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Conference Highlights: ASCO 2016

Conference Highlights: ASCO 2016
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New research was presented at ASCO 2016, the annual meeting of the American Society of Clinical Oncology, from June 3 to 7 in Chicago. The features below highlight some of the studies that emerged from the conference.
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An App to Improve Lung Cancer Survival

Comparisons of standard follow-up to web-mediated follow-up among lung cancer survivors are lacking. To address this research gap, investigators studied patients with stage III or IV lung cancer who had completed initial chemotherapy, radiation therapy, or surgery who were randomly assigned to standard follow-up or web-mediated follow-up. Web-mediated follow-up used a web-based application (app) through which patients self-assessed 12 symptoms weekly. The app used an algorithm to assess specific changes in symptoms and triggered email alerts to patients’ clinicians. At 1 year, patients in the web app group had a survival rate of 75%, compared with a rate of 49% observed in the standard care group. Although relapse rates were about 50% for both groups, 74% of patients in the web app group were able to receive the full recommended treatment for disease recurrence, compared with about 33% of those in the standard follow-up group. The web app also reduced the average number of imaging tests needed by 50% per patient per year and required only about 15 minutes per week of clinicians’ time in order to follow patients.

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Hormone Therapy & Breast Cancer Recurrence

Previous studies have shown that survivors of early-stage hormone-receptor positive breast cancer have a high risk of recurrence. Options for reducing recurrence are limited. For a study, nearly 2,000 postmenopausal women who had received 5 years of aromatase inhibitor (AI) therapy or any duration of prior tamoxifen were continued on an AI or placebo. After 5 years, women who received AI therapy had a 34% lower risk of recurrence than those who received placebo. Overall and menopause-specific quality of life were similar in both groups.

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Characterizing Use of Aggressive Care

Experts strongly advise against using cancer-directed therapy in patients with advanced solid tumors who are unlikely to benefit from it. These patients should instead receive symptom-directed palliative care. A study of patients younger than 65 with a metastatic lung, colorectal, breast, pancreatic, or prostate cancer who died between January 2007 and December 2014 showed the following regarding their last 30 days of life:

  • 62% to 65% had a hospital of emergency department visit.
  • 30% to 35% died in the hospital instead of at home.
  • 14% to 18% utilized hospice care.
  • Chemotherapy use ranged from 24% to 33%.
  • Radiotherapy used ranged from 6% to 21%.
  • Invasive procedures occurred in 25% to 31%.
  • ICU admissions occurred in 16% to 21%.

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Chemotherapy for Elderly Glioblastoma Patients

The average age of onset for glioblastoma is about 64 years, but previous studies assessing glioblastoma treatment have had an average participant age of 54 years. Optimal treatment for patients aged 70 and older remains unclear. Researchers conducted a study of patients multiforme aged 65 and older with glioblastoma who were randomized to 3 weeks of radiation therapy alone or this treatment plus 3 weeks of chemotherapy and monthly chemotherapy until the disease progressed or 12 cycles. The average overall survival was 9.3 months with chemoradiation and 7.6 months with radiation alone. The average progression-free survival was 5.3 months with chemoradiation and 3.9 months with radiation alone. Survival rates for chemoradiation and radiotherapy alone were 37.8% and 22.2%, respectively, at 1 year and 10.4% and 2.8%, respectively, at 2 years.

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Adult Cancer Care Affordability & Accessibility

Few investigations have examined the financial burden and healthcare experiences of cancer survivors with regard to affordability and accessibility. For a study, researchers compared difficulties affording and accessing care in a national sample of adult cancer survivors and matched control subjects. Whereas adult survivors were more likely to be insured (90% vs 87%), they were also more likely to report problems with delayed (15% vs 13%) and foregone (11% vs 9%) care. Odds of affordability and accessibility issues decreased over time for both groups, but adult cancer survivors were more likely than the control group to report such issues.

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Racial Disparities in BRCA-Positive Breast Cancer

Many studies exploring follow-up care among breast cancer patients with BRCA mutations have been limited to single academic centers or health systems. Also, few have included minority women. In a new analysis, researchers assessed genetic testing rates and how results were acted upon among Caucasian, African-American, and Hispanic women diagnosed with invasive cancer at age 50 or younger. Genetic testing was used in 65% of Caucasian women and 62% of Hispanic women, compared with just 36% of African-American women. Among those who tested positive for BRCA mutations, the researchers found significantly lower rates of using preventative mastectomy and oophorectomy among African-American women when compared with Caucasian and Hispanic women.

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Comparing Surgical Approaches for Cervical Cancer

There is little research comparing disease-specific survival rates among women with stage 1B1 cervical cancer after they receive less radical surgery (LRS; conization, trachelectomy, and simple hysterectomy) or if they are treated with more radical surgery (MRS; modified radical or radical hysterectomy). A study comparing these approaches found that 10-year disease-specific survival rates were 92.8% for LRS and 92.3% for MRS among women with stage 1B1 cervical cancer. While LRS and MRS were not independently associated with disease-specific survival, several factors appeared to increase risk for disease-specific mortality, including:

  • Adenosquamous histology.
  • Grade 3 disease.
  • Tumor size larger than 2 cm.
  • Lymph node positivity.

 

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Rectal Cancer Surgery by Race

Data indicate that advances in neoadjuvant chemoradiation therapy have resulted in increased rates of anal-sphincter-preserving surgery. While this strategy has improved quality of life in patients with rectal adenocarcinoma, few analyses have assessed if racial disparities exist with regard to the rates of these individuals undergoing sphincter-sacrificing rectal surgery. A study of patients with non-metastatic rectal cancer who underwent either sphincter-preserving or -sacrificing rectal surgery separated participants by race to explore the issue further. Researchers found that sphincter-sacrificing surgery was performed in 36.7% of African-American patients, compared with a rate of 28.9% that was observed in non-African-Americans.

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Age & Colectomy Outcomes

Among patients with colon cancer who have undergone colectomy, it is not well known if age impacts the rate and/or cause of death beyond the 30-day postoperative period. For a study, patients with stage I to III colon adenocarcinoma who had undergone colectomy from 2004 to 2011 were grouped into different age groups. Major complication rates were as follows:

  • 23.3% for patients younger than 65.
  • 29.9% for patients aged 65 to 74.
  • 38.2% for patients aged 75 or older.

Postoperative complications significantly increased 1-year mortality risks for all age groups. Increasing age was associated with a decrease in mortality from colon cancer and an increase in deaths from cardiovascular disease.

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Comparing Breast-Conserving Surgery Approaches

Applying the oncoplastic technique to breast-conserving surgery has been shown to allow for wide excisions while conserving breast shape. However, the oncologic safety of this approach in primary breast cancer has not been determined. For an investigation, patients with breast cancer were divided into those who underwent oncoplastic surgery, conventional breast-conserving surgery, or total mastectomy. Oncoplastic surgery allowed for large-volume resections in more diffuse cancer and lesions that were closer to the nipple when compared with conventional breast-conserving surgery. The approach also maintained oncological safety, and the safety margin was improved with oncoplastic surgery when compared with other strategies.

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