New research was presented at ASCO 2015, the American Society of Clinical Oncology’s annual meeting, from May 29 to June 2 in Chicago. The features below highlight some of the studies that emerged from the conference.
Immunotherapy Improves NSCLC Survival
The Particulars: Data are lacking on the optimal treatment approach for patients with advanced non-squamous non-small cell lung cancer (NSCLC) who have failed treatment with platinum-based doublet chemotherapy.
Data Breakdown: For a study, researchers compared chemotherapy with immunotherapy in patients with advanced non-squamous NSCLC who had failed treatment with platinum-based doublet chemotherapy. They observed the following for immunotherapy vs chemotherapy:
♦ 12-month overall survival rate: 51% vs 39%
♦ Objective response rate: 19% vs 12%
♦ Average response rate: 17.2 months vs 5.6 months
♦ Treatment related adverse event rate: 69% vs 88%
♦ Serious treatment-related adverse event: 7% vs 20%
Take Home Pearls: Immunotherapy appears to improve survival among patients with advanced non-squamous NSCLC when compared with chemotherapy. Adverse event rates also appear to favor immunotherapy in this patient population.
Weighing the Pros & Cons of Whole-Brain Radiation
The Particulars: Whole-brain radiation has been shown in previous studies to improve tumor control in the brain by addressing micro-metastases that avoid stereotactic radiosurgery. However, few studies have assessed whether the benefits of whole-brain radiation outweigh the side effects.
Data Breakdown: Mayo Clinic researchers analyzed outcomes for patients who underwent stereotactic radiosurgery with or without whole-brain radiation to treat brain metastases. Although combination therapy significantly decreased brain tumor progression qwhen compared with surgery alone, overall survival was similar for both approaches. Cognitive decline at 3 months occurred in more than 90% of patients in the combination therapy group, compared with a rate of less than 65% in the surgery alone group.
Take Home Pearls: Adding whole-brain radiation to stereotactic radiosurgery for treating brain metastases appears to reduce tumor progression. However, the combination does not appear to improve survival and may increase cognitive decline when compared with stereotactic radiosurgery alone.
Addressing Hyperglycemia in Cancer Patients
The Particulars: Clinical research has yet to determine if inpatient management of hyperglycemia should be modified according to the type of malignancy among diabetics with co-existing cancer.
Data Breakdown: Study investigators analyzed data on patients with a new solid-organ malignancy who were hospitalized from 2009 to 2011. No associations were observed between any of nine cancer types and hyperglycemia. However, among patients with the most frequent hyperglycemia, 44% received bolus insulin only or no insulin at all.
Take Home Pearls: The management of hyperglycemia among patients with cancer does not appear to be affected by cancer type. However, standards of inpatient care do not appear to be met among many individuals in this patient population.
End of Life Cancer Care & Family Experiences
The Particulars: Anecdotal evidence suggests that patients with advanced cancer often receive aggressive medical care near death despite concerns that hospital-based care at the end of life (EOL) reflects poor quality of care. Little is known about how family members perceive EOL care for their loved ones with advanced cancer.
Data Breakdown: Family members of older patients with advanced cancer were surveyed for a study. Family members of patients enrolled in hospice 3 or more days before death were most likely to report excellent quality of care at EOL. Family members of patients admitted to the ICU within 30 days of death or of patients who died in the hospital were least likely to report excellent EOL care.
Take Home Pearl: Improving earlier hospice enrollment, reducing ICU admissions at the EOL, and avoiding terminal hospitalizations may improve the quality of cancer care for patients with cancer and may enhance the experience of family members.
Online & Social Media Use by Breast Cancer Patients
The Particulars: Few studies have assessed if newly diagnosed cancer patients use online communication (OC) and social media (SM) for care support and making treatment decisions or how these individuals use these tools.
Data Breakdown: A survey of newly diagnosed breast cancer patients found that 37% reported some or frequent use of either OC or SM to discuss their diagnosis, treatment decisions, or care support. Patients aged 54 and younger, those with a higher education, and those who were Caucasian were most likely to use OC or SM. The most common reasons cited for some and frequent use of OC or SM included:
- Informing others of their diagnosis: 69%.
- Obtaining treatment advice: 56%.
- Coping with negative feelings or emotions: 46%.
Frequent users had higher decision satisfaction than those who never used OC or SM.
Take Home Pearls: Newly diagnosed cancer patients appear to frequently use OC and SM for treatment decisions and care support. This finding suggests that there are emerging opportunities to incorporate both tools into clinical practice.
Elective Neck Dissection for Oral Cancer
The Particulars: Research assessing the optimal treatment of early-stage, node-negative oral cancers have resulted in inconclusive findings.
Data Breakdown: For a study, patients with lateralized T1 or T2, node-negative squamous carcinoma of the oral cavity were randomized to elective neck dissection of the lymph nodes at the time of primary tumor surgery or to receive a watch and wait approach with therapeutic neck dissection at the time of relapse. When compared with the watch and wait approach, immediate neck dissection:
♦ Improved overall survival by 12.5%.
♦ Reduced the risk of recurrence by 55%.
♦ Decreased the risk of mortality by 36%.
Take Home Pearl: Among patients with early-stage, node-negative oral cancers, elective neck dissection at the time of primary tumor surgery appears to improve survival and reduce recurrence.
CLND: Any Survival Benefit for Melanoma?
The Particulars: Guidelines currently recommend that patients with melanoma that is detected in the sentinel lymph node undergo complete lymph node dissection (CLND). However, clinicians have increasingly questioned whether the benefits of CLND outweigh the risks of infection, nerve damage, and lymphedema, among other potential complications.
Data Breakdown: Patients with stage III melanoma were randomized to CLND or observation for a study. In the observation group, 14.6% of patients developed lymph node regional metastases, compared with a rate of 8.3% observed in the CLND group. However, no significant differences were observed between the groups in 5-year recurrence-free survival, distant metastasis-free survival, or melanoma-specific survival.
Take Home Pearl: Performing CLND in patients with melanoma does not appear to increase survival when compared with observation.
Benefits Seen With Cavity Shaving During Partial Mastectomy
The Particulars: Prior research shows that excising a margin of normal tissue surrounding a breast tumor mass does not sufficiently remove all cancer cells in 20% to 40% of cases. In these situations, re-excision becomes necessary. Data are lacking on whether or not cavity shaving to remove more tissue can reduce rates of re-excision.
Data Breakdown: Study investigators randomized patients with early-stage breast cancer who were undergoing partial mastectomy to routine resection around the tumor to eliminate positive margins. Patients then underwent either further shaving of the cavity or no shaving. Those in the shave group had a l9% rate of positive margins, compared with a rate of 34% observed in the no-shave group. Rates of re-excision for margin clearance were 10% in the shave group and 21% in the no-shave group. Cosmetic outcomes were similar in both groups.
Take Home Pearls: Cavity shaving during partial mastectomy appears to reduce the rate of re-excision without affecting cosmetic outcomes. Further research is needed to determine if cavity shaving affects local recurrence.
Obesity & Endometrial Cancer Resection Recovery
The Particulars: Previous studies have found that excess body fat is a risk factor for endometrial cancer. However, the effect of obesity on recovery and quality of life after endometrial cancer resection has not been well defined.
Data Breakdown: University of Wisconsin researchers evaluated the extent to which BMI predicted depression, insomnia, and fatigue at 1, 4, and 6 weeks after surgical resection of endometrial cancer tumors in women participating in a study. Women with higher BMIs reported greater depression and fatigue, but no significant association was observed between BMI and insomnia. Activity levels appeared to mediate the relationship between BMI and fatigue.
Take Home Pearl: Obesity appears to negatively affect mood and fatigue following surgical resection of endometrial cancer.
Surgeon Payment for Cancer Resections Varies Widely
The Particulars: Anecdotal evidence indicates that demand is increasing for price transparency in healthcare. However, data are lacking on payments to surgeons who perform oncologic resections.
Data Breakdown: For a study, researchers assessed geographic variations of private payer expenditures to surgeons for cancer resections. They also analyzed variations within geographical regions in the United States for these expenditures. For simple mastectomy, the average allowed medical benchmark (AMB) ranged from $487 to $1,364. AMBs ranged from $1,716 to $5,775 for robotic radical prostatectomy and from $498 to $5,047 for open lobectomy. Standard deviations for the 50th percentile of AMBs were $1,450 for open lobectomy and $1,173 for robotic radical prostatectomy. Investigators also observed substantial variations within geographic regions.
Take Home Pearls: The allowed reimbursement for common oncologic surgical procedures appears to vary widely both across and within geographic regions in the U.S. Transparency about these payments could impact patient and employer choices and facilitate assessments of cancer care values.