Beth Fand Incollingo

Patients with cancer who contract COVID-19 were not more likely to get severely ill or die from the virus than people who do not have cancer, a recent study showed.

Across all patients in the study, only age and obesity were associated with worse COVID-19 outcomes.

Because patients who have received recent treatment for cancer are likely to be immunocompromised, the question of whether they are more susceptible to dire complications of COVID-19 has been the subject of numerous studies over the last eight months, with mixed results.

By shedding more light on the issue, the results of this latest research could be meaningful in helping patients and their doctors make treatment decisions, according to its authors, a team from Weill Cornell Medicine/NewYork-Presbyterian.

“This finding suggests that a diagnosis of active cancer alone and recent anticancer therapy do not predict worse COVID-19 outcomes, and therefore, recommendations to limit cancer-directed therapy must be considered carefully in relation to cancer-specific outcomes and death,” the study authors wrote in their paper published in the 

. “Our results suggest that patients with cancer with limited comorbidities (additional health conditions) may continue their cancer care with caution.”

The study looked retrospectively at data about patients admitted to two of the health system’s hospitals for COVID-19 treatment between March 3 and May 15, 2020.

It included 585 adults with COVID-19 (median age, 71 years; 55% men), 117 of whom had either a blood cancer or a solid tumor (18.8% genitourinary, 16.2% gastrointestinal, 16.2% chronic leukemia and 12.8% breast). Patients with cancer received treatment or were under active surveillance within six months of entering the hospital. Nearly half of the patients with cancer were receiving therapy, with 45% of them having received chemotherapy or immunosuppressive treatment within 90 days of admission, the study authors reported. Each patient with cancer was matched, for the sake of comparison, with four patients who had COVID-19 without cancer. The patients compared with each other were similar in age, gender and the number of other health conditions they had, such as diabetes, asthma, obesity and hypertension.

The researchers found that symptoms upon diagnosis with COVID-19, as well as complications encountered while in the hospital such as admission to the intensive care unit or use of a ventilator, were similar between the cancer and noncancer groups. There were no statistically significant differences in the levels of sickness or death between patients with and without cancer. The researchers recorded 29 deaths (24.8%) among hospitalized patients with cancer compared with 100 deaths (21.4%) among patients without cancer.

They suggested that earlier studies linking cancer and its treatments to worse COVID-19 outcomes were flawed because they failed to take into account age, gender and other health conditions contributing to worse outcomes. They noted, however, that the reason other health conditions were not linked with poor COVID-19 outcomes in their study could have been because most patients had few health issues besides the virus and cancer. The study authors added that it was difficult for them to evaluate the role of ethnicity or smoking in COVID-19 outcomes, as the patients in their study were largely white and nonsmokers. Finally, many of the patients with chronic myeloid leukemia were taking Bruton’s tyrosine kinase inhibitors to treat the cancer, which are anti-inflammatory, and could have contributed to their recovery from COVID-19, the authors pointed out.

Nevertheless, the researchers believe their findings should have a bearing on care decisions for patients with cancer.

“During the COVID-19 pandemic, we may be able to deliver anticancer care safely to patients who are younger with limited comorbidities,” the study authors wrote. “We may consider a more conservative approach in older patients with metastatic cancer and multiple comorbidities, for whom the efficacy of continued lines of therapy may be limited. Conversely, we would consider cautious continuation of therapy in patients with fewer comorbidities and in whom therapy is associated with significant benefit.”

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A retrospective study of patients with COVID-19 showed that those with cancer were not more likely to experience severe symptoms or death due to the virus than those without cancer. Rather, only age and obesity were associated with poor COVID-19 outcomes.

Cancer May Not Suggest Poor Health Outcomes After COVID-19, Study Shows

since the requirements for what’s included on nutritional labels had been updated. Because our eating habits and understanding of dietary health have changed quite a bit since then, the Food and Drug Administration (FDA) recently updated its format for the labels attached to nearly all foods sold in the United States.

The FDA published its final rule on the subject in 2016, and by January of this year, most major food manufacturers were in compliance. Smaller food manufacturers have until January 2021 to start using the new labels. Jill Reedy, chief of the Risk Factor Assessment Branch in the National Cancer Institute’s Division of Cancer Control and Population Sciences, contributed to some of the research that helped inform the Dietary Guidelines for Americans, which serves as the basis for information on the labels and prompted some of the changes.

“It was really time to update that food label for consumers,” says Reedy, who holds a doctorate in nutrition and a master’s degree in public health. “Now there’s updated science, nutrition and public health information, including updated dietary guidance.”

, Reedy shared more about what shoppers will see on food labels and why.

CURE®: What is the main goal of the changes?

: The goal is to ensure that the nutrition facts label is aligned with the science about diet and its impact on health — because the label has been and will continue to be a key tool that helps consumers follow the Dietary Guidelines for Americans and make better-informed food choices. 

The guidance that we have from the dietary guidelines recommends a healthy dietary pattern that includes and encourages foods like fruits, vegetables, whole grains, low-fat dairy and a variety of lean proteins, and limits and constrains foods that are high in added sugars, saturated fats and sodium. And so, some of these recent changes to the food label, like the inclusion of added sugars, tie back to research that’s been done to understand the relationship between diet and health outcomes, including cardiovascular disease and cancer. It’s exciting to see an updated food label that reflects that current science for overall health promotion and disease prevention, including cancer prevention.

Have there been any changes in what constitutes a serving of a food?

How much Americans eat and drink have changed since that previous food label over 25 years ago. One example ... is the reference amount that’s used to set a serving. For example, a serving of ice cream used to be half a cup on the food label, and now it’s two-thirds of a cup. And the reference amount for a soda used to be 8 ounces and now is 12 ounces on the food label. The serving sizes that are included on the label have to be based on the amount of food and beverages that people are actually consuming, not what’s recommended that they should be eating.

As far as vitamins and minerals, what has been added and deleted from the nutritional label?

We now see vitamin D and potassium as new things listed on the updated food label. They’re included because of data (showing) that Americans don’t always get enough (of them). We will still see calcium and iron on the food label; those were there before. What we won’t see are vitamins A and C. Those are no longer required on the food label because most Americans are consuming enough of those.

What are the changes on the labels regarding sugar?

To follow a healthy dietary pattern, the recommendation is to limit calories from added sugars to less than 10% of total calories per day. We know from our data looking at the state of the American diet that we’re consuming too many calories from added sugars, and that makes it really difficult to meet our overall nutrient needs while staying within our calorie limits. Added sugars come from obvious sources like sugar-sweetened beverages, such as soda and sweetened coffees and teas. 

But then they are also in some packaged foods where we might not be thinking that there would be added sugars, like ketchup, spaghetti sauce or yogurt. That’s something we can now look at on the food label, and having that information can help increase our awareness and help us make choices to limit added sugars.

What is the Dietary Patterns Methods Project, and how did its findings contribute to this initiative?

Researchers have done a lot of research on this topic, with the goal of strengthening the evidence base for the dietary guidelines, and that includes the Dietary Patterns Methods Project. In that project, we looked at key quality indices, including the Mediterranean diet score, DASH (Dietary Approaches to Stop Hypertension) score, the Healthy Eating Index and the Alternative Healthy Eating Index. We used those indices to examine the dietary patterns of people who participated in three very large studies, the NIH-AARP (National Institutes of Health-American Association of Retired Persons) Diet and Health Study, the Women’s Health Initiative and the Multiethnic/Minority Cohort Study of Diet and Cancer. 

And we found very similar results across all three cohorts. People whose diets were consistent with any of these dietary indices had anywhere from an 11% to 28% reduced risk of dying from cancers, from cardiovascular diseases and from all causes combined. We also found that the healthier the diet based on these indices, the greater the reduction in the risk of dying, including from cancer. 

Relevant to the new, updated label is that higher intake of added sugars was associated with an increased risk for those negative health outcomes. So we can really see from this kind of analysis that a healthier diet, defined by any of these dietary patterns, is associated with better health outcomes.

What should people know about diet and lifestyle as they read the information on food labels?

We can consider information about each food through tools like the food label but also in the context of the overall dietary pattern. We also know that there are interrelationships with diet, physical activity, sleep and weight; these things are all connected. Diet, physical activity and obesity are all linked to many cancers, and so our goal is to support and address all these behaviors because it’s not necessarily just one or the other. It’s all of those things together. And as part of that, the nutrition facts label and the dietary guidelines are great resources for the public.

How will people know about the changes to food labels?

To help people better understand the updated nutrition label, the FDA has developed a really comprehensive public education campaign. They have videos and a lot of other helpful information on their website that folks can access to answer specific questions, either for us as consumers or for us as health educators.

What percentage of Americans pay attention to food nutrition labels?

There are studies that look at this, and we see that the majority of Americans do read the food label. And studies show that those who are using the food label are more likely to consume more fruits and vegetables and fewer sodas. So more frequent use of the food labels is associated with better diet quality.

The science underlying the dietary guidelines and the food label comes from research that’s grounded in the idea of the total diet and dietary patterns. And it’s important for us to take this more holistic approach and look at dietary patterns — rather than only looking at an individual food or nutrient — as we think across our lifetime, and any person’s lifetime, because we know it’s not just one thing that we eat that can affect health. It’s really that totality of our diet. And the food labels are an important tool that we have to continue to improve our dietary patterns.

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Paying attention to the updated nutritional labels on food can help Americans stay within dietary guidelines and prevent illness, including cancer.

Reading Updated Food Nutrition Labels May Help People Adhere to Dietary Guidelines and Prevent Cancer

“My doctor told me that cancer treatment will add years to my life. After my first week of chemotherapy, I feel older already.”

Mark Kantrowitz knew there was nothing funny about receiving a diagnosis of testicular cancer two weeks after the birth of his son. But he believed in the healing power of laughter, and the passage of nearly 20 years hasn’t changed that. Hence, his latest book: “Tumor Humor: Cancer Jokes and Anecdotes,” published this year by Cerebly, Inc.

Kantrowitz started writing cancer jokes and posting them to his website while he was in treatment for the disease in 2003. Since then, the collection has grown. Some are corny puns that fall into the “dad joke” category. Others are more risqué. Kantrowitz advises those who are easily offended not to read his quips but hopes that, for most, they will help dispel stress and depression.

“Beware,” he writes, “cancer jokes are contagious.”

The 143-page book is set up in chapters. Having a bad experience in the infusion room? Read jokes about chemotherapy. Worried about your next needle stick? Read jokes about IVs and blood draws. The book includes silliness about nausea, dietary restrictions, hair loss, paperwork, money, oncology nurses, specific cancer types and more.

Along the way, Kantrowitz shares pieces of his own journey, which inspired much of the humor, and the text is punctuated with occasional cartoons by Jerry King. Kantrowitz discusses being strapped in for scans that lasted hours, receiving test results, living with chemotherapy’s side effects, and enduring hospital parking problems and the things people say.

“One time I was talking to a young man about my cancer experience and he exclaimed, ‘Did you survive?’ to which I replied, ‘Well, I am standing here talking to you, aren’t I?’” Kantrowitz recalls in the book.

He adds that, “One acquaintance said, ‘Good luck on your double vasectomy.’ I think they meant to say mastectomy, but I was having an orchiectomy. I was having my testicle removed, not my breasts. Seriously, dude.”

Kantrowitz also gives “helpful” advice to those with cancer who want to pull pranks on their caregivers, such as using a green glow stick to make it look like they’re radioactive after radiation therapy; eating 

beets, blackberries or asparagus to change the color of urine; and even convincing someone a glass of apple juice is a urine sample and then drinking it.

The book is a good place to turn for a giggle, even when your situation doesn’t seem to call for humor. “It can take your mind off the cancer,” Kantrowitz says, “at least for a little while.”

One man discovered that his experience with testicular cancer inspired jokes he could share with others.

One Man's Journey with Testicular Cancer Inspired Him to Share Jokes with Others

A recent promise by the Food and Drug Administration (FDA) to give an expedited review to the experimental drug MK-6482 as a treatment for renal cell carcinoma (kidney cancer) associated with von Hippel-Lindau (VHL) disease was an exciting development for people with VHL.

Granted a breakthrough therapy designation from the FDA, the HIF-2a inhibitor is the first medication specifically indicated for people with VHL, which causes masses, some of them malignant, to grow in any of 10 organs. The disease is caused by a mutation to the VHL gene.

MK-6482 interferes with the activity of the HIF-2a protein, which — in the absence of a properly working VHL gene — accumulates, leading to the formation of tumors.

Because it’s a rare condition that affects about 10,000 people in the United States and 200,000 worldwide, VHL is not widely understood or recognized. CURE® spoke with Joshua Mann, director of engagement and outreach for the nonprofit VHL Alliance (vhl.org), to learn more.

CURE®: Please tell us a little bit about VHL.

: Von Hippel-Lindau disease is a rare hereditary tumor predisposition syndrome. It’s caused by a mutation in the VHL gene, which normally prevents tumor growth. This mutation can cause tumors to grow and develop in up to 10 different organs repeatedly throughout a patient’s lifetime. There’s no cure, and the best practices for treatment involve invasive surgeries that can be dangerous, painful and expensive. VHL runs in families, but it’s not restricted or predominant to any particular demographic. Its prevalence is about 1 in 36,000.

Not strictly. Approximately 80% of people who have the disease inherited it from a parent. Every child of a parent with VHL has a 50% chance of inheriting the disease. The other 20% of people with VHL have it as a result of a random genetic mutation that occurred soon after fertilization during the early human cell- division process.

In people with VHL, tumors may develop in up to 10 different parts of the body, including the brain, spine, eyes, ears, kidneys, adrenals, pancreas, lungs, liver and reproductive organs. All of these tumors involve the abnormal growth of blood vessels. Most of the tumors are benign, meaning they won’t spread to nearby organs. However, VHL tumors in the kidneys, adrenals and pancreas can grow to a stage where they become malignant, which is when the cancer can spread to other parts of the body.

It’s also important to mention that just because some of the tumors associated with VHL are benign does not mean that they aren’t serious or dangerous. Brain and spinal lesions can lead to extreme pain and permanent disability, and retinal tumors can lead to blindness. VHL is different in every patient, even in the same family. Since it’s impossible to predict exactly which VHL manifestations each person will have, and at what age, it’s important to continue to check for all the possibilities throughout a patient’s lifetime.

How can people find out they have VHL if no one else in their family has it?

Oftentimes, it happens that a manifestation of the disease comes out that’s unexplained any other way, and then the patient is sent for genetic testing. The rule of thumb is that, when any of the features of VHL are found, a diagnosis of VHL should be considered and a full diagnostic evaluation of all the other areas of the body should be carried out.

The only conclusive way to diagnose VHL is through a genetic test. Anybody who thinks they might have VHL in their family should see a genetic counselor. It is estimated that no DNA mutation or deletion can be found in approximately 10% of people who are clinically diagnosed with VHL. These people still have VHL and should begin a surveillance protocol.

Are there any preventive measures people can take if they know they have the disease?

To prevent some of the worst outcomes associated with the disease, the best thing people can do is be vigilant about active surveillance and always work with VHL-experienced specialists. Other than that, having a healthy diet and an active lifestyle, not smoking and moderating alcohol intake are things that can be done to contribute to overall good health.

What does active surveillance look like throughout an affected person’s lifetime?

Surveillance is the first line of defense in preventing the worst aspects of the disease, and it should begin as soon as there’s a diagnosis, before symptoms appear, to make sure that any issues are found early and treated at the best time to ensure long-term health.

The VHL surveillance guidelines include an annual eye exam with a retinal specialist and a complete physical exam. At age 5 begins an annual urine collection or blood testing for pheochromocytomas, which are associated with tumors in the adrenal glands. Starting at age 11, patients will get an annual hearing test by an audiologist, as well as imaging of the brain and spine every two years.

Then around age 15, they will begin getting an MRI of the abdomen every two years to check their pancreas and kidneys. It’s certainly an ongoing endeavor. If anybody’s interested in learning about the specific details of the surveillance guidelines, you can find them 

What are your thoughts on the development of MK-6482?

We are extremely excited by the designation of MK-6482 as a breakthrough therapy by the FDA. If approved, it would be the very first medication specifically for VHL. This offers a lot of hope to the VHL community, as it could mean, one day, an alternative to these repeated, dangerous and painful surgeries.

It’s also exciting because the VHL Alliance’s vision is curing cancer through VHL. Advanced treatments and a cure for VHL are going to have major implications not just for patients with VHL, but also for the general population. For example, renal cell carcinoma is a major disease that affects many people, and by finding a cure for VHL and improved treatments for its manifestations, we’re going to be able to cure renal cell carcinoma. It starts with research at the basic level, and that’s why supporting VHL research is so crucial.

In fact, the 2019 Nobel Prize in Physiology or Medicine was awarded to three doctors including Dr. William Kaelin Jr., a VHL researcher. The reason we have MK-6482 today is because of that research. I think the world is finally starting to see the importance of medical research with the VHL gene.

What were the origins of the VHL Alliance?

The VHL Alliance was founded in 1993 by three families affected by VHL. This was done in the pre-internet era when people had limited means to connect and share information, so this was a vital service for those who had this disease that not much was known about. Since then, we’ve grown significantly. We have an international network of VHL clinical care centers capable of providing coordinated care by VHL-experienced specialists, and we have an enormous reach online and via social media, engaging with thousands of patients and families annually from all over the world.

We’ve also put a major emphasis on research, developing an in-depth, longitudinal online patient registry called MyVHL, as well as awarding over $2.3 million in research grants. We are the largest provider of research grants specifically for VHL in the world. Recently, we have been active in lobbying Congress to support spending on rare diseases and have participated in FDA listening sessions to share firsthand the importance of VHL research, clinical trials and the development of non-invasive treatment alternatives.

Are there any special projects on the horizon for the group?

We are in the final stages of publishing an updated VHL handbook with information about research and best practices and details of the disease. And we recently had a task force of top VHL experts in different specialties that put together updated surveillance guidelines based on a literature review, from which a manuscript will be published soon. We’re also focusing on addressing the needs of marginalized populations to make sure that everyone in the VHL community has access to quality care.

In October, we’ll have two huge online events. One is our Annual Family Weekend Oct. 23-25, where we bring families impacted by VHL together to talk with doctors and each other for support and to learn what can be done to better support the community. Our biennial Research/Medical Symposium will be Oct. 29-31. We’ll bring together top VHL researchers and physicians from all over the world to discuss what’s going on in research and see where we can capitalize on improvements and things that we’ve learned. We’re very excited about the great things that are going to come out of it.

How has the COVID-19 pandemic affected your organization?

The biggest impact that the COVID-19 pandemic has had on our organization was transitioning our Annual Family Weekend and biennial Research/Medical Symposium from being large, well-attended, in-person events into remote, digital events. Over the past seven months, we’ve put a focus on bringing our community together digitally.

We created an initiative called Surviving and Thriving Together, which consisted of several dozen live videos on Zoom and Facebook where patients, family members and caregivers had a chance to interact and support each other. At other events, they had a chance to learn more about their doctors, advances in research and our staff. The end goal was to make sure that everybody felt a sense of community.

The FDA is reviewing what could become the first-ever medication specifically for kidney cancer associated with von Hippel-Lindau disease. 

Beth Fand Incollingo | Contributors

Cancer May Not Suggest Poor Health Outcomes After COVID-19, Study Shows

Reading Updated Food Nutrition Labels May Help People Adhere to Dietary Guidelines and Prevent Cancer

One Man's Journey with Testicular Cancer Inspired Him to Share Jokes with Others

Promising Drug Puts Focus on Rare Condition That Can Lead to Growth of Tumors, Cysts

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