CA: A Cancer Journal for Clinicians最新文献

Increased attention to the rehabilitation needs of children with cancer is vital to enhance health, quality-of-life, and productivity outcomes. Among adults with cancer, rehabilitation recommendations are frequently incorporated into guidelines, but the extent to which recommendations exist for children is unknown. Reports included in this systematic review are guideline or expert consensus reports containing recommendations related to rehabilitation referral, evaluation, and/or intervention for individuals diagnosed with cancer during childhood (younger than 18 years). Eligible reports were published in English from January 2000 to August 2022. Through database searches, 42,982 records were identified; 62 records were identified through citation and website searching. Twenty-eight reports were included in the review: 18 guidelines and 10 expert consensus reports. Rehabilitation recommendations were identified in disease-specific (e.g., acute lymphoblastic leukemia), impairment-specific (e.g., fatigue, neurocognition, pain), adolescent and young adult, and long-term follow-up reports. Example recommendations included physical activity and energy-conservation techniques to address fatigue, referral to physical therapy for chronic pain management, ongoing psychosocial surveillance, and referral to speech-language pathology for those with hearing loss. High-level evidence supported rehabilitation recommendations for long-term follow-up care, fatigue, and psychosocial/mental health screening. Few intervention recommendations were included in guideline and consensus reports. In this developing field, it is critical to include pediatric oncology rehabilitation providers in guideline and consensus development initiatives. This review enhances the availability and clarity of rehabilitation-relevant guidelines that can help prevent and mitigate cancer-related disability among children by supporting access to rehabilitation services.

Despite their elevated risk for developing cervical, oropharyngeal, and other human papillomavirus (HPV)–related cancers and the strong and consistent evidence for the HPV vaccine’s safety and efficacy, many young cancer survivors reject this vaccine. In a new study appearing in Cancer, researchers from Emory University School of Medicine and the Aflac Cancer & Blood Disorders Center (both in Atlanta, Georgia), the University of Alabama at Birmingham, and St. Jude Children’s Research Hospital (Memphis, Tennessee) investigate the reasons that many young survivors are rejecting this vaccine (doi:10.1002/cncr.34521).

Senior study author Wendy Landier, PhD, a professor in the Division of Pediatric Hematology/Oncology and deputy director of the Institute for Cancer Outcomes and Survivorship at the University of Alabama at Birmingham Marnix E. Heersink School of Medicine, says that this is the first study to systematically characterize reasons for HPV vaccine refusal by a large group of young cancer survivors (or their parents).

HPV vaccine–naive childhood, adolescent, and young adult cancer survivors were invited to participate in an open-label clinical trial conducted from January 12, 2013, and October 5, 2018, that evaluated the immunogenicity of the vaccine and safety of a quadrivalent HPV vaccine. According to Dr Landier, “We methodically recorded study refusal reasons in real time for those declining participation.”

Two researchers independently reviewed these reasons for refusal and developed coding lists for primary and secondary reasons for declining the vaccine. Four of the study researchers then developed the final categories of reasons for refusal. Associations of these various reasons with participant characteristics, including sex, race/ethnicity, cancer diagnosis, and age, were examined to help guide clinicians in improving adherence with vaccine guidelines.

Of the 755 survivors eligible to participate in the study of vaccine safety and efficacy, 301 (39.9%) declined to participate. Among those who declined, 86 survivors or their parents (28.6%) cited reasons unrelated to the HPV vaccine. For example,

some said that they simply were not interested or were uncomfortable with taking part in any research study or had concerns about the needle sticks required for study-related blood draws, or they mentioned “logistical concerns.”

The 215 survivors or their parents who refused clinical trial participation for vaccine-related reasons became the focus of this study. Approximately 75% (75.3%) were non-Hispanic White, 53.0% were male, and 54.9% had had leukemia or lymphoma. The ages of the survivors ranged from 9.0 to 26.9 years; the median age at which they were first offered study participation was 14.2 years. The survivors had completed cancer therapy 1–5 years (median, 2.8 years) before they were offered the study.

In light of these findings, the study authors suggest that better distress screening access and improved availability of psychosocial support for at least the most vulnerable high-risk patients with cancer, both before and after surgery, are urgently needed to reduce the risks of suicide in this patient population.

The study appears in JAMA Oncology (doi:10.1001/jamaoncol.2022.6549).

Study author Chi-Fu Jeffrey Yang, MD, a thoracic surgeon at Massachusetts General Hospital and an assistant professor of surgery at Harvard Medical School in Boston, says that previous studies reported that the risk of suicide is higher among patients diagnosed with cancer. “However, the risk of suicide among patients undergoing cancer operations was largely unknown.”

According to the researchers, the study had three goals: to determine how common suicide is among patients with cancer who have been treated with surgery, to discover when suicide is most likely relative to the time of cancer operations, and to identify clinical and demographic clues to help clinicians to recognize patients likely to commit suicide after surgery.

For the study, researchers culled cancer incidence, treatment, and cause-specific mortality data (including suicide data) between the years 2000 and 2016 from 18 population-based US registries of the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Patients with more than one type of cancer were excluded, they wrote, “to avoid potential biases resulting from the

influence of past or future cancer diagnoses on suicide risk.”

They identified more than 1.8 million (1,811,397) adult patients with cancer who had surgery for one of 15 solid-organ cancers. Seventy-four percent of the subjects were women, and the median age was 62 years. The researchers calculated standardized mortality ratios (SMRs) to compare suicide rates of patients in the cohort with suicide rates in general in the United States.

In addition, they used both unadjusted analyses and multivariable Fine–Gray competing risk models to examine whether patients’ risk of suicide was associated with their year of death or with any clinical characteristics (cancer type and stage and cohort-level 5-year survivor for each cancer type) or demographic characteristics (gender, marital status, race, and age).

During a median follow-up period of 4.6 years (range, 1.7–9.0 years), the researchers found that 1494 patients (0.08%) committed suicide after undergoing surgery for cancer; this represents 14.5 suicides per 100 000 person-years, a rate much higher than the suicide rate in the general US population when it is adjusted by age, sex, race, and calendar year of death (SMR, 1.29). The 10 solid organ cancers examined in this study with suicide rates that are statistically significant relative to the general US population (adjusted by age, sex, race, and calendar year of death), in SMR result order, are as follows: la

The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long-term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1–T2N1M0 disease, (2) redefined stage IIIA as T3N0–N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.

A 63-year-old woman who was a former smoker with a past medical history of hypertension and gastroesophageal reflux disease initially presented with upper abdominal pain. Her family history was notable for breast cancer in her mother, lung cancer in her father, and renal cell carcinoma in her sister. An ultrasound showed a heterogenous mass in the left lobe of the liver measuring 8.7 × 7.0 × 5.1 cm that was abutting the common bile duct and concerning for a neoplasm (Figure 1A). On laboratory testing, her alpha fetoprotein (AFP) was elevated (15.7 ng/mL), carbohydrate antigen 19-9 (CA 19-9) was normal (<15 U/ml), and carcinoembryonic antigen (CEA) was slightly elevated (0.6 ng/ml). She underwent an ultrasound-guided biopsy that demonstrated cytokeratin 7 (CK7)-positive, poorly differentiated adenocarcinoma with nonmucinous gland formation and papillary architecture within sclerotic stroma. Given that the biopsy was positive for CK7 with negative hepatocellular (hepatocyte-specific antigen, arginase, glypican), CDX2, TTF1, and synaptophysin markers, the mass was diagnosed as an intrahepatic cholangiocarcinoma (iCCA). A computed tomography (CT) scan of the chest, abdomen, and pelvis did not show any extrahepatic metastatic disease but did show a central left hepatic lobe mass in segment 4a/4b that measured 7.7 × 6.7 cm with calcifications suggestive of iCCA (Figure 1B,C). A CT scan also revealed potential tumor thrombus within the middle hepatic vein and distal left portal vein branches, extrahepatic (periportal, gastrohepatic, peripancreatic, portacaval) lymphadenopathy, left intrahepatic biliary ductal dilation, and common bile duct dilation.

The patient was started on gemcitabine, cisplatin, and nanoparticle albumin-bound paclitaxel (nab-paclitaxel). After 3 months of chemotherapy, the patient's AFP increased to 43.8 ng/ml and her CA 19-9 increased to 21.4 U/ml. On repeat CT scan, the size of the tumor was stable, but there was suspected intraductal extension toward the central inferior aspect of segment 4b. Given her suboptimal response to chemotherapy, radiation oncology was consulted. Approximately 4 months after starting chemotherapy, the patient underwent yttrium-90 radioembolization (Y90 RE) to the left hepatic hemiliver and subsequently was resumed on a gemcitabine, cisplatin, and nab-paclitaxel regimen (Figure 2A). A CT scan 5 months after starting treatment and 1 month after Y90 RE demonstrated a stable left hepatic lobe mass with interval necrosis. However, this effect was mostly seen in the tumor in the left lobe of the liver, whereas there was still some residual arterial enhancement along the right side of the mass because where the tumor extended into the right lobe was not treated given concern of toxicity to the remaining liver. After nine cycles of chemotherapy and the Y90 RE treatment, re-staging CT scans did not demonstrate any metastatic disease, and the tumor in the left lobe of the liver had a seemingly good res

I first encountered CA: A Cancer Journal for Clinicians as a medical student. Back then, the American Cancer Society (ACS) printed hundreds of thousands of copies that were mailed (without any charge) to practicing physicians and dropped off by ACS volunteers at medical schools, with the goals of educating students about cancer and inspiring some of us to pursue careers in cancer-related specialties. I recall appreciating that the Society deemed medical students worthy of their attention. After carrying each issue in the pocket of my short white medical student coat for a few days (back when the journal was printed in a small, digest-sized format), I realized that I was unlikely to get beyond the first few pages anytime soon, so I carefully separated the journal pages and filed the articles in folders labeled by topic, wishing that someday I would be able to read them. (Note—foreshadowing alert).

After 2 decades of pathology residency, fellowship, academic pathology practice, and laboratory-based cancer research, this wish came true. A series of fortunate events led me to a staff position at the ACS national office, where one of my roles was reading CA: A Cancer Journal for Clinicians. Every article. At least twice. For more than 20 years.

The first message of this editorial is my retirement from the position of Editor. This role has been tremendously fulfilling and enjoyable, but it's time for some new ideas from someone else. By the time you read this I will be almost completely retired from my work with the ACS and looking forward to some other pursuits that, until recently, I haven't had time for.

More importantly, this editorial also gives me an opportunity for some reflection about this journal, to thank the people who are responsible for its success, and to introduce the incoming editor, Don Dizon, MD. It would be difficult to name all the distinguished contributors to CA during my tenure as Editor, so I apologize for any truncations in the lists below and for any omissions resulting from lapses in my memory. There are several individuals who have contributed to CA in more than one capacity, and many of them are included below on only one list (the one for which their role seems most significant or most memorable to me). I appreciate them all and extend my utmost gratitude for their expertise and time.

CA reaches a heterogeneous audience of clinical and public health professionals to provide information relevant to the entire cancer continuum, from prevention through survivorship and end-of-life care. Content includes educational review articles; ACS guidelines for cancer prevention and early detection; ACS summaries of the most recent data on cancer incidence, mortality, risk factors, and screening prevalence; virtual tumor board discussions; and brief news stories that offer perspectives on recent research. CA has always been free to access and remains free online witho

Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer is defined by the presence of the estrogen receptor and/or the progesterone receptor and the absence of HER2 gene amplification. HR-positive/HER2-negative breast cancer accounts for 65%–70% of all breast cancers, and incidence increases with increasing age. Treatment varies by stage, and endocrine therapy is the mainstay of treatment in both early stage and late-stage disease. Combinations with cyclin-dependent kinase 4/6 inhibitors have reduced distant recurrence in the early stage setting and improved overall survival in the metastatic setting. Chemotherapy is used based on stage and tumor biology in the early stage setting and after endocrine resistance for advanced disease. New therapies, including novel endocrine agents and antibody-drug conjugates, are now changing the treatment landscape. With the availability of new treatment options, it is important to define the optimal sequence of treatment to maximize clinical benefit while minimizing toxicity. In this review, the authors first discuss the pathologic and molecular features of HR-positive/HER2-negative breast cancer and mechanisms of endocrine resistance. Then, they discuss current and emerging therapies for both early stage and metastatic HR-positive/HER2-negative breast cancer, including treatment algorithms based on current data.

Study author Kelly D. Blake, ScD, director of the Health Information National Trends Survey (HINTS) and a health scientist in health communication and informatics research at the National Cancer Institute in Bethesda, Maryland, notes that it had been almost a decade since the last nationally representative assessment of public support for R rating designations by the Motion Picture Association (MPA) for movies with cigarette smoking. “Our study adds to prior assessments and suggests that public support among the general population of US adults is gradually trending upward, from 40% in 2003, to 45% in 2013, to 47% in 2020.”

The main goals of this study by National Cancer Institute researchers were to determine the proportion of adults who support, are ambivalent about, or oppose the depiction of smoking as a sufficient criterion for an R rating and to identify characteristics of study participants that were associated with their opinions on this issue.

The researchers used data from the 2020 HINTS, a National Institutes of Health–initiated national, cross-sectional postal survey of 3865 individuals at least 18 years old. This survey included an item that assessed support, opposition, and neutrality regarding the idea that “movies with cigarette smoking should be rated ‘R’ to protect children and youth from seeing cigarette smoking in movies.” Demographic data recorded in HINTS included each participant’s age, gender, and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, or non-Hispanic other); income; educational level; sexual orientation; geographic location; marital status; child status (whether a participant had children or not); and political leanings. They also asked participants about cigarette smoking and e-cigarette use (both classified as current, former, or never).

A slight majority of the participants were female (50.2%,), whereas more than half (58.7%) were non-Hispanic White. Current cigarette smokers and current e-cigarette users constituted 13.6% and 6.3% of the participants, respectively.

Overall, 20.3% strongly opposed or opposed a policy designating R ratings for movies containing cigarette smoking, 30.3% were neutral, and 47.0% supported or strongly supported this idea.

Using weighted, multivariable logistic regression models to identify characteristics associated with neutrality or opposition, with support as the referent category, the researchers found noteworthy differences by age and race/ethnicity. Older adults (at least 50 years old) were significantly less likely than the younger adults (18–34 years old) to be opposed to or neutral regarding smoking as an R rating criterion. For example, participants aged 50–64 years were only 56% as likely to be opposed to or neutral regarding this proposal, whereas those aged 65–74 years or older than 75 years were 39% and 27% as likely, respectively. The only significant difference by race/ethnicity was that non-Hispa

Cancer survivors may be more susceptible to frailty-related bone fractures to the pelvis and vertebrae according to a study by American Cancer Society (ACS) researchers.

“Prior to our study, there was some evidence to suggest that cancer survivors may be at a higher risk of bone fractures,” says Erika Rees-Punia, PhD, MPH, senior principal scientist of the Department of Population Science at the ACS in Atlanta, Georgia. “But many prior studies focused on one cancer type, most often breast cancer only; combined all fracture sites together, even though we know that certain fracture sites, like hip and spine, are the costliest and the most likely to be associated with further morbidity and mortality down the road; and only studied cancer survivors immediately after treatment.” The study appears in JAMA Oncology (doi:10.1001/jamaoncol.2022.5153).

The participants in this study were from the ACS’s Cancer Prevention Study II (CPS-II) Nutrition Cohort (NC) and had provided demographic and lifestyle information in a series of questionnaires since 1992. Cancer incidence information was self-reported by the study participants and verified by the researchers via medical record abstraction and state cancer registries.

Because both CPS-II and Centers for Medicare & Medicaid Services claims databases include a patient’s Social Security number, name, sex, and date of birth, the researchers were able to link data provided to the ACS with Medicare inpatient, outpatient, and physician

claims files, which were used to identify incident pelvic, radial, and vertebral fractures when subjects were at least 65 years old.

“Linking CPS-II data with Medicare Claims data allows us to benefit from both datasets in one study,” says Dr Rees-Punia. “CPS-II has years of validated physical activity, smoking, and diet data (pre- and post-diagnosis for cancer survivors), while Claims data provide an opportunity to identify sites and dates of bone fractures without relying on self-reporting.”

Following cancer survivors for more than 15 years, the study included survivors of all cancer sites and explored the differences in fracture risk by three sites (wrist, pelvis, and vertebrae) that are associated with frailty. “This was important, as we indeed found that the risk of fracture was different by fracture site, and the risk of fracture was elevated for cancer survivors for many years after diagnosis and treatment,” Dr Rees-Punia says.

Participants were classified by their cancer history, including the time since diagnosis and the stage at diagnosis. The researchers then examined potential associations of these and other clinical characteristics with the number of pelvic, radial, and vertebral fractures.

“These analytic decisions align with those made in previous studies of bone health in cancer survivors and with other studies of cancer survivorship within CPS-II NC,” the researchers wrote.

This study used data from

Advances in biomarker-driven therapies for patients with nonsmall cell lung cancer (NSCLC) both provide opportunities to improve the treatment (and thus outcomes) for patients and pose new challenges for equitable care delivery. Over the last decade, the continuing development of new biomarker-driven therapies and evolving indications for their use have intensified the importance of interdisciplinary communication and coordination for patients with or suspected to have lung cancer. Multidisciplinary teams are challenged with completing comprehensive and timely biomarker testing and navigating the constantly evolving evidence base for a complex and time-sensitive disease. This guide provides context for the current state of comprehensive biomarker testing for NSCLC, reviews how biomarker testing integrates within the diagnostic continuum for patients, and illustrates best practices and common pitfalls that influence the success and timeliness of biomarker testing using a series of case scenarios.