Research Highlights from the 2017 Cancer Survivorship Symposium
Cosponsored by the American Academy of Family Physicians, the American College of Physicians, and the American Society of Clinical Oncology
♦ Three-Quarters of Survivors Report Decreased Physical Activity After a Cancer Diagnosis
A new survey of people treated for cancer finds that as many as 75 percent of survivors report reducing their physical activity levels following a cancer diagnosis, despite its proven benefits. Psychological barriers such as difficulty getting motivated and staying disciplined, along with fatigue and pain associated with cancer treatment, were identified as factors contributing to decreased activity.
“Many people associate cancer treatment with needing to rest, but we’re learning that moderate forms of physical activity can not only help patients feel better generally but also, in some cases, potentially improve their cancer outcomes,” says lead author Sally A.D. Romero, PhD, a postdoctoral research fellow at Memorial Sloan Kettering Cancer Center in New York, NY. “Our research sheds light on the reasons patients are unable to achieve their exercise and physical activity goals. We found that psychological factors – such as motivation and discipline – were associated with a decrease in physical activity.”
ASCO’s clinical practice guidelines recommend that providers encourage all cancer survivors to engage in a moderate level of physical activity after cancer treatment (in other words, 150 minutes of moderate aerobic exercise per week).
“The side effects of cancer treatment like fatigue and pain can be addressed relatively easily, but the other reasons patients aren’t exercising can be more complicated, and we need to focus on those as well,” Dr. Romero says. “Our challenge as providers is to help our patients think about physical activity in new ways, while personalizing their care.”
♦ Young Thyroid Cancer Survivors Face Increased Risk of Heart Conditions and Osteoporosis
In the U.S., thyroid cancer incidence is increasing more rapidly than any other cancer, and it is commonly diagnosed at a younger age than most adult cancers. A new study finds that younger survivors of thyroid cancer, those diagnosed before the age of 40, are at increased risk for hypertension, heart disease, and osteoporosis.
“Patients diagnosed with thyroid cancer often have an excellent prognosis and survival rate, especially those diagnosed at younger ages […]. But as the number of thyroid cancer survivors grows, more people are living with other serious health conditions resulting from treatment,” says the study’s lead author, Brenna Blackburn, mph, a member of the Hashibe Lab at Huntsman Cancer Institute in Salt Lake City, UT, and a PhD candidate at the University of Utah. “It’s important to understand these long-term risks so that we can […] inform how oncologists care for these patients from the onset of diagnosis.”
While such late effects are typically associated with aging, the authors speculate that younger thyroid cancer survivors are likely being treated with more aggressive treatments, including surgery, radioactive iodine therapy, external-beam radiation, and hormone therapy.
“Younger patients are often considered healthier, and it’s assumed they’re better equipped to handle aggressive types of therapy that have been linked to heart damage, such as radiation and hormone therapy. But we’ve seen that they’re also developing worrisome side effects later,” Ms. Blackburn says.
♦ Nearly Half of Partners of Young Breast Cancer Survivors Experience Anxiety
A new analysis finds that 42 percent of partners of young breast cancer survivors experience anxiety, even several years after their partner’s cancer diagnosis. Researchers note that ineffective coping strategies, parenting concerns, and other factors were associated with anxiety. “As the number of breast cancer survivors continues to grow in the United States, interventions targeting the concerns of partners – and entire families – are needed to help them cope with the inevitable and often unanticipated changes that come with a cancer diagnosis,” says lead study author Nancy Borstelmann, MPH, MSW, LICSW, director of social work at Dana-Farber Cancer Institute in Boston, MA.
Research Highlights from the 2017 Genitourinary Cancers Symposium
Cosponsored by the American Society for Radiation Oncology, the American Society of Clinical Oncology, and the Society of Urologic Oncology
♦ In Advanced Kidney Cancer, Antibiotic Use Lowers Efficacy of Immunotherapy
A new retrospective analysis suggests that immunotherapy may be less effective in people who receive antibiotics less than a month before starting treatment. In the study, cancer worsened more quickly in such survivors than in those who did not receive antibiotics.
The researchers believe that the negative effect of antibiotics is due to the antibiotics wiping out the “good bacteria” in the gut. Earlier research in mice has suggested that certain microorganisms dwelling in the gut interact with the immune system in a way that seems to help immune checkpoint inhibitors work better. “These early findings show that doctors prescribing cancer immunotherapy should pay closer attention to antibiotic use,” says lead study author Lisa Derosa, MD, a PhD candidate at the Gustave Roussy Cancer Institute, Paris-Sud University in Villejuif, France. “This research may be relevant to more than just kidney cancers, as antibiotics are commonly prescribed to patients with cancer to prevent or treat infections related to cancer treatment or a weakened immune system.”
♦ Some Survivors Experience Long-Term Tumor Control Even After Stopping Immunotherapy Early
Early findings from a new study appear to challenge the current standard practice for immune checkpoint inhibitor therapy – continuing treatment until cancer worsens. Among people with advanced kidney cancer who stopped PD1/PD-L1 immunotherapy early due to side effects, 42 percent had a durable response, meaning they were able to remain off additional systemic therapy for six months or more. More broadly, this insight may help alleviate some patients’ concerns about the impact of discontinuing immunotherapy.
“In medicine, we are constantly balancing the benefits and risks of any given treatment,” says lead study author Rana R. McKay, MD, an assistant professor of Medicine at the University of California San Diego School of Medicine in San Diego, CA. “This is a small study, and while our findings need to be validated in a larger group of patients, it underscores that in some cases, immunotherapy can have lasting benefits even after treatment discontinuation.”
♦ Blood Test Uncovers Potential New Treatment Targets in Advanced Prostate Cancer
Analysis of free-floating cancer DNA from blood samples has yielded leads for new prostate cancer treatment targets. Using a commercially available “liquid biopsy” test in men with advanced prostate cancer, researchers found several genetic changes in cell-free, circulating tumor DNA (ctDNA).
Cell-free ctDNA provides comprehensive information about all the different genetic changes in the tumor. Today, treatments can sometimes be tailored to the genetic changes in a tumor, but these changes evolve over time. The cell-free ctDNA tests can be used to track new genetic changes, and this information can be used to stop treatment to which resistance is emerging and to switch the person to another treatment. The changes in ctDNA found by the blood tests were similar to those previously reported in analyses of tumor tissue specimens, suggesting that ctDNA testing may be a viable alternative to tissue biopsy.
Research Highlights from the 2017 Gastrointestinal Cancers Symposium
Cosponsored by the American Gastroenterological Association Institute, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology
♦ PET Scans Can Inform and Improve Treatment for People with Esophageal Cancer
Findings from a federally funded clinical trial point to a new way to improve the outlook for people with esophageal cancer: using PET scans to assess tumor response to initial chemotherapy may allow doctors to tailor further chemotherapy.
People with stage II–III esophageal and gastroesophageal junction cancers typically receive five and a half weeks of chemotherapy with radiation, followed by surgery. Use of chemoradiation before surgery has been shown to improve survival compared to surgery alone. Several chemotherapy regimens are available for use during chemoradiation, but doctors have no reliable method to predict whether a particular chemotherapy will be effective in a given person.
“In this study, we are adding induction chemotherapy before chemoradiation and showing that using PET scans after the induction chemotherapy to assess response can help doctors make quick course corrections to maximize patient benefit from chemotherapy,” says Karyn A. Goodman, MD, a radiation oncologist at the University of Colorado School of Medicine in Aurora, CO. “Although our approach does lengthen a patient’s time before surgery, we found that assessing treatment efficacy by PET scans can improve the efficacy of the treatment as shown by the ability to achieve a pathologic complete response, meaning there were no traces of cancer in the tissue specimen taken at the time of surgery.”
♦ Physical Activity Linked to Longer Survival in Advanced Colorectal Cancer
A new analysis suggests that people with metastatic colorectal cancer who are more physically active fare better than those who are less active. In a large clinical trial, people who at the time of starting chemotherapy reported engaging in physical activity equivalent to 30 or more minutes of moderate exercise daily had a 19-percent reduction in mortality and a 16-percent reduction in cancer progression.
In a secondary exploratory analysis, researchers found that more time spent in non-vigorous physical activity, such as walking or lawn mowing, was linked to improved survival. People who spent five or more hours per week engaged in non-vigorous activity had a 25-percent reduction in mortality. However, there was no association between vigorous physical activity, such as running and playing sports, and cancer outcomes.
♦ Watch-and-Wait Approach for Rectal Cancer Appears an Option for More People
Data from a large observational study suggests that omitting surgery in strictly selected rectal cancer survivors with a clinical complete response does not compromise outcomes. The three-year survival rate among people who received watch-and-wait care after initial cancer treatment was 91 percent, which is similar to historic survival rates for people who undergo surgery. This is welcome news, as rectal surgery carries the risk of distressing complications, such as colostomy and urinary and sexual problems.
In most countries, people with stage II–IV rectal cancer receive chemotherapy and/or radiation before surgery. Although in about 20 percent of survivors the tumor completely disappears after pre-surgery therapy, it is not standard to re-assess or “restage” the tumor to see if surgery is still needed.
“Some people with rectal cancer undergo surgery after chemoradiation therapy, even though it may not be necessary,” says Maxime van der Valk, MD, one of the study coordinators of the International Watch and Wait Database Consortium and Leiden University Medical Center in Leiden, Netherlands. “From the data we have now, it seems that watch-and-wait may be safe in selected patients with rectal cancer, but it is too soon to say whether this approach should be routinely offered.”
ASCO represents more than 40,000 oncology professionals who care for people living with cancer. Visit asco.org for more highlights from these Symposia. ASCO’s patient information website can be found at cancer.net.
This article was published in Coping® with Cancer magazine, March/April 2017.