Cancer

Among women who are Medicare beneficiaries, those who have 2 or more visits to a primary care physician during a 24-month interval have lower odds of breast cancer mortality, all-cause mortality, and late-stage breast cancer diagnosis compared with women who have 0 visits or 1 visit when the analysis is adjusted for other covariates, including mammography and nonprimary care physician visits. The current findings suggest that primary care physicians play an important role in reducing beast cancer mortality among this population.

Although there has been a decline in the proportion of patients presenting with advanced paranasal sinus squamous cell carcinoma, overall survival has remained stable over time. There appears to be evidence of racial disparity in the incidence and (to a lesser extent) the outcome of paranasal sinus squamous cell carcinoma.

This is the first report of an anti–epidermal growth factor receptor monoclonal antibody used in combination with chemoradiation in locally advanced anal canal carcinoma. Cetuximab could not be integrated with pelvic chemoradiation based on 5-fluorouracil and cisplatin, due to the high toxicity rate.

Analysis of paired samples taken at diagnosis and after relapse from a group of leukemia patients with drug-resistant cancer revealed that each patient had a unique gene signature representing different mechanisms of resistance. The data underline the need for personalized molecular analysis in order to design specific treatments suitable for individual patients with acute myeloid leukemia.

Patients undergoing partial nephrectomy have improved overall survival compared with controls, suggesting that the apparent survival advantage documented in retrospective case series is the result of selection bias.

A significant proportion of medical decisions are made without available or applicable randomized evidence to inform radiotherapeutic medical decision making in an academic radiation oncology clinic. These findings underscore the limitations of relying solely on prospective randomized controlled trials for the development of evidence-based health care.

This update of a 2002 report provides evidence that diversity in the recruitment of cancer clinical trials participants has not improved in the decade since the report was published. Women and racial/ethnic minorities remain severely underrepresented in cancer clinical trials, thus limiting the utility of cancer clinical research.

It is unknown whether Agent Orange exposure increases the overall risk of developing prostate cancer or whether it specifically increases the risk of lethal prostate cancer. The objective of this study is to determine the association between Agent Orange exposure and the risk of detecting high-grade prostate cancer (Gleason score ≥7) on biopsy in a US veteran cohort.

Illness-related uncertainty is a significant psychological experience for patients with primary brain tumors. It may be possible to lessen perceived symptoms by reducing uncertainty in patients with primary brain tumors and promoting more positive mood states.

Both pemetrexed and erlotinib are active in patients with pretreated nonsmall cell lung cancer (NSCLC). In this randomized controlled phase 3 trial, the 2 drugs are compared, and the results indicate that both agents are equally effective in unselected patients with previously treated NSCLC, although they have different toxicity profiles. Exploratory biomarker analyses indicate no difference in efficacy irrespective of EGFR status, whereas the presence of KRAS mutations is correlated with treatment efficacy.

Black race, Hispanic ethnicity, and higher area-based poverty are salient predictors of lower human papillomavirus 16/18 positivity among women with high-grade cervical lesions. These findings have implications for vaccine impact monitoring, vaccination programs, and new vaccine development.

Immunohistochemical analysis of mutant (substitution of valine by glutamic acid at position 600 [V600E]) v-Raf murine sarcoma viral oncogene homolog B1 (BRAF) protein expression yields highly concordant results with a DNA-based assay for the detection of BRAF^V600E mutations in human colon carcinomas. This finding suggests that immunohistochemistry is an alternative approach for detecting BRAF^V600E mutations in clinical practice.

Inotuzumab ozogamicin achieves high response and molecular remission rates in patients with relapsed/refractory acute lymphoblastic leukemia with tolerable toxicity. It warrants further studies of inotuzumab in combination with chemotherapy or other targeted therapy.

Inotuzumab single-agent therapy is highly active, safe, and convenient in refractory-relapsed acute lymphocytic leukemia. A weekly dose schedule appears to be equally effective and less toxic than a single-dose schedule.

Circadian-based chemotherapy, which accounts for physiologic oscillations in biologic functions over 24 hours, achieves the best efficacy when good tolerance occurs. The main clinical implication of the current study is that optimization of circadian-based delivery should allow concomitant improvements in the safety and efficacy of chemotherapy with increased benefit for the individual patient.

Intensity-modulated radiation therapy provides local control rates comparable to those achieved with 2-dimensional and 3-dimensional radiotherapy in pediatric patients with low-grade glioma. Margins ≥1 cm added to the gross tumor volume to create the clinical target volume may not be necessary, because excellent local control is achieved by adding a 0.5-cm margin to the clinical target volume and by dose painting.

The survival of older adults with acute myeloid leukemia remains poor, but has improved in patients up to age 75 years. The current data support the importance of recognizing clinically relevant differences between “younger old” and “older old” patients.

Posterior reversible encephalopathy syndrome (PRES) is associated with immunotherapy using antidisialoganglioside (anti-G_D2) monoclonal antibody, which is now standard for high-risk neuroblastoma, but has not previously been implicated in PRES. Patients receiving this treatment should be closely monitored for, and undergo immediate treatment or evaluation of, symptoms (eg hypertension or headaches) that may herald PRES.

The effect of tobacco use on disease control and late toxicity in men treated with dose-escalated external beam radiotherapy for prostate cancer has not been well-defined. Tobacco use was not independently associated with biochemical failure or gastrointestinal toxicity, but a history of tobacco use was associated with worse late grade ≥2 genitourinary toxicity and current smokers had worse late grade ≥3 genitourinary toxicity compared with prior and never smokers.

Despite high cure rates following treatment for stage I testicular seminoma, survivors experience increased all-cause mortality and mortality from second malignant neoplasms and suicide but not cardiovascular disease following modern radiotherapy. The absolute risk of second malignancies is lower than reported in older series.

Lonafarnib, an oral selective farnesyltransferase inhibitor, can be safely combined with temozolomide. This combination is effective in patients with recurrent glioblastoma.

Human immunodeficiency virus (HIV)-infected lymphoma survivors reach long-term immune recovery and virologic suppression similar to what is observed in cancer-free, HIV-infected patients. Clinical events are more common among lymphoma survivors, especially during the first year of follow-up.

Patients with relapsed osteosarcoma have a poor prognosis. Whereas surgery is essential for survival, chemotherapy may slow disease progression in patients without remission. This study provides data on prognostic factors and event-free survival after relapse that are needed for the design of phase 2 trials of novel agents.

Although effective and durable tumor control is attainable with radiation therapy in older patients, frequent progression and long-term morbidity is common in young patients who undergo chemotherapy to delay the use of radiation therapy.

Patients with chronic myeloid leukemia have experienced improvements in overall survival among all age groups. Nonetheless, elderly patients continue to have worse outcomes when examined at the population level.

Two simulation models examine 6 strategies: combinations of increased screening and/or receipt of indicated treatment or elimination of obesity are compared to continuation of current patterns. Maximal reductions in breast cancer deaths could be achieved by 2025 through optimizing treatment use, followed by increasing screening use and then obesity prevention.

Adjuvant radiation dose appears to influence overall survival in patients with resected pancreatic adenocarcinoma. Prospective data evaluating optimally delivered postoperative radiotherapy in these patients are needed.

Organizations are recommending the use of life tables or comorbidity assessment in patients before prostate cancer screening or prostate biopsy to reduce overtreatment; however, they do not provide specific means for comorbidity analysis. In the current study, the authors present the Charlson Comorbidity Index and the patient-reported Total Illness Burden Index for Prostate Cancer (TIBI-CaP) as tools to predict acute hospital admission as a surrogate for poor overall health and those patients who should avoid prostate biopsy.

Pathologic response and tumor thickness at the tumor-normal interface are reproducible criteria that may be used in routine clinical practice and are new end points for the assessment of biomarkers of chemotherapy response in colorectal liver metastases.

Rates of nonadherence to aromatase inhibitors among Medicare beneficiaries with hormone receptor-positive early breast cancer are high. The elimination of copayments for aromatase inhibitors for these Medicare beneficiaries would be cost saving to society.

Stereotactic Body Radiotherapy (SBRT) is an alternative to surgery for clinical Stage I non-small cell lung cancer. Our retrospective investigation demonstrates similar overall survival, locoregional control, and total recurrence control with surgery or SBRT after controlling for prognostic and patient selection factors.

A significant improvement in the objective complete response rate is observed with 1200 mg barasertib versus 400 mg low-dose cytosine arabinoside in older patients with acute myeloid leukemia. The safety profile of barasertib, although more toxic than that of low-dose cytosine arabinoside, is manageable and consistent with previous studies.

This randomized, phase 2 trial shows that objective response rates and progression-free and overall survival are numerically inferior in patients who receive axitinib plus combined 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX-6) versus bevacizumab plus FOLFOX-6. Shorter treatment duration and more discontinuations because of adverse events observed in the axitinib arm suggest that vascular endothelial growth factor receptor tyrosine kinase inhibitors plus chemotherapy may be somewhat less well tolerated than bevacizumab plus chemotherapy.

The 3-year and 5-year rates of second primary malignancy are lower for patients with index squamous cell carcinoma of the oropharynx than for patients with index nonoropharyngeal cancer. In patients with squamous cell carcinoma of the head and neck, index cancer site and smoking status affect the risk and distribution of second primary malignancies.

This study of outcomes after either surgery or stereotactic ablative radiotherapy for patients with early-stage non-small cell lung cancer found that overall survival was correlated only with the Charlson Comorbidity Index, and that only tumor diameter was correlated with locoregional tumor control. These findings will increase clinical equipoise and facilitate patient inclusion into ongoing trials comparing both treatments.

Because germ cell tumors are rare in men aged ≥ 50 years, there is limited knowledge regarding the clinical characteristics and outcomes, including treatment tolerability in this population. This retrospective study provides important data on differences in histology and primary tumor site distribution for older versus younger men and details the increased rate of complications that occur in older men with germ cell tumors who are treated with chemotherapy.

AR and its phosphorylation at serines 213 and 650 are differentially expressed in breast cancer tumorigenesis and progression. Phosphorylation of AR at serines 213 and 650 is increased in ER-negative breast cancers, ductal carcinomas, and metastases and may have predictive value in breast cancer prognosis.

Mammography rates in the United States did not decrease among women aged >40 years after publication of the US Preventive Services Task Force recommendations in 2009. It appears likely that the vigorous policy debates and coverage in the media and medical literature impacted the adoption of these recommendations by patients, providers, or both.

The authors report on a phase 2 trial investigating sorafenib as treatment for progressive epithelioid hemangioendothelioma. Two partial responses (in 2 of 15 patients) are observed, and the 9-month progression-free rate is 38.4% (4 of 13 patients).

Nurse navigation was found to significantly shorten time to consultation for breast cancer patients older than 60 years. Further studies are indicated to assess the long-term effects and durability of this quality improvement initiative.

Crizotinib therapy rapidly reduced total testosterone levels in 84% of men studied (27 of 32), reflecting decreases in both gonadotropins and in testosterone-binding proteins. Free testosterone was low in 76%, with the majority (84%) manifesting symptoms of androgen deficiency and more than half experiencing benefit from testosterone replacement.

In patients with resected, HER2-positive, early stage breast cancer, a baseline body mass index of ≥25 kg/m² is associated with a lower 5-year disease-free survival. Adjuvant trastuzumab leads to an improvement in disease-free survival for all patients, regardless of their body mass index.

Compared with the general population in Ohio, individuals with mental illness experienced excess mortality from cancers, possibly explained by a higher prevalence of smoking, substance abuse, and chronic hepatitis B or C infections in individuals with mental illness, but also by hindered access to care.

Uterine serous carcinomas represent an aggressive variant of endometrial cancer that overexpress tubulin-β-III relative to ovarian serous carcinomas. Among patients with advanced-stage disease, tubulin-β-III overexpression by quantitative real-time polymerase chain reaction or immunohistochemistry stratifies patients who are simultaneously at risk of reduced overall survival after platinum/taxane combination chemotherapy and likely to respond to epothilones.

After the enactment of policies designed to improve access to breast reconstruction, overall rates of postmastectomy immediate breast reconstruction increased. Medicaid and Medicare patients saw the greatest relative rise in rates of immediate breast reconstruction, yet their likelihood of undergoing immediate breast reconstruction still remain low compared with privately insured patients.

To assess incidence patterns and trends in the era before human papillomavirus (HPV) vaccination, the authors describe the incidence of preinvasive and invasive potentially HPV-related neoplasms in the US population during 1978 to 2007. Notable findings include the rising incidence of HPV-related head and neck cancers among white males and the exponential increase in incidence of preinvasive and invasive anal tumors by sex, age, and racial/ethnic groups, supporting an urgent need for vaccination given the absence of effective screening modalities for tumors at these sites.

This progress report verifies that concurrent chemoradiotherapy plus adjuvant chemotherapy provides significant survival benefits over radiotherapy alone in patients with stage III to IVB nasopharyngeal carcinoma from endemic regions of China, and combined treatment induces more acute toxicities but does not increase late toxicities apart from cranial neuropathy, peripheral neuropathy, and ear damage.

In postmenopausal women initiating aromatase inhibitors (AI) for adjuvant hormonal treatment of early-stage breast cancer, arthralgia (joint pain) trajectories diverge in comparison with the background rate at 6 weeks following AI initiation, and arthralgia worsens over a year following the divergence. Menopausal symptom severity and existing joint conditions at AI initiation should be assessed in women initiating AI to identify patients at risk for later new or exacerbating arthralgia.

UGT2B17 and UGT2B28 are 2 of the most commonly deleted genes in the human genome and are metabolizers of environmental and endogenous compounds. This study found that the UGT2B17 gene deletion is associated with decreased colorectal cancer risk, suggesting a protective function for UGT2B17 gene, because individuals without the gene may have higher circulating levels of flavonoids and nonsteroidal anti-inflammatory drugs.

Racial differences in prostate cancer care are well-documented, but few studies characterize patients based on their prostate cancer risk category. In medical record analysis of a population-based sample of men from North Carolina who had newly diagnosed prostate cancer, receipt of guideline-concordant care did not differ by patient race after multivariable analysis.

Cigarette smoking is associated with engagement in other modifiable risk factors in patients with head and neck cancer, yet self-report measures may not accurately depict true smoking status. Regular screening and targeted interventions for these behaviors are warranted.

To the authors' knowledge, this population-based study (n = 1809) is the first systematic exploration of the use and need for psychosocial support in patients with minor children, providing a comprehensive understanding of family-relevant and child-relevant concerns and distress for these patients. The findings suggest that parental cancer should be considered in adult health care planning and psychosocial clinical services.

The editorial puts into perspective the results of the study by Tichelli et al, given its study limitations, and provides insights how best to translate the findings into clinical practice. It ends by giving arguments for conducting a clinical trial to address some of the risk factors that may have led to increased suicide and accidental deaths after hematopoietic stem cell transplantation.

Molecular prognostic factors will be helpful in identifying patients with colorectal cancer who will benefit from adjuvant therapies, thus leading to an improved prognosis. Zinc finger protein 148 (ZNF148) expression may be used as a significant prognostic factor after surgery in patients with colorectal cancer.

The results from this retrospective analysis indicate that pretreatment squamous cell carcinoma antigen (SCCAg) levels in patients with squamous cell carcinoma of the anal canal and margin correlate with clinical tumor classification and lymph node status. In addition, elevated pretreatment levels of SCCAg are associated with a reduced chance of achieving a complete response and an increased chance of recurrence and death.

Among 209 siblings of children with cancer, higher distress is associated with more family functioning problems, higher parental psychological control, and lower parenting acceptance. When family risk factors are considered in combination, the results support a quadratic model in which associations between family risk and sibling distress are stronger at higher levels of risk.

Close margins alone in the absence of additional adverse features do not warrant postoperative adjuvant radiotherapy for patients with oral squamous cell carcinoma. In this study, the local control rate among patients who undergo surgery alone is 91%.

Patients with triple-negative breast cancer reportedly have a high rate of locoregional recurrence (LRR), but data are limited on the patterns of recurrence and prognostic factors of LRR specific to early stage triple-negative breast cancer. In a retrospective analysis of a large series of patients who had triple-negative breast cancer with pathologic T1/T2 tumors and N0/N1 lymph node status who underwent modified radical mastectomy without postmastectomy radiotherapy, several risk factors are identified that correlate independently with LRR, which will aid decision making for locoregional therapy in this specific population.

Acupuncture, an ancient medical therapy, might be the latest treatment for breast cancer–related lymphedema (BCRL). In this review, you will learn about diagnostic assessments, risk factors, complete decongestive therapy, and the potential role of acupuncture for BCRL.

Acupuncture for breast cancer–related lymphedema appears safe and may reduce arm circumference. Although these results await confirmation in a randomized trial, acupuncture can be considered for women with no other options for sustained arm circumference reduction.

Therapeutic options for patients with recurrent multiple myeloma after autologous stem cell transplantation (ASCT) include novel agents, conventional chemotherapy, or salvage ASCT with no standard of care. In the current study, the authors demonstrate that the use of lenalidomide and bortezomib for reinduction has improved the results after salvage ASCT in 200 patients, suggesting that novel agents and salvage ASCT are complementary rather than alternative treatment approaches

Metastatic tumor antigen 1 (MTA1) overexpression is closely associated with postoperative recurrence of hepatocellular carcinoma. The results from this study suggest that adjuvant pegylated interferon therapy may reduce the recurrence in patients who have MTA1-positive hepatocellular carcinoma after undergoing curative surgical resection.

This study shows that SAPK interacting protein 1 (SIN1) is overexpressed in hepatocellular carcinoma (HCC), and its overexpression correlates with a poor prognosis of HCC. Furthermore, the results demonstrate that SIN1 plays an important role in HCC invasion and metastasis by facilitating epithelial-mesenchymal transition.

Exposing outpatient cancer patients to 2 different videotaped patient–physician discussions regarding code status, one ending a do-not-resuscitate (DNR) discussion with a question and the other one with a recommendation, did not significantly impact patients' DNR decisions or perception of physician compassion, and therefore both approaches are clinically appropriate. A DNR order for the video patient was predicted by DNR decision for the patient themselves, older age, and being of white ethnicity.

To the authors' knowledge, this study is the first to examine the combination of S-1 (an oral fluoropyrimidine), carboplatin, and bevacizumab followed by maintenance therapy with S-1 and bevacizumab in chemotherapy-naive patients with advanced nonsquamous non–small cell lung cancer. The objective response rate is 54.2% (95% confidence interval, 39.2%-68.6%), and the median progression-free survival is 6.8 months (95% confidence interval, 4.3-8.2 months).

Cancer patients who have discordance between actual and preferred roles in treatment decision making report poorer physical health and poorer mood (anger, confusion, fatigue, and vigor) than their concordant counterparts. These results indicate the need to support patient preferences as the health care system moves toward patient-centric care.

The cumulative incidence of 6 preventable or screen-detectable cancers after transplantation is estimated using population-based data on 164,156 US transplantation recipients. High-risk subgroups are identified that may benefit from targeted screening or prevention, including thoracic organ recipients at the extremes of age for non-Hodgkin lymphoma, older thoracic organ recipients for lung cancer, and kidney recipients aged >35 years for kidney cancer.

The authors identify racial variation in the use of follow-up diagnostic care after an elevated prostate-specific antigen level among men aged <65 years in the screening arm of the Prostate, Lung, Colorectal, and Ovarian cancer screening trial. Such variation is paradoxical with respect to risk for prostate cancer and prostate cancer mortality, and it raises concern for differential access to care in men below the age of Medicare eligibility.

A report in this issue of Cancer on disparate follow-up of abnormal prostate-specific antigen (PSA) levels among younger black men in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial raises new concerns regarding the adequacy of evidence available to assess the balance of risk and harms of PSA-based screening for these men. Clinicians should analyze published screening recommendations with an understanding of the data gaps regarding this population, and shortcomings in the existing evidence base must be addressed.

The costs of cancer treatment were substantial in all states. The high cost of cancer treatment at the state level underscores the importance of preventing and controlling cancer as one approach to manage state-level medical costs.

The editorial puts into perspective the results of the study by Tichelli et al, given its study limitations, and provides insights how best to translate the findings into clinical practice. It ends by giving arguments for conducting a clinical trial to address some of the risk factors that may have led to increased suicide and accidental deaths after hematopoietic stem cell transplantation.

Emerging evidence suggests that cancer survivors spend two-thirds of their waking hours sitting. The authors of this commentary propose that sedentary behavior represents an important field of scientific enquiry for cancer survivorship, because prolonged sitting may contribute independently to adverse cancer outcomes (disease progression, recurrence, or death) and to the development of comorbid chronic disease.

This Web-only perspective commentary discusses a new class of monoclonal antibodies that have garnered tremendous enthusiasm within the field of cancer immunotherapy, which has previously been hampered by complex, cumbersome agents and cells; individualized and laborious preparations; and questionable clinical efficacy.