Monthly Archives: February 2018

HHC study supports web-based care plans for head, neck cancer patients

Source: www.hartfordbusiness.com
Author: John Stearns

A joint study by the Hartford HealthCare (HHC) Cancer Institute and the Memorial Sloan Kettering (MSK) Cancer Center has demonstrated benefits of a web-based care plan for patients with head and neck cancer as a tool to better cope with side effects of treatment.

A web-based tool to help patients with head and neck cancer better deal with effects of their cancer treatment has proved beneficial to patients and doctors, according to a HHC doctor involved in developing the tool and studying its effectiveness.

“The compelling reason to do this work is because head and neck cancer has changed,” said Dr. Andrew Salner, medical director of the Hartford HealthCare Cancer Institute at Hartford Hospital, HHC’s lead doctor on the joint study with MSK.

Head and neck cancer, once mostly associated with heavy drinkers and smokers who had other chronic diseases, is showing up more in younger and healthier patients, he said. That’s because of the prevalence of human papillomavirus (HPV), now the leading cause of the cancers that often target the tonsils and back of the tongue.

HPV is the most commonly sexually transmitted infection in the U.S. HPV is equally divided among males and females, the latter who’ve been getting vaccinated against HPV to prevent cervical cancer, but oral cancers are happening more prevalently and are appearing in males and females, Salner said. As such, boys and girls are now recommended for the vaccine before they become sexually active to hopefully prevent future disease, he said.

Immunization rates were 38 percent for boys and 50 percent for girls in 2016, Salner said.

Most people with HPV will not develop cancer, according to HHC, but for those who do, treatment outcomes are good, but the effects of head and neck cancer treatment can cause difficulty with taste and swallowing, dental problems, jawbone injury, underactive thyroid and other issues, Salner said.

The study of 43 head and neck cancer patients in Hartford and New York tracked the benefit of a web-based care plan tailored to their specific cancer, treatment and side effects. Historically, so-called survivorship care plans were fairly generic in addressing issues patients might or might not encounter, Salner said.

“This study was unique because it personalized the side effects for the tumor site and the treatment for each patient,” Salner said. It offers specific effects to watch for, some of which may not show up for years after treatment, ways to help prevent problems, cope with treatment side effects and timelines for follow-up medical screenings.

“The patients really appreciated all components of the care plan,” which also included a 60- to 90-minute meeting to review with medical staff.

HHC and MSK are talking with the National Cancer Institute to do a much wider study of the care plan, Salner said. He also wants to examine how to scale up the plan for larger populations and integrate it into patients’ medical records.

Salner and Dr. David Pfister, chief of head and neck oncology services at the MSK Cancer Center, will discuss the study and link between HPV and head and neck cancer in a talk this afternoon, from 4 to 5, at the Hartford Hospital Wellness Center at Blue Back Square, West Hartford.

February, 2018|Oral Cancer News|

In Memoriam: Jimmie C. Holland, MD

The Oral Cancer Foundation is deeply saddened by the passing of OCF Science Advisory Board member, Dr. Jimmie C. Holland. When our organization was in it’s infancy, Dr. Holland was an early supporter of OCF.  She was one of the first in the profession to focus attention on the mental well being of cancer patients. With OCF being a foundation that is heavily geared to funding the advancement of research, and being very hard science and research oriented,  her compassion for the mental health of cancer patients was a key component in humanizing our efforts, and ensuring that we stayed people centric.  We are tremendously grateful for her advanced work in Psycho-oncology, the good it has done for so many in the oral cancer community, and the guidance she offered us. She will be missed by many.

Author: William Breitbart
Source: https://blog.oup.com
Date: Feb. 23, 2018

Jimmie C. Holland, MD, internationally recognized as the founder of the field of Psycho-oncology, died suddenly on 24 December 2017 at the age of 89. Dr. Holland, who was affectionately known by her first name, “Jimmie,” had a profound global influence on the fields of Psycho-oncology, Psychosomatic Medicine, and Oncology.

Dr. Holland was the Attending Psychiatrist and Wayne E. Chapman Chair at Memorial Sloan-Kettering Cancer Center (MSK) and Professor of Psychiatry, Weill Medical College of Cornell University in New York. In 1977, she was appointed Chief of the Psychiatry Service in the Department of Neurology at MSK. The Psychiatry Service at MSK was the first such clinical, research, and training service established in any cancer center in the world. In 1996, Dr. Holland was named the inaugural Chairwoman of the Department of Psychiatry and Behavioral Sciences at MSK Cancer Center, also the first such department created in any cancer center in the world. Over 25 years ago, Dr. Holland founded and co-edited the international Psycho-Oncology journal.

Dr. Holland edited the first major textbooks of Psycho-oncology, and in 1989 edited the Handbook of Psychooncology: Psychological care of the patient with cancer. This landmark textbook was notable for several reasons; it established a “new” field, a subspecialty of both Psychosomatics and oncology. I remember being a young faculty member in Dr. Holland’s service and the very real sense that we were creating something that had not existed before. I remember her asking me to write multiple chapters, including several in which I had very little expertise. I expressed my concern, “I’m not an expert on the psychiatric complications of head and neck cancer!” She calmly reassured me, “Well, Bill, no one is. So when you finish researching and writing the chapter I suppose then you’ll be the world’s expert!”

Psycho-oncology was born and named with the publication of this textbook and with Dr. Holland’s founding of the International Psycho-oncology Society (IPOS) in 1984, then the American Psychosocial Oncology Society in 1986. Subsequently, Dr. Holland edited, with a group of co-editors, what became known as the “Bible” of Psycho-oncology; Psycho-oncology was published in 1998, and represented the most comprehensive, multidisciplinary, and international encyclopedia of a field entering its adolescence. 2010 saw the publication of the second edition followed by the third edition in 2015. Every card-carrying “psycho-oncologist” (in 57 countries with national psycho-oncology societies) had to have the latest edition in their library to demonstrate their link to Jimmie Holland. Dr. Holland also co-wrote two well received books for the public: The Human Side of Cancer and Lighter as We Go: Virtues, Character Strengths, and Aging, the latter reflecting her interests in Geriatric Oncology as she approached her 90th birthday.

Dr. Holland was born in the small farming community of Nevada, Texas in 1928. She credits the local family physician in that community for her interest in medicine and caring for those who were suffering. She was one of only three women in her class at Baylor College of Medicine. In 1956, Dr. Holland married the renowned oncology pioneer James Holland, MD, who was then Chief of Medical Oncology at Roswell Park in Buffalo, NY. She would chide James, complaining that cancer patients were asked every conceivable question about their physical functioning but never, “How do you feel emotionally?” Dr. Holland pioneered the inclusion of psychological and emotional well-being patient-reported outcomes in quality of life measures and as a component of clinical outcomes in clinical trials.

Dr. Holland has received too many awards to list, however some notable ones include: The Medal of Honor for Clinical Research from the American Cancer Society, The Marie Curie Award from the Government of France, and the Margaret L. Kripke Legend Award for contributions to the advancement of women in cancer medicine and cancer science from the MD Anderson Cancer Center. She served as President of the Academy of Psychosomatic Medicine (APM) in 1996 and was the recipient of the APM’s Hackett Lifetime Achievement Award in 1994. She was also the inaugural recipient of the Arthur Sutherland Award for Lifetime Achievement from IPOS.

Over a 40-year career at MSK Cancer Center, Dr. Holland created and nurtured the field of Psycho-oncology, established its clinical practice, advanced its clinical research agenda, and through her pioneering efforts, launched the careers of the leaders of a national and worldwide field who mourn her passing and continue to work in what has become a shared mission to emphasize the care in cancer care.

After stepping down as Chairman of the MSK Department of Psychiatry and Behavioral Sciences in 2003, she kept working full time, seeing patients, conducting research, training and supervising fellows, and traveling the world lecturing and teaching. She also helped bring Psycho-oncology to Africa through her work with the African Organization for Cancer Research & Training in Cancer (AORTIC).

Born in a humble farming community with a one room school house, Dr. Holland created a life that led her to New York and the capitals of the world, honored by so many organizations and societies. She was teaching and seeing patients up until two days before her death. I think we’ll all remember her for various reasons. I certainly have many memories from a 34 year career working beside her. But on that list was her generosity and loving attitude towards her family, her patients, her colleagues, trainees, and everyone who crossed her path. Those who worked alongside her in medicine have made her mission our mission. We will continue this mission’s work, always remembering and honoring Dr. Jimmie Holland. Her death is a profound loss for all of Psychiatry, Psychosomatic Medicine, Psycho-oncology, and Oncology. We’ve lost a pioneer, a remarkable woman, a once-in-a-generation influencer.

Suicide Among Cancer Survivors — Highest Risk in HNC

Author: Roxanne Nelson, RN, BSN
Source: MedScape.com
Date: Feb. 20, 2018

ORLANDO, Florida — Head and neck cancer (HNC) accounts for only about 4% of new cancer cases in the United States, but the risk for suicide among survivors is significantly higher than for survivors of all other cancer types, with the exception of pancreatic cancer.

“The risk of suicide is significantly elevated across cancer sites, and the risk is especially high among HNC and pancreatic cancer survivors,” said Nosayaba Osazuwa-Peters, BDS, MPH, CHES, instructor, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri.

“Cancer survivors are candidates for suicide-related psychosocial surveillance,” he added.

Cancer is the number 2 cause of death in the United States and accounts for 1 of every 4 deaths. Suicide is the tenth cause of death, independent of cancer. “If you add cancer to it, you get the perfect storm,” he said.

“Survivorship does come at a cost, and this is one of the more unfortunate costs of cancer survivorship,” Osazuwa-Peters told delegates here at the Cancer Survivorship Symposium (CSS) Advancing Care and Research.

Currently, there are more than 16 million survivors in the United States. The good news is that more people are surviving cancer, and there is now more focus on competing causes of death and comorbidities, he explained. There is also more focus on the increased risk for acute and late toxicities, which needs to be addressed as the rate of survival increases.

Osazuwa-Peters pointed out that there are “a lot of unmet psychosocial needs and struggles with functionality in this population. The overall risk of suicide among cancer survivors is 50% higher than in the general population.”

Findings from a recent study presented in 2017 at the European Psychiatric Association Congress found that a diagnosis of cancer significantly increases an individual’s risk of dying by suicide by 55% as compared to those without cancer.

“Throughout the lifetime of a survivor, the risk of suicide consistently remains higher,” Osazuwa-Peters pointed out.

Suicide Risk Significantly Higher in HNC

In this study, Osazuwa-Peters and colleagues sought to estimate the incidence of HNC-associated suicide in comparison with other common cancers and to quantify the suicide rate among HNC survivors compared with survivors of cancers other than HNC.

They used data from the Surveillance, Epidemiology and End Results (SEER) database from 2000-2014 to identify all cancer deaths that were confirmed as suicide. The death rates from suicide were estimated for the 21 most common cancers, including HNC.

SEER data revealed that there were 4513 suicides among 4,235,657 cancer survivors during that time frame. This extrapolates to an incidence rate of 23.6 suicides per 100,000 person-years.

For cancers in all other sites combined, the suicide rate was 45% lower than for HNC for both males (mortality rate ratios [MRRs] = 0.55; 95% confidence interval [CI], 0.48 – 0.64) and females (MRR = 0.55; 95% CI, 0.37 – 0.81).

Pancreatic cancer was the only cancer type in which the suicide rate was higher than for HNC (86.4 suicides per 100,000 person-years for pancreatic cancer vs 63.4 suicides per 100,000 person-years for HNC). When stratified by sex, this finding held true only for males; the suicide MRR was significantly higher for male pancreatic cancer survivors compared to that of HNC survivors (MRR = 1.54; 95% CI, 1.23 – 1.90). For females, the suicide MMR was highest with HNC compared with all other cancer types.

“A lot of conversation revolves around depression and fear, but depression does not equate to suicide, and data show that even patients who screen okay for depression still commit suicide,” said Osazuwa-Peters. “There are other factors, such as pain and fear, that may heighten the risk of suicide.”

It is important “that suicide is tackled as a problem” when guidelines are developed by the National Comprehensive Cancer Network and other major players, he said.

“Misery Index”

In a discussion of the paper, Christopher J. Recklitis, PhD, MPH, director of research at the Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, Massachusetts, noted that the suicide risk among cancer survivors has been studied for a while, and it has previously been suggested that HNC survivors are particularly at risk.

 

“This study is important because it focused on head and neck cancers, which isn’t often seen, and we can say that these data are largely confirmatory showing the elevated risk,” he said. “My take on this is that it highlights the need for better integration of mental health care into medical survivorship care.”

Not only does the risk for suicide need to be considered, but in general, the psychosocial needs of this population need to be considered more broadly, because suicide is something of a “misery index,” he commented.

“The number of people who are unfortunately ending their lives through suicide suggests that there is large group of people who are quite miserable and thinking about suicide and suffering in a way that needs attention,” he said.

But the study opens the door to several questions, he noted, namely, what is it about HNC that explains this excess risk?

“HNC survivors face poor prognosis, pain, disfigurement, and functional impairments, but that can be said of other cancer survivors,” he pointed out. He added that this group also has a higher risk for substance abuse and depression, but it is not known whether that risk contributes to risk for suicide.

“We need to understand these risks better so we can identify patients at risk and provide effective interventions, and also support the medical providers caring for this high-risk group,” Recklitis added. “We also need to move beyond registry data and study the risk over the course of survivorship, as it can change over time.”

Dr Osazuwa-Peters and Dr Recklitis have disclosed no relevant financial relationships.

Cancer Survivorship Symposium (CSS) Advancing Care and Research. Abstract 146, presented February 17, 2018.

 

 

February, 2018|Oral Cancer News|

Bareback Rider Cody Kiser Uses Tucson Rodeo Role to Rail Against Oral Cancer

Author: Norma Gonzalez
Source: Arizona Daily Star
Date: Feb. 23, 2018

Prior to Friday’s first event, Cody Kiser stretched and danced around the dressing room behind the chutes. Kiser was nothing but smiles as he loosened up for bareback riding at the 93rd annual La Fiesta de los Vaqueros.

While in high school in 2006, Kiser suffered an injury competing in bull riding. The bull stepped on his face, breaking all the bones in its left side. Kiser’s jaw was broken in two places and had to be wired shut. Through plastic surgery, Kiser had his face put back together.

Now, Kiser’s smile is more than just a gruesome injury story. The 27-year-old from Carson City became a spokesperson and role model with the Oral Cancer Foundation in 2014, and is the first spokesman to be affiliated with the rodeo.

“My side of it isn’t giving out a lot of facts,” he said. “Everyone knows smoking and chewing is bad. If you do it long enough, it’ll kill you.”

Kiser has never smoked or chewed. He simply doesn’t like it.

“I was never part of that,” Kiser said. “I just like to lead a healthy lifestyle and it just worked out so perfect to get involved with the foundation.”

So now, the bareback rider lends his voice to the foundation and helps in the prevention of tobacco use. According to oralcancer.org, as many as 15 percent of high school boys use smokeless tobacco in the United States. The nicotine content in a can of dip equals approximately 80 cigarettes, the website says.

The foundation’s slogan “Be smart — don’t start” could be seen embroidered down Kiser’s right sleeve.

“My part is the anti-tobacco, chewing or smoking, for the kids,” he said. “So I go around and represent the Oral Cancer Foundation and try to spread the word to these youngsters coming out to the rodeo that you don’t need to smoke or chew to be cool or to be a cowboy.”

At rodeos, Kiser hangs out with children and will have autograph sessions at times. Even if he finds kids hanging out nearby, he’ll reach out to the children.

Kiser said he knows plenty of cowboys who started using tobacco at a young age, so talking to children is important.

“It’s not so much smoking, but everyone’s chewing. It’s so prevalent (in the rodeo community),” Kiser said. “You talk to guys and they say they started chewing at 13 because their dad would do it.”

Kiser’s rodeo career has taken him all over the United States. He worked as Bradley Cooper’s stunt double in “American Sniper.” When Kiser stops to think about everything he’s been able to do at such a young age, he says he knows he’s been able to live an amazing life.

“So when I talk to younger people, I tell them not to smoke or chew, but I also tell them they need to travel — even if it’s just in the United States,” Kiser said. “I’m just the luckiest guy to be able to do all that, and rodeo has been the gateway to that.”

La Fiesta de los Vaqueros

  • Meili Chuinard Hepner, a 12-year-old student at Miles-Exploratory Learning Center, was honored after the bareback riding event. Meili, who came out to the Tucson Rodeo through the Children’s Western Wish Foundation, was named an honorary princess and was presented with a sash, buckle and cowboy hat signed by contestants. Meili, who was accompanied by her mother, Lisa, and siblings Noah and Amira, has neurofibromatosis (NF2), which causes tumors to grow on nerve endings. Lisa Chuinard said Meili was already suffering from hearing loss when she was adopted from China, but wasn’t diagnosed with NF2 until 2016. The 12-year-old said she was happy to be able to come out to the rodeo.
  • Evan Jayne made his seventh appearance at the Tucson Rodeo when he competed in bareback riding on Friday. Jayne was inspired by Louise Serpa’s book of rodeo photographs as a kid and eventually moved to the United States from France to pursue rodeo. The 35-year-old met Serpa 10 years ago and was photographed by the Tucson icon.

Jayne finished Friday’s run with a 73.00 score.

  • Riker Carter was the first bull rider to compete Friday, and the only one to have a qualifying run. Carter was awarded an 86.50.
  • The Tucson Rodeo announced a crowd of 9,000.

 

 

 

February, 2018|Oral Cancer News|

E-cigarette Vapor Filled With Dangerous Toxins Like Lead, Study Finds

Source: www.newsweek.com
Author: Melissa Matthews

Electronic cigarettes may have been deemed safer than traditional smoking by the American Cancer Society, but that doesn’t make it a risk-free habit. Past research has found that oils used to vape contain toxins, and a new study shows that the latest e-cigarette devices might leak dangerous amounts of metal, including lead, which could have serious health risks.

Tolga Akmen/AFP/Getty Images

In a study published in the February 2017 issue of Environmental Research, public health expert Ana María Rule of Johns Hopkins University found that liquids used in the first generation of e-cigarettes could be potentially toxic and carcinogenic. However, things have changed in just one year as companies constantly offer new, more sophisticated devices. Plus, Rule was often met with questions about the safety of inhaled aerosol.

“A lot of people were asking, ‘You found these metals in the liquid, but what does this mean?’ Are they getting into the vapor that I’m inhaling?’” Rule explained to Newsweek.

So, the team began a new project studying the latest devices, called Mods, as well as the aerosol inhaled by smokers.

For this study, 56 daily e-cigarette smokers lent their devices to Rule’s lab, where scientists tested the vaping liquid, liquid inside the e-cigarette tanks, and the aerosol. They looked for 15 different metals including lead, chromium, nickel and manganese, which are the most dangerous, according to Rule.

Some of the refilling dispensers did contain small amounts of metal. However, liquids in the e-cigarette tanks and aerosols contained higher levels. Rule believes the heating coils found in the tanks could somehow be transferring metal into the aerosol. This is alarming as aerosol is inhaled by users.

The data showed that nearly 50 percent of aerosol samples contained lead in quantities above the Ambient Air Quality Standards set by the Environmental Protection Agency. In addition, the concentrations of nickel, chromium and manganese found in nearly half of the aerosol samples exceeded the limits. Every e-cigarette in the study was different, so the amounts varied per model. This variety, explained Rule, is one of the study’s strengths.

“Every person that came into our study brought in their own device,” she said. “We think it’s representative of what people are vaping in the country.”

Arsenic also was found in some of the e-liquid samples, both in the chamber and refills, as well as some vapor samples.

Now that exposure has been established, the next steps are to determine if, and how, it impacts the body. Rule hopes this study, and corresponding research, will push the Food and Drug Administration to begin regulating e-cigarette pens. She believes quality control and newer, safer devices are issues that need to be addressed.

“Maybe there’s another way to heat or isolate the liquid from the heating element,” she said. Although she doesn’t believe vaping is safe, Rule asserts there needs to be better devices for those who insist on the habit. “There’s got to be a safer way to do it,” she said.

February, 2018|Oral Cancer News|

New cancer test isn’t ready for prime time

Author: H Gilbert Welch
Date: February 14, 2018
Source: http://www.cnn.com/2018/02/13/opinions/liquid-biopsy-opinion-welch/index.html

(CNN)- A simple blood test to detect cancer early. How great is that?

There has been enthusiasm about the so-called “liquid biopsy” for years. In mid-January, however, doctors learned more — both about this vision and its problems.

A widely reported study in the journal Science described a liquid biopsy test — CancerSEEK — which combined measuring eight tumor biomarkers with testing for pieces of DNA with cancer associated mutations in 16 genes.

It’s not one test; it’s a battery of tests. And while collecting the blood may be simple, the subsequent analysis is extraordinarily complex.

The task at hand is particularly challenging. We all have pieces of DNA in our blood. Distinguishing the tumor DNA from the background DNA requires finding the mutations specifically associated with cancer.

Adding to the complexity, healthy individuals can have mutations. To avoid labeling innocuous mutations as cancerous requires a bunch of statistical fine-tuning.

In other words, there are a lot of steps in a liquid biopsy and much potential for things to go awry.

To their credit, the CancerSEEK investigators were very forthright that the study conditions were ideal for the test to accurately detect cancer. The liquid biopsy simply had to discriminate between patients with known cancer (the majority of whom had symptoms) and healthy individuals. And the statistical fine-tuning was tailored to the study participants — with the knowledge of who had, and who did not have, cancer.

Although the test was able to detect most of the late-stage cancers, it detected less than half of the stage 1 cancers.

But doctors don’t screen to find advanced cancer, we screen to find early cancer. And we don’t screen people with symptoms of cancer, we screen people who don’t have symptoms of cancer.

There’s no doubt that there would be more detection errors in the less controlled environment of the real world.

Just how often was made clear in a recent JAMA-Oncology study. Forty patients with metastatic prostate cancer received liquid biopsies to tailor therapy in real time to the genetics of their spreading tumors. That’s the vision for precision medicine.

But the investigators added a little twist. They wanted to know whether it mattered which lab the liquid biopsies were sent to. So they sent each patient’s blood for two different commercial liquid biopsies: Guardant360 and PlasmaSELECT. Both tests were designed to detect mutations in the same genes.

Yet in over half of the 40 patients, the tests gave different answers about which mutations were present. Different liquid biopsy tests give different answers in a majority of patients? That’s not precision, that’s awful.

Sure, the analyses of liquid biopsies will improve. But if this much confusion exists about what mutations are present in the blood of patients with metastatic cancer (who have a lot of tumor DNA), imagine the uncertainty that will exist for asymptomatic individuals not known to have cancer — the very people who would be screened.

And then there is the question of what to do with a positive result. This is very different than detecting a concerning lung nodule on a screening chest CT scan or a concerning breast mass on a screening mammogram. In these cases, it’s clear what to do to get a definitive answer: surgically biopsy the nodule or the mass. But with a liquid biopsy, the anatomic location of a cancer can be a mystery. It may not even be clear what organ the cancer is in.

Imagine what this might mean for a patient: A doctor says, “It looks like you have cancer, but we are not sure where.”

Even if there is certainty that the cancer is in, say, the liver, doctors may not know where in the organ. What to do then? Randomly biopsy different parts of the liver?

This is doubly concerning when screening average-risk individuals, because most positive results are expected to be false alarms. We typically learn that a screening test is falsely positive because a surgical biopsy is normal. But absent the knowledge of where to biopsy, how can we ever be sure a positive liquid biopsy is wrong?

Doctors won’t know where to look, but we will keep looking. Liquid biopsies are a recipe for more health anxiety, more procedures, more complications and more overdiagnoses. Not to mention, more out-of-pocket costs for our patients.

Of course, we should continue to study liquid biopsies. The detection of circulating tumor DNA may ultimately prove useful in selected settings, such as tailoring therapy for aggressive cancers that are rapidly mutating. But the real enthusiasm is for screening average-risk individuals.

One reason is obvious: there is a lot of money to be made. A Goldman Sachs video estimated the potential liquid biopsy market to be $14 billion annually, adding “and we’re just at the beginning.” That kind of money doesn’t come from testing the few patients with aggressive cancer, that comes from screening millions of people.

And there is a less obvious reason: it is easier for a new test to pass regulatory muster than it is for a new drug. While the FDA has a longstanding mandate to protect us from snake oil treatments, this often doesn’t extend to snake oil testing.

The enthusiasm for finding things that might benefit people in the future ignores the fact that doing so can cause people to have problems now. In short, a bad test can do as much damage as a bad drug. Worrisome liquid biopsies will start a cascade of subsequent, not-so-simple tests and procedures. People will be hurt in the process.

February, 2018|Oral Cancer News|

Should kids be required to get the HPV vaccine?

Source: www.forbes.com
Author: Bruce Y. Lee

If a bill recently introduced in Florida passes, the human papillomavirus (HPV) vaccine would be mandatory for adolescents attending public school in the state. Currently, the vaccine is mandatory for boys and girls in Rhode Island and just girls in Virgina and Washington, DC. (AP Photo/John Amis, File)

Florida isn’t kidding about low human papillomavirus (HPV) vaccination rates. If you are a kid enrolled in a Florida public school, come July 1, 2018, you may be required to get the HPV vaccine. That is if you are old enough and if a bill now being debated in the Florida state legislature ends up passing.

If it gets through, Senate Bill 1558 would then become known as the “Women’s Cancer Prevention Act”, which is a much easier name to remember and also reflects some major benefits of the HPV vaccine. As the National Cancer Institute explains, HPV vaccine can help prevent not only cervical cancer but also many vaginal and vulvar cancers. In fact, two types of HPV (16 and 18) cause around 70% of cervical cancers. But just because you don’t have a vagina, cervix, and vulva doesn’t mean that you are in the clear. HPV is responsible for about 95% of anal cancers, 70% of oropharyngeal (the middle part of the throat) cancers, and 35% of penile cancers. Thus, the “Women’s Cancer Prevention Act” is really a “Cancer Prevention Act.”

Regardless, Florida State Senator José Javier Rodríguez (D-Miami) filed this bill on January 4 in an effort to boost Florida’s not so great HPV vaccination rates. According to the just-released Blue Cross Blue Shield Association (BCBSA) Health of America Report, only 29.0% of adolescents in Florida got the first dose of the HPV vaccine and only 7.3% got all doses in the series as of 2016. Those numbers are lower than the national average (34.4% got the first dose) but not the worst in the country.

New Jersey was the worst (not in general as a state but in terms of HPV vaccination rates). Based on the BCBSA report, as of 2016, only 20.6% of adolescents in New Jersey had gotten the HPV vaccine by age 13 and only 3.4% had completed the series. The Health of America report was the result of an analysis of medical claims data from 2010 through 2016 of over 1.3 million BCBSA commercially-insured adolescents across the country. The analysis considered vaccination to be on time if performed between the adolescent’s 10th and 13th birthdays, corresponding with the Centers for Disease Control and Prevention (CDC) recommendations of 11 to 12 year olds getting the vaccine.

Of course, the analysis did not include all adolescents in America. As BCBSA Chief Medical Officer Trent Haywood, MD, JD, explained, “the analysis represented the commercial population and didn’t include Medicaid populations. Also, to be included in the analysis, an adolescent had to be continuously enrolled with BCBS.” But studying such a large population is a pretty good shot at trying to figure what’s going on with shots and adolescents nationwide.

The report also showed that girls were better than boys (again, not in general, but in terms of HPV vaccination rates). In 2016, 37% of girls had received the first dose of the HPV vaccines by age 13 compared to 32%.

The best state of the bunch? Rhode Island with 57% of adolescents having received their first dose by age 13. Not coincidentally Rhode Island is the only state requiring HPV vaccine for both male and female students, starting with the first dose by 7th grade. Virginia and Washington, DC, have requirements just for females.

The good news is that nationwide vaccination rates steadily rose from 22% getting the first dose by age 13 in 2013 to 34% in 2016. But why are vaccination rates still well below 50% in most states? A BCBSA-commissioned survey of over 700 parents of adolescents aged 10-13 revealed the following top three reasons for parents not vaccinating their child against HPV:

  • Being concerned about adverse side effects (59.4%)
  • Not thinking their child is at risk (23.6%)
  • Not knowing their child needed an HPV vaccination (15.7%)

Is requiring the HPV vaccine the solution? One argument against making the HPV vaccine mandatory is that people should be allowed freedom of choice. When Rhode Island first introduced its requirement, protests resulted various groups such as parents, a 2,400-member plus Facebook group, and the American Civil Liberties Union.

However, the counter-argument is that freedom of choice does not always hold when in the words of Spock, “the needs of the many outweigh the needs of the few.” You aren’t free to run up and down the aisle of an airplane naked and screaming because the needs of other on the plane outweigh the needs of you. Similarly, the HPV vaccine could help slow and even stop the transmission of HPV throughout the population, which can result in cancers that not only affect the cancer victims but also society by adding to health care costs.

Here is a Today show segment on the HPV vaccine:

Also, when a child doesn’t get vaccinated, it is usually because of the parent’s choice and not the child’s. Could making the vaccine mandatory in fact be protecting the child?

Another argument used by some is that the HPV vaccine has adverse effects. There are websites claiming that HPV vaccine can cause “crippling side effects” and “death.” But many of these scarier claims are not supported by rigorous scientific evidence. (Note: there are also websites that say that the Earth is flat, Elvis was an alien, and the government controls the weather). While nothing is completely safe (e.g., even a chocolate chip cookie in the right situation could do some real damage) and all vaccines do have their risks, the risks of the HPV vaccine are comparatively very low and far outweighed by the potential benefits as indicated by the CDC.

As I wrote before for Forbes, some have argued that the HPV vaccine is a “gateway to sex” and thus making it mandatory would increase the number of teenagers having sex and encourage promiscuity. However, this goes counter to the recent trend of teenagers delaying when they first have sex and suggests that teenagers would not have sex if it weren’t for that darn HPV vaccine. A related argument is that the HPV vaccine would give teens a false sense of security that they are protected against all sexually transmitted infections, leading them to not practice safe sex. However, raising awareness of what the HPV vaccine actually does could help overcome this concern.

All of this does not necessarily mean that making HPV vaccination mandatory is the solution. However, what then is the solution to a majority of adolescents still not getting vaccinated (at least by age 13 and when sexual activity for some begin)? As Haywood described, this is a situation in which many are “not taking full advantage of preventive measures. A big issue is lack of awareness of the HPV vaccine and its benefits.” HPV vaccine awareness campaigns may help push up vaccination rates, but by how much?

The wonderfully straight-forward and transparent world of politics will help determine whether Senate Bill 1558 becomes a law in Florida. A similar bill failed to pass in 2011. But things have changed since 2011, in good ways and bad.

February, 2018|Oral Cancer News|

Living with cancer in the country: Many Wyoming residents must leave home to seek the care they need

Source: trib.com
Author: Katie King

Bob Overton is all too familiar with the 140-mile stretch of land between Thermopolis and Casper.

He and his wife, Sherry, made the two-hour trip in their white pickup dozens of times while Bob was undergoing treatment for lymphoma in 2015. Even with the help of Alan Jackson and Martina McBride’s music, the hours still lagged, with nothing to stare at except endless grassy plains.

“That trip is pretty monotonous, and it doesn’t get any better with time,” he recalled.

But the couple didn’t have a choice. Their hometown of Thermopolis, population 3,009, doesn’t offer the care Bob needed.

And the Overtons aren’t alone.

As the least populated state in the country, Wyoming appeals to those in search of space and wilderness. But the peace and quiet comes with drawbacks: Services that urban residents may take for granted, like advanced medical care, aren’t readily available for thousands of people living in small towns and rural areas.

Many of those battling cancer in Wyoming subsequently end up seeking treatment in Casper, according to Rocky Mountain Oncology’s Patient Navigator Sam Carrick. She said the center is the only medical facility in the state that offers radiation, chemotherapy and Positron emission tomography scans.

Other areas may offer one or two of those services, but many prefer the convenience of a one-stop shop, she said.

About 15 percent of their patients are from out-of-town, added Carrick, who is responsible for guiding all patients through the treatment process. She said it’s often devastating for people to learn that they can’t get the care they need at home.

“First you are hit over the head with a diagnosis that you didn’t want, and then you can’t get treatment at home, so you have to travel and be away from your family members or pets,” she said.

Some patients drive back-and-forth, but temporarily relocating often becomes necessary during the more intensive treatment phases.

And that was the case with Bob. The 75-year-old initially remained in Thermopolis, only traveling to Casper for intermittent doses of chemotherapy. But he said that wasn’t possible while he was undergoing radiation, which he needed daily for 30 days.

Sherry remembers breaking down into tears when she realized they had to leave home. Already faced with the possibly of losing her husband, not to mention mounting medical bills, the thought of relocating for a month was overwhelming.

“That was just more than I could handle … I just thought, ‘How are we going to do this?’” she said.

***
Battling cancer is difficult for anyone, but those living far away from treatment centers need extra help, said Wyoming Foundation for Cancer Care treasurer Kara Frizell. Finding the money for gas and hotel accommodations can quickly become a serious problem.

“It’s not something you can just come up with,” she explained.

Frizell said the Casper-based charity annually spends between $20,000 and $30,000 assisting patients with necessary travel expenses. The nonprofit also oversees a network of volunteers, called Angels, who help out-of-towners feel at home by delivering meals or dropping off gift baskets.

***
Robert Rasmussen also lives in Rawlins, but he hasn’t had much of a chance to grow attached to the town. He moved from Tuscon, Arizona, in search of peace and quiet. But about a year after moving, he was diagnosed with stage four throat cancer last fall. It quickly became apparent that traveling back and forth to Casper for treatment wasn’t a safe option.

Sitting in his bed in January at the Shepherd of the Valley Healthcare Community — where he’s recovering from surgery — the emaciated 50-year-old removed his oxygen mask and explained that intense radiation and chemotherapy treatments left him far too nauseous and exhausted to drive.

Rasmussen temporarily relocated to Casper in October and brought along his dog, Piggy. The Australian Shepherd is family, and he couldn’t bear to be without her.

“She’s the only thing that keeps me together,” he explained.

Although Rasmussen was worried hotels wouldn’t allow animals, Carrick arranged for both patient and pet to stay at the Sleep Inn in Evansville. The patient navigator also connected him with the cancer foundation to help with the bill.

The hotel staff has since fallen in love with Piggy, according to general manager Carmen Bartow. Employees walk her each day, sneak her treats from the breakfast buffet and even take her to visit her dad.

“She’s our mascot,” said Bartow.

The manager said the inn annually receives about 15 guests who are in town for cancer treatments, likely because of their close proximity to the oncology center. The hotel offers discounted rates for its sick visitors and employees try to help them out in any way possible.

“If we can’t help one another out then there is something wrong with us,” she said.

Rasmussen greatly appreciates everyone who made it possible for Piggy to stay in Casper.

His condition is serious, and distracting himself from the possibly of death isn’t easy, he explained. Surrounded by feeding tubes and beeping monitors, it’s impossible to forget his situation.

“I try to read or watch TV or just focus on something different, but when I’m just sitting here by myself, it’s hard,” he said.

But Rasmussen said he can manage with Piggy by his side for support.

Although his former home in Tuscon was closer to advanced medical care, Rassmussen said he prefers living in small towns because its safer and more peaceful.

“I don’t have any regrets [about moving],“ he said. “City life isn’t for everybody.”

February, 2018|Oral Cancer News|

Biofilms in tonsil crypts may explain HPV-related head and neck cancers

Source: www.genengnews.com
Author: staff

Human papilloma virus (HPV) encased in biofilms inside tonsil crypts (pictured) may explain why the roughly 5% of HPV-infected people who develop cancer of the mouth or throat are not protected by their immune systems. Tonsil crypts with HPV are shown in green; epithelial and biofilm layers are shown in red. [Katherine Rieth. M.D.]

How can human papilloma virus (HPV) be prevalent in otherwise healthy people not known to carry it? A just-published study concludes that the virus may be lurking in small pockets on the surface of their tonsils.

Researchers from University of Rochester Medical Center (URMC) found HPV encased in biofilms inside tonsil crypts, where HPV-related head and neck cancers often originate. HPV is shed from the tonsil during an active infection and gets trapped in the biofilm, where it may be protected from immune attack.

In the crypts, the virus likely lays in wait for an opportunity to reinstate infection or invade the tonsil tissue to develop cancer.

“The virus gains access to the basal layer of stratified squamous epithelium through structural breaks in the stratified epithelial superstructure,” the investigators reported in the study. “Tonsillar crypt reticulated epithelium itself has been shown to contain numerous small blood vessels and has a discontinuous basement membrane, which may facilitate this infection and reinfection process.”

The URMC researchers said their finding could help prevent oropharyngeal cancers that form on the tonsils and tongue—and may explain why the roughly 5% of HPV-infected people who develop cancer of the mouth or throat are not protected by their immune systems.

HPV 16 and 18, high-risk strains that are known to cause cervical cancer, also cause head and neck cancers. While verified tests can detect HPV in people before they develop cervical cancer, that’s not the case with head and neck cancers, which according to a 2016 study are expected to outnumber cervical cancer cases by 2020.

“Far-Reaching Implications”
“Given the lack of universal HPV immunization and the potential for the virus to evade the immune system, even in individuals with detectable HPV in their blood, our findings could have far-reaching implications for identifying people at risk of developing HPV-related head and neck cancers and ultimately preventing them,” Matthew Miller, M.D., associate professor of otolaryngology and neurosurgery at URMC, said in a statement.

Dr. Miller and six colleagues detailed their findings in “Prevalence of High-Risk Human Papillomavirus in Tonsil Tissue in Healthy Adults and Colocalization in Biofilm of Tonsillar Crypts,” published online January 25 in JAMA Otolaryngology-Head & Neck Surgery, and announced by URMC today. The study’s corresponding author is Katherine Reith, M.D., an otolaryngology resident at URMC.

The researchers carried out a retrospective, cross-sectional study using samples obtained from tonsils archived at a university hospital following elective nononcologic tonsillectomy from 2012 to 2015. The samples consisted of formalin-fixed, paraffin-embedded samples of tumor-free tonsil tissue from 102 adults who had elective tonsillectomies and were between ages 20 and 39. More than half the patients (55, or 53.9%) were female.

Five of the samples contained HPV and four contained HPV 16 and 18. In every case, HPV was found in tonsil crypts biofilms.

HPV status was assessed by polymerase chain reaction (PCR), and high-risk subtypes 16 and 18 were assessed with quantitative PCR assay. Samples that demonstrated presence of HPV were then analyzed by in situ hybridization to localize the viral capsid protein.

These samples were then stained with concanavalin A to establish biofilm presence and morphology and with 4′,6-diamidino-2-phenylindole (DAPI) to visualize location of the virus in relation to cell nuclei. Data was assembled for aggregate analysis to colocalize HPV in the biofilm of the tonsillar crypts, the URMC researchers reported.

The research team plans to develop topical antimicrobials designed to disrupt the biofilm and allow the immune system to clear the virus—part of their investigation of potential screening tools, such as an oral rinse, to detect HPV in the mouth and throat.

February, 2018|Oral Cancer News|