematologic malignancies undergoing potentially curative hematopoietic stem-cell transplantation.
The study randomly assigned people to routine transplantation care or transplantation care with integrative supportive and palliative care. At the start of the study and at 6 months after transplantation, the investigators assessed quality of life, anxiety, and symptom burden, among other factors. The researchers found that patients in the intervention arm (integrated palliative care) had lower depression symptoms and lower post-traumatic stress disorder symptoms, but there was no benefit for quality of life or anxiety. On the basis of this study, incorporating inpatient palliative care into routine transplantation could lead to decreased psychological distress that typically persists 6 months after the transplantation.
Voices for Cancer Research: Alan P. Lyss, MD
“NCI-funded research helps to level the playing field and assure that the latest innovations are available to people who need them–wherever they live, whatever their social circumstances, whatever their race, ethnicity, age, or gender.”
As a clinician researcher, one of Dr. Lyss’ missions is to provide advanced care and treatment options to patients through cutting-edge research. For many of his patients who live in a rural setting, access to proper care can be a real challenge and often leads to delays in diagnosis and treatment. Support from the NCI Community Oncology Research Program (NCORP) has helped Dr. Lyss bridge the gap for his patients, allowing them to gain access to clinical trials in their communities rather than having to travel long distances to receive care.
Dr. Lyss specializes in breast cancer prevention and treatment, aiming to improve the quality of life for his patients. Among the studies available through NCORP, he offers a simple but important study evaluating whether aspirin can help prevent recurrence in women with node-positive, HER2-negative breast cancer. He and his colleagues are also helping test strategies to decrease the number of lymph nodes removed during surgery for women with locally advanced breast cancer, lessening the chance of arm swelling after surgery.
Dr. Lyss pins a bright red “Research Cures Cancer” button on his white coat every day to remind himself of the importance of cancer research. “There are real lives at stake, and they’re at stake every day. As long as we have people who are dying of cancer, as long as we have people who suffer long-term effects related to cancer or its treatment, we can do better, and we must do better,” said Dr. Lyss.
Dr. Lyss is an oncologist at Missouri Baptist Medical Center, Heartland Cancer Research NCORP, in St. Louis, Missouri. Disclosures: none.
To learn more about why Dr. Lyss lives to conquer cancer, please visit asco.org/live-to-conquer-cancer.
Alternative Medicine Is Not a Substitute for Conventional Therapy
Studies quantifying benefits and risks of alternative and unproven therapies in many cancers have not been extensive. An observational study56 of data from the National Cancer Database confirmed that there is a much higher likelihood of death among patients diagnosed with early-stage or curable breast, lung, or colon cancers who only received alternative medicine, compared with those treated with standard therapy. In this study, which included data from 840 patients treated between 2004 and 2013, authors defined alternative therapies as unproven cancer treatments given by nonmedical personnel.
The 5-year survival rate for patients treated with alternative medicine was 54.7% compared with 78.3% for those who received standard therapy. Cancer-specific 5-year survival rates were also higher for patients with breast, lung, and colorectal cancer who were treated with conventional therapy. The rates were lower, however, for patients treated with conventional therapy for prostate cancer. Researchers suspect this can be attributed to the typically slower progression of prostate cancer.
According to the National Cancer Opinion Survey conducted by ASCO in 2018, nearly four in 10 Americans, or 39%, believe cancer can be cured solely through alternative therapies, such as enzyme and oxygen therapy, diet, vitamins, and minerals. The survey also found that younger people (47% of survey respondents age 18 to 37 years and 44% of participants age 38 to 53 years) are the most likely to hold these views.14
The National Cancer Database study provides important information to help guide patient decisions about care and might help mitigate concerns about the use of conventional therapies compared with alternative approaches. The researchers also emphasized that alternative medicine should not be confused with integrative or complementary medicine.
Voices for Cancer Research: Sarah Bryan Miller
“On one side, you may benefit personally from participating in a clinical trial, and on the other, you may be helping someone else. That’s a pretty compelling argument to me.”
Sarah Bryan was 58 when she was diagnosed with a rare form of breast cancer, stage III inflammatory disease, which was followed by a second diagnosis two years later of ductal carcinoma in situ. The treatments she received – including chemotherapy, radiation therapy, and multiple surgeries – have helped to prolong her life but have also resulted in mobility issues.
However, as a former professional opera singer, a current member of her church choir, and the classical music critic at the St. Louis Post-Dispatch, Sarah Bryan was determined to continue supporting herself financially and to participate in the activities she loves. She credits cancer research and her “honest, straightforward, caring” oncologist Dr. Lyss for enabling her to keep working and living independently.
Since her initial diagnosis, Sarah Bryan has participated in multiple clinical trials. She believes the federal government has the power to make a positive effect by funding cancer research.
“I’m grateful to live in a time when discoveries are being made and new treatments are being developed,” said Sarah Bryan. “I benefited from research that others have participated in, and it makes going through all of this a little more meaningful if my participation in a trial helps other people, too.”
Sarah Bryan is an active volunteer with her local cancer support community in St. Louis, Missouri.
New Combination Treatment Halves Hearing Loss Risk in Children With Hepatoblastoma
Hepatoblastoma, a form of liver cancer that develops in infants and children, can often be treated effectively with a combination of cisplatin chemotherapy and surgery. Cure rates for standard-risk hepatoblastoma are now consistently greater than 80%, and close to 50% of children with high-risk disease can also be cured. The intensive use of cisplatin in young children, however, is associated with irreversible hearing loss.
In a recent federally funded study, SIOPEL6 (ClinicalTrials.gov identifier: NCT00652132),57 109 children with standard-risk hepatoblastoma were randomly assigned to receive cisplatin or cisplatin plus sodium thiosulfate treatment (this study was funded, in part, by NIH and the US Department of Veterans Affairs). Sodium thiosulfate is a basic chemical compound that is on the WHO list of essential, safe medicines.58
In the study, the two medicines were given over four courses before surgery and two courses after surgery. Hearing loss of any grade was nearly halved with the combination treatment. Grade 1 or greater hearing loss (on a scale with grade 1 being the least loss of hearing and grade 4 the most) occurred in 33% of children in the cisplatin plus sodium thiosulfate group compared with 63% of children in the cisplatin-alone group. Survival was not affected by adding sodium thiosulfate to cisplatin, suggesting that the addition did not have a tumor-protective effect.
"I am proud that the 21st Century Cures Act included funding increases for NIH signed into law on a bipartisan basis. Oncologists and lawmakers both care about people with cancer, and, together, we can work toward even greater increases for NIH to find answers that will improve treatments patients receive."
—Representative Fred Upton (R-MI)
Surveillance of Postsurgical Patients With Colorectal Cancer Could Effectively Be Lessened
The optimal frequency of follow-up testing for people who have been treated for colorectal cancer has not been quantified. In an unblinded trial, COLOFOL (ClinicalTrials.gov identifier: NCT00225641),59 conducted in Sweden, Denmark, and Uruguay, more than 2,500 people with stage II or III colorectal cancer were randomly assigned to either low-frequency follow-up (computed tomography of the chest, abdomen, and pelvis and measurement of carcinoembryonic antigen, a blood antigen, at 12 and 36 months after surgery) or high-frequency follow-up (the same tests at 6, 12, 28, 24, and 36 months after surgery). Primary outcomes showed no difference in the number of deaths overall after 5 years as a result of colorectal cancer or any other cause.
The finding—that less frequent surveillance does not result in worse survival outcomes—indicates that it is safe for patients to have less testing over time, a finding that should reduce health care costs as well as reduce patients’ exposure to unnecessary radiation from computed tomography scans.