Cate Douglass

Shorter and more intense radiation for early stage prostate cancer can be performed without compromising cancer control, according to a recent study.

Currently, the standard regimen lasts eight weeks to treat the cancer; however, the study, conducted by a team of researchers at the Duke Cancer Institute, shortened that therapy to 5.5 weeks.

The study involved 1,100 men who had been diagnosed with early-stage prostate and compared two treatment regimens to determine whether the cure rates were similar.

Half of the men were randomly assigned to receive either the 5.5-week schedule that provided 28 hypofractionated radiotherapy (H-RT) treatments and the other half was assigned to the standard eight-week regimen control arm, which consisted of a total of 41 conventional radiotherapy (C-RT) treatments.

Researchers found that the five-year disease free survival (DFS) rate was about 85.3 percent for men in the eight-week trial and 86.3 percent in the 5.5-week program. Additionally, overall survival (OS) was also no different between the groups, 93.2 percent and 92.5 percent, respectively.

“This study has implications for public policy,” said lead study author W. Robert Lee, a professor in the Department of Radiation Oncology at Duke, in a statement. “Because the shorter regimen has advantages such as greater patient convenience and lower costs, it’s important to establishing whether we can cure as many patients with the shorter regimen. Our study provides that information for the first time.”

One potential drawback of the H-RT regimen, however, is slightly higher side effects in patients. The study’s authors reported mild gastrointestinal and genitourinary toxicity was observed more frequently in patients getting the higher daily dose, shorter frequency radiation. However, no differences were observed in more severe side effects, which were occurred less than 5 percent with either regimen. The study also noted that data on patient experience with side effects are still being analyzed. 

"An estimated 220,000 men are expected to be newly diagnosed with prostate cancer each year in the United States, and the majority will have early-stage disease at low risk for recurrence,” Lee noted. “These findings should help guide clinical decisions, and doctors should be comfortable recommending a shorter radiotherapy course as an alternative to the conventional schedule.”

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Patients with early-stage prostate cancer may be able to shorten their radiation time, thanks to the results of a recent study conducted by the Duke Cancer Institute. 

Shorter Radiation Therapy Effective and Tolerable in Early-Stage Prostate Cancer

Treatment for patients with ductal carcinoma in situ (DCIS) is getting more individualized, thanks to a team of researchers at Brigham and Women’s Hospital (BWH) and the Dana-Farber Cancer Institute.

The researchers discovered a set of three measurable risk factors that can help predict survival benefits that radiation therapy would offer after breast-conserving surgery for DCIS.

“Radiation therapy after breast cancer surgery has become a widely accepted treatment option for patients undergoing breast-conserving therapy with DCIS. Our results provide information that can guide individual treatment options and better predict survival benefit from radiation therapy based on an individual’s case,” Mehra Golshan, one of the study’s senior authors, explained in a statement.

Golshan, the Al-Tuwaijri Family Distinguished Chair of Surgical Oncology at Dana-Farber/Brigham and Women’s Cancer Center, and colleagues analyzed SEER data from 32,144 patients diagnosed with DCIS between the years 1988 and 2007.

Of this group, 20,329 patients were treated with radiation therapy following breast cancer surgery and the remaining 11,815 only underwent breast cancer surgery. At the conclusion of their retrospective, longitudinal, NIH-funded study, the research team found low cancer mortality rates at 10-years for both groups: 1.8 percent for patients who received radiation therapy and 2.1 percent for those who did not receive the therapy. There were 304 breast cancer—specific deaths overall.

Each patient was assigned a validated prognostic score using a 0-6 scale based on three risk factors: nuclear grade, patient’s age and tumor size. A higher nuclear grade, younger age, and/or larger DCIS received a higher score and vice versa.

They found that radiation therapy resulted in a significant survival benefit for patients with higher scores. Patients who scored a four or five on the prognostic tests displayed a 70 percent reduction in breast cancer mortality if they were treated with radiation therapy after surgery. Patients with lower scores from both the radiation and surgery-only cohorts showed no significant difference in breast cancer mortality.

Although DCIS results in low cancer mortality overall, officials estimate that nearly 60,000 of Americans will be diagnosed with DCIS in 2016 — a rate that has tripled in the past three decades.

“Using three factors that are routinely measured, we can predict whether there will be a survival benefit or no survival benefit for patients receiving radiation therapy,” lead author Yasuaki Sagara, of the BWH Department of Surgery and Dana Farber/Brigham and Women's Cancer Center, said in a statement. “Our finding suggests, for the first time, that patients with more aggressive cancer who are at higher risk may actually live longer if they are treated with radiation therapy.”

Nonetheless, study investigators advised thorough counseling about the benefits and risks of radiation therapy for patients with DCIS who are seeking treatment options.  

 Sagara Y, Freedman RA, Vaz-Luis I, et al. Patient prognostic score and associations with survival improvement offered by radiotherapy after breast-conserving surgery for ductal carcinoma in situ: a population-based longitudinal cohort study. J Clin Oncol. 2016;34(11):1190-1196.

A team of researchers just discovered a set of risk factors that could help patients with ductal carcinoma in situ (DCIS) evaluate the potential benefits of radiation after breast-conserving surgery.

Radiation Benefit May Be Predictable for Patients With DCIS

Cancer Epidemiology, Biomarkers & Prevention 

points to a correlation between diets with a high glycemic index (GI) and the development of lung cancer in non-Hispanic whites. According to the study, people with the highest daily GI had almost a 50 percent higher risk than those in the lowest GI category. This suggests that diet can play a role in altering one’s risk of lung cancer.

GI is a measure of the quality of dietary carbohydrates, defined by how quickly blood sugar levels are raised following a meal. Glycemic load (GL), is a related measure of carbohydrate quantity.

The study is the largest to examine the relationship between GI and lung cancer and the first to examine this relationship in particular subgroups, including those who never smoked and those diagnosed with the squamous cell carcinoma (SCC) subtype of lung cancer.

“Diets high in glycemic index result in higher levels of blood glucose and insulin, which promote perturbations in the insulin-like growth factors (IGFs),” noted lead study author Stephanie Melkonian, a postdoctoral fellow at The University of Texas MD Anderson Cancer Center, in a statement. “Previous research suggests increased levels of IGFs are associated with increased lung cancer risk. However, the association between glycemic index and lung cancer risk was unclear.”

To further elucidate this relationship, the MD Anderson team surveyed nearly 1,905 patients with newly diagnosed lung cancer and 2,413 healthy individuals recruited from Kelsey-Seybold Clinics, a large physician group in the Houston area. Individuals reported their past dietary habits and health histories, including food frequency and portion size, through in-person interviews.

Participants were then divided into quintiles depending upon their answers. Those in the highest quintile of GI had a 49 percent increased risk of lung cancer versus those in the lowest quintile. Those in the highest quintile also had a 92 percent higher risk of developing SCC, but a less significant association was seen with developing adenocarcinoma.

Although tobacco use is the leading cause of lung cancer, among never-smokers in the highest quintile of GI, the researchers discovered that they were more than twice as likely to develop lung cancer as those in the lowest quintile. Among smokers, the risk was only elevated by 31 percent between the two groups.

GL was not associated with increased lung cancer risk for most patients, which the authors said suggests that it is the average quality, rather than quantity, of carbohydrates consumed which may impact lung cancer risk

The study also examined the impact of education, which is often related to socioeconomic status and has been linked with diet quality and smoking behaviors. Among participants with less than 12 years of education, those in the highest GI quintile had a 55 percent higher risk of developing lung cancer than those in the lowest quintile.

“Although smoking is a major, well-characterized risk factor for lung cancer, it does not account for all the variations in lung cancer risk,” said senior study author Xifeng Wu, professor of epidemiology at MD Anderson, in a statement. “This study provides additional evidence that diet may independently and jointly with other risk factors impact lung cancer etiology.”

“Traditionally, glycemic index is only emphasized for diabetes prevention and management. However, if the results from this study are confirmed, healthcare providers should be made aware of the link between glycemic index and lung cancer, so they can communicate with their patients and the public about dietary changes for lung cancer prevention,” Wu continued.

Wu also noted that as a retrospective study, one limitation of the research is errors in participants’ recall and reporting of dietary intake; additionally, the study did not include information on whether participants had existing diabetes, hypertension or heart disease.

The authors said that further research would be necessary to determine whether the association between GI and lung cancer carries over to other racial and ethnic groups.  

 Melkonian SC, Daniel CR, YeY, et al. Glycemic index, glycemic load, and lung cancer risk in non-Hispanic whites. Cancer Epidemiol Biomarkers Prev. 2016;25(3):532-539. 

A recent study pointed out that food intake may play a role in lung cancer, as people who had a diet with a higher glycemic index (GI) were at greater risk for developing the disease.

High Glycemic Index Diet Associated With Increased Risk of Developing Lung Cancer

Chemotherapy can have a number of side effects on patients with cancer, including chemotherapy-induced peripheral neuropathy (CIPN), which affects the majority of patients. According to a recent study by researchers at The University of Texas MD Anderson Cancer Center, the pain associated with this condition can be reduced by neurofeedback.

“Chemotherapy-induced peripheral neuropathy is very common in patients with cancer, and there is currently only one medication approved to treat it,” noted lead study author Sarah Prinsloo, PhD, in a statement. Prinsloo is an assistant professor of palliative, rehabilitation and integrative medicine at MD Anderson.

“I’m encouraged to see the significant improvements in patients’ quality of life after treatment. This treatment is customized to the individual, and is relatively inexpensive, noninvasive and non-addictive.”

The study, which was presented at the recent annual meeting of the American Psychosomatic Society, enrolled 71 patients who scored higher than three on the National Cancer Institute’s neuropathy rating scale. The majority of participants, 52 of them, were women with breast cancer; eight had a gynecologic cancer diagnosis, and the remaining 11 had other cancer types. The participants had an EEG and completed validated pain and symptom assessments, including the Brief Pain Inventory and the Pain Quality Assessment Scale, at baseline and after 10 weeks of treatment.

Patients were evenly randomized to either the neurofeedback arm or a waitlist control group. Neurofeedback is a method of brain training that induces neuroplasticity—the ability of the brain to form new connections and change existing ones.

For this study, researchers located the areas in the brain that contribute to the physical and emotional aspects of pain. With these identifiers, patients could modify their own brain activity through electroencephalogram (EEG) biofeedback, a device that tracks and records brainwave patterns through small metal discs with thin wires that are attached to the scalp and connect to a computer for results.

The group receiving neurofeedback engaged in 20 sessions of training where they played a computer game that rewarded them when they modified their brainwave activity in the affected area. Over time, they learned to modify the activity without an immediate reward from the game.

After the treatment, study participants had another EEG, and investigators noted that patients with CIPN exhibited specific and predictable EEG signatures that changed with the neurofeedback, which induced neuroplasticity to modulate brain activity and improve CIPN symptoms.

Participants also completed posttreatment symptom assessments to gauge changes in neuropathic pain. After controlling for participants’ baseline levels, pain was 3.5 with neurofeedback, versus 5.3 in the waitlist group; for numbness, levels were 2.9 and 5.6, respectively, and intensity (3.5 with the intervention versus 5.3 in the control arm). Overall, 73 percent of patients in the neurofeedback group experienced an improvement in pain and quality of life.

Prinsloo said that she found the findings to be statistically and clinically significant, and the results provide valuable information for better understanding neuropathic pain.

The researchers are planning a second study involving focused solely on patients with breast cancer who are experiencing neuropathic pain.

Prinsloo S, Novy D, Driver L, et al. Neurofeedback as treatment for chronic chemotherapy-induced peripheral neuropathy (CIPN). Presented at: American Psychosomatic Society Annual Meeting March 9-12, 2016; Denver, CO. Abstract 1567

Pain from chemotherapy-induced peripheral neuropathy may be able to be reduced using neurofeedback, according to a recent study.

Neurofeedback Reduces Pain Associated With Peripheral Neuropathy From Chemotherapy

Symptom burden and quality of life can be greatly affected by a patient's financial status, according to a recent study published by researchers at the Dana-Farber Cancer Institute that looked at patients newly diagnosed with lung or colorectal cancer.

, assessed any relationship between a patient’s financial strain and the symptoms and quality of life (QOL) the patient reported upon diagnosis—earlier time points than the focus than that of previous research.

“Most of the studies looking at financial stress look at what cancer does to your finances after diagnosis,” Christopher Lathan, MD, MS, MPH, lead author of the study and a thoracic oncologist at Dana-Farber, said in a statement. “We were interested in looking at what happens when you have 

, defined in our study as little or no savings at the time of your diagnosis, and how that factor can impact quality of life.”

Study participants were drawn from patients in the Cancer Care Outcomes Research and Surveillance study. Patients were asked about their experienced QOL, symptom burden and financial reserves four months after diagnosis, and survivors were interviewed at 12 months, using validated assessments, such as the Brief Pain Inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, and  the EuroQoL-5 Dimension scale to gage responses for QOL.

Forty percent of patients with lung cancer reported and 33 percent of patients with colorectal cancer reported having limited financial reserves equivalent to two months or less. When compared with patients who had more than 12 months of financial reserves, these financially-strained patients with either lung or colorectal cancer reported significantly more pain, greater symptom burden and poorer quality of life.

The investigators also reported that as a patient’s financial resources decreased, so did their well-being measures, and this relationship persisted in outcomes reported by survivors after one year.

In follow-up interviews conducted one year after the baseline assessments, researchers found that patients across both tumor types who initially reported greater financial strain at diagnosis to have worse overall health, impairment in activity level, more pain and more depression as compared with those with greater financial reserves.

“We found that patients who had financial distress at the time of diagnosis were more likely to have poorer outcomes in physical and mental quality of life measures, pain, and symptom burden. This effect persisted after adjusting for stage of disease, co-morbidity, income, age and insurance,” Lathan added.

Study investigators hope that these findings will prompt healthcare professionals to evaluate patients for signs of financial distress at the time of initial diagnosis. Additionally, the research team urged clinicians to seek the appropriate resources and treatment options for patients who are already struggling financially before diagnosis.

Lathan C, Cronin A, Tucker-Seeley R, et al. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer [published online ahead of print February 29, 2016]

According to a recent study, financial distress can affect a newly diagnosed patient's overall well-being and quality of life. 

Cate Douglass

Shorter Radiation Therapy Effective and Tolerable in Early-Stage Prostate Cancer

Radiation Benefit May Be Predictable for Patients With DCIS

High Glycemic Index Diet Associated With Increased Risk of Developing Lung Cancer

Neurofeedback Reduces Pain Associated With Peripheral Neuropathy From Chemotherapy

Financial Status Affects Quality of Life of Newly Diagnosed Patients

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