Standard therapy prevails in head & neck cancer trial

Author: Charles Bankhead, Senior Editor, MedPage Today

Neither a single immune checkpoint inhibitor nor a combination improved survival versus standard of care for patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), an international randomized trial showed.

Durvalumab (Imfinzi) alone led to a media overall survival (OS) of 7.6 months, and patients treated with the combination of durvalumab and tremelimumab had a median OS of 6.5 months. Both values were numerically lower than the 8.3-month median achieved with standard therapy, according to Robert L. Ferris, MD, of the University of Pittsburgh Hillman Cancer Center, and colleagues.

In landmark analyses, both single-agent durvalumab led to numerically higher OS at 12, 18, and 24 months, and the combination had higher OS at 18 and 24 months. None of the differences achieved statistical significance versus standard of care, they reported in the Annals of Oncology.

“Despite the apparent lack of benefit over standard of care, durvalumab clinical activity was in line with other checkpoint blockade agents in this setting,” they wrote. “Although cross-trial comparisons should be approached with caution, median OS for durvalumab was similar to median OS for nivolumab (Opdivo) and pembrolizumab (Keytruda) in comparable patient populations. Likewise, 12-month survival rates for all three were similar.”

“This study was characterized by an unexpectedly high OS for the standard-of-care arm, with a median of 8.3 months,” the authors continued. “This outcome was higher than median OS values for standard-of-care arms reported in similar studies with PD-1 inhibitors.”

Ongoing biomarker studies may provide insight into the clinical activity of immune checkpoint inhibition in HNSCC, they added.

The rationale for the EAGLE trial included evidence from studies of other tumor types showing enhanced additive activity with the combination of a PD-1/L1 inhibitor with a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor. The evidence included studies of durvalumab and tremelimumab in other solid tumors, Ferris and colleagues noted. Moreover, single-agent durvalumab demonstrated activity in previous studies of relapsed/metastatic HNSCC.

Investigators at 156 sites around the world enrolled patients with HNSCC that progressed during or after treatment with a platinum-based regimens. Patients were randomized to one of three treatment groups: durvalumab alone, durvalumab plus tremelimumab, or a standard-of-care single-agent therapy (such as cetuximab [Erbitux], a taxane, or methotrexate). The primary endpoint was OS.

The primary analysis included 736 randomized patients. The results showed no significant difference in the survival hazard ratio (HR) versus standard of care for single-agent durvalumab (HR 0.88, 95% CI 0.72-1.08) or the combination (HR 1.04, 95% CI 0.85-1.26).

The 12-month OS numerically favored durvalumab (37.0% vs 30.5% for standard of care), whereas the combination arm had a 12-month OS almost identical to that of the control arm (30.4% vs 30.5%). Analysis of 24-month survival showed numerical advantages favoring both experimental arms (18.4% for durvalumab, 13.3% for the combination, 10.3% for standard of care). The trial was not designed or statistically powered to compare the durvalumab and combination arms.

Multiple factors might explain the “disappointing” results of the trial, wrote Marco Carlo Merlano, MD, of Candiolo Cancer Center in Torino, Italy, in an accompanying editorial. In a previous study of pembrolizumab, a fourth of patients had PD-L1 expression ≥50. In the current study, 28% of patients had PD-L1 expression ≥25%.

“Therefore, we can speculate that the population that benefits most by the anti-PD-L1 durvalumab therapy is less represented in this study, reducing the overall benefit of the drug,” said Merlano, who also questioned the accuracy and reliability of the methodology used to determine PD-L1 staining in the trial.

A strong theoretical rationale exists for combining a PD-L1 inhibitor and a CTLA-4 inhibitor in HNSCC. However, functional or physical elimination of regional lymph nodes during surgery or radiation therapy for HNSCC might reduce CTLA-4 inhibition in the disease, Merlano continued.

Although ipilimumab (Yervoy) and tremelimumab both target CTLA-4, the antibodies have structural differences that leave tremelimumab unable to induce antibody-dependent cell cytotoxicity. An additional potential consideration is the reduced CTLA-4 expression by natural killer (NK) cells, which are the most common type of T-cells found in the HNSCC microenvironment.

Merlano cited imbalances potentially favoring the standard-of-care arm in the multivariable analysis. He insisted that, in the absence of direct comparisons, there could be differences in the potency of PD-1 inhibitors (such as nivolumab and pembrolizumab) versus PD-L1 inhibitors (such as durvalumab).

“However, regardless of the result of anti-PD-(L)1/CTLA-4 combinations in HNSCC, combinations of immunotherapy or combinations of immunotherapy and conventional therapies are the most promising approaches to solid tumors,” Merlano concluded.

Author: Charles Bankhead is senior editor for oncology and also covers urology, dermatology, and ophthalmology.

Common causes of dysphagia in seniors may differ by sex, study finds

Author: Alicia Lasek

Common causes of swallowing problems may differ significantly between older men and women, according to physician researchers.

In a two-year swallowing clinic study, neuromuscular and esophageal problems were the most frequent causes of dysphagia among 109 study participants, reported Jeremy Applebaum, M.D., from Johns Hopkins University. Many patients (16%) had either diverticula (a soft pouch in the esophagus that can collect food particles), reflux (14%) or scarring caused by radiation treatment (8%). These problems also were associated with significant quality-of-life burden, the researchers added.

Causal differences were also found between the sexes. Men were more likely to have oropharyngeal dysphagia, a difficulty with initiating swallowing as food is introduced to the pharynx and esophagus from the mouth. In contrast, women were more likely to present with esophageal dysphagia, which can have several causes and is typically associated with the sensation of food sticking in the throat or chest after starting to swallow.

Higher rates of smoking and head and neck cancer may explain the prevalence of oropharyngeal problems found in male participants, whereas the esophageal problems in women likely were due to the high prevalence of reflux disease among that cohort, the authors surmised. They did not find significant differences in cause between older age cohorts.

Up to 33% of people age 65 and older are known to have swallowing problems due to physical changes, yet dysphasia also may be the result of underlying disease, the investigators said.

“A complaint of dysphagia in older adults should therefore be regarded as pathologic, especially given the wide spectrum of neuromuscular and structural disorders that increase in prevalence with age,” wrote Applebaum and colleagues. “We hope to inform more nuanced, patient-based approaches to this increasingly important topic,” they concluded.

The study was published in OTO Open: The Official Open Access Journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Researchers take head and neck cancer by the throat

Author: Stuart Layt

Research has identified more weak spots in a deadly type of head and neck cancer that it is hoped will lead to more effective treatments.

Oropharyngeal cancer can affect the base of the tongue, the tonsils, soft palate and parts of the throat, and almost half of all cases in Australia are caused by the human papillomavirus (HPV).

Current immunotherapies target two protein receptors on the cancer; however, they have had mixed success.

Lead researcher Professor Rajiv Khanna from QIMR Berghofer said they had identified four more spots on the genome of the cancer that they believed could be targeted by immunotherapy.

“Everybody has been trying to make immunotherapies that target those two antigens, but what we have found is that while those two are important, we were ignoring some of the other antigens,” Professor Khanna said.

“We took immune cells out of our patients and effectively asked them what they could “see” other than [the two proteins] E6 and E7, and actually they could see others.”

The study analysed immune cells taken from 66 oropharyngeal cancer patients at the Royal Brisbane and Women’s Hospital and the Princess Alexandra Hospital.

Co-lead author Professor Sandro Porceddu, the director of radiation oncology research at the Princess Alexandra Hospital, said they were now developing therapies based on the research.

“We’re already working on developing better killer T-cell immunotherapies that recognise all, or a combination, of these proteins,” Professor Porceddu said.

“Different combinations of the proteins are present on different patients’ cancer cells, so we will develop immunotherapies with different bunches of keys for different patients.”

At present, the cancer is treated with a combination of chemotherapy and radiation therapy, but it is hoped an effective immunotherapy will eventually become the standard treatment.

Oropharyngeal cancers are the sixth-most-common type of cancer worldwide, with US actor Michael Douglas diagnosed with stage four oral cancer in 2010, before going into remission after aggressive radiation treatment and chemotherapy.

Douglas credited HPV for his cancer but later said he was a heavy smoker and drinker, habits that also increase the risk of developing the disease.

In Queensland the incidence rate for the cancer type has increased by 162 per cent in men and 40 per cent in women over a 15-year period, according to data from the Cancer Alliance Queensland.

That is despite the development of the HPV vaccine from Professor Ian Frazer and his team at the University of Queensland in the early 2000s.

However, experts warn the impact of widespread immunisation programs for HPV will not be felt for decades.

The research has been published in the Journal of Experimental Medicine.

Towards the early detection of oral cancers

Authors: Dr Tami Yap and Professor Michael McCullough, University of Melbourne

If you noticed a new dark spot on your shoulder or changes in an old mole – you would know to get it checked out.

But would you know if you had a skin cancer in your mouth?

As our population ages, the diagnosis of oral cancer is increasing. Globally, this devastating cancer affects 750,000 people and has a five-year mortality rate of approximately 50 per cent if not detected and treated early.

The insidious nature of oral cancer means it is often detected at a later stage; up to half of people who are diagnosed with oral cancer have large tumours as oral cancer is often painless and unseen.

A further challenge is the limited tools to detect and monitor potential oral cancers and skin lesions over time; this forces clinicians to remove suspicious lesions by scalpel biopsy and assess pathology. A new research project aims to identify individuals who are likely to develop oral cancer, without invasive biopsies.

The Melbourne University Dental School has partnered with Victorian company OptiScan, to improve screening and early diagnosis of oral cancer.

The project is led by our team at the Melbourne Dental School and uses Optiscan’s state-of-the-art confocal laser endomicroscope (CLE). Known as InVivage ™, the hand-held microscope uses a laser light and confocal optics to painlessly perform “digital biopsies”.

Oral cancer can have a devastating impact on a person’s life – removing a cancer from the mouth and tongue can impact on a person’s speech, their ability to swallow and eat, and ultimately, their self-esteem.

With the hand-held confocal laser endomicroscope (CLE), tissue can be viewed in 3D with 1,000-times magnification.

What we want to ascertain through our trial is how we can use OptiScan’s technology to microscopically see tumour cells in our clinic, helping us to assess the tissue and determine if a biopsy or surgery is required there and then.

Although 95 per cent of the lesions we see are not cancerous, without a biopsy, which can be painful and invasive, it’s very difficult to determine which lesions are cancerous or not. The earlier the diagnosis can be made, and the least tissue we can remove – the better for the patient.

Oral cancers are often preceded by changes in the appearance, such as the colour and thickness of the skin of the mouth. These changes are considered to have the potential to grow an oral cancer and affect as many as one in 20 people. However, only around three to five per cent of people with these changes will develop an oral cancer.

Once a biopsy sample is taken, it’s is assessed by a pathologist to see if there is any cancer present.

Sometimes there are changes in the way the skin is growing, called dysplasia, which tells us there may be an increased risk of cancer developing in the future. Still, this assessment is a limited predictor and can only be made on the small piece of skin that has been sampled.

OptiScan’s confocal laser endoscope allows microscopic visualisation of oral skin in real time.

With the hand-held confocal laser endomicroscope (CLE), tissue can be viewed in 3D with 1,000-times magnification.

This could allow clinicians and surgeons to diagnose cancerous tissue in real time, reducing or eliminating the need to have one or more biopsies taken and sent to a laboratory for analysis.

Alongside trialing the CLE, our project also aims to develop software to comprehensively record an annotated map of the patient’s mouth with Optiscan as well as our other project partner, MoleMap. This means we could compare a patient’s mouth map the next time that they come in, to assess any changes. We can also use special dyes that show us all the cells in the skin surface or another that only binds to molecules that are found more commonly in cancer, identifying potential ‘hot spots’ of skin growth.

Our broader Mouthmap™ project will enable a detailed collection of a large amount data to compare this new CLE technology to diagnosis using standard light microscopy; this has the potential to establish a new standard of diagnosis and allow advancement of both human and computer algorithm-based learning.

Our research aims to provide a solid foundation to advance towards clinical trials and recommendations to changes in standard of care.

The participants in this clinical study will be recruited by invitation from our main oral pre-cancer referral centre, networked with regional community centres where only individuals on healthcare card and pension card holders are eligible for treatment. This is important because lower socioeconomic status ,as well as older age, are both considered risk factors for oral cancer.

Our goal is that this technology will help to reduce the need for scalpel biopsy in the future, allowing for more comprehensive assessment of skin changes in the mouth and earlier detection of oral cancer.

The Melbourne Dental School trial is due to commence in September this year, by referral.

NSAID use may improve overall survival during chemoradiation for patients with HNSCC

Author: Hannah Slater

This study demonstrated a possible advantage in overall survival for patients taking NSAIDs during chemoradiation for head and neck squamous cell carcinoma.

A study published in JAMA Network Open suggested a possible advantage in overall survival (OS) for patients taking nonsteroidal anti-inflammatory drugs (NSAIDs) during chemoradiation for head and neck squamous cell carcinoma (HNSCC).

However, researchers suggested that future studies evaluating this association are warranted.

“This large, retrospective cohort study suggests a significant association with improved OS for patients with HNSCC taking NSAIDs during definitive CRT,” the authors wrote. “While the change in LC with NSAID use was not significant, future studies should continue to evaluate this possibility.”

Overall, 460 patients with HNSCC who were treated with chemoradiation therapy (CRT) at a single institution between January 1, 2005 and August 1, 2017 were included in the study, including 201 patients (43.7%) who were taking NSAIDs during treatment. Patient and tumor characteristics included age, race/ethnicity, smoking status, alcohol use, comorbidities (respiratory, cardiovascular, immune, renal, endocrine), disease stage, human papillomavirus (HPV) status, and treatment duration.

On univariate analysis, NSAID use (hazard ratio [HR], 0.63; 95% CI, 0.43-0.92; P = 0.02) was associated with better OS. Moreover, on Cox regression analysis, after backward selection adjustment for possibly confounding factors such as age, smoking status, primary tumor site, human papillomavirus status, diabetes, stroke, and hyperlipidemia, NSAID use continued to be significantly associated with better OS (HR, 0.59; 95% CI, 0.38-0.90; P = 0.02).

Even further, at 5 years NSAID use was associated with significantly better OS compared with those who did not take concurrent NSAIDs (63.6% [56 of 88 patients]; 95% CI, 58%-73% vs 56.1% [83 of 148 patients]; 95% CI, 50%-63%; P = 0.03).

However, NSAID use was not associated with better disease-specific survival (DSS) in univariate (HR, 0.82; 95% CI, 0.48-1.41; P = 0.47) or multivariate (HR, 0.98; 95% CI, 0.57-1.70; P = 0.44) analysis. NSAID use was also not associated with better response to treatment (HR, 1.44; 95% CI, 0.91-2.27; P = 0.12) or distant failure (HR, 1.12; 95% CI, 0.68-1.84; P = 0.65). Furthermore, change in local control with NSAID use was not found to be statistically significant (HR, 0.59; 95% CI, 0.31-1.10; P = 0.10).

“This suggests the observed survival advantage may be associated with the cardiovascular benefits of NSAIDs rather than any chemoprotective properties they may have, particularly because there was a higher proportion of patients with diabetes and coronary artery disease in the group taking NSAIDs,” the authors wrote. “This is increasingly important because the risk of noncancer death now surpasses that of cancer death, with heart disease being the leading cause of noncancer mortality.”

“The fact that anticoagulants were not associated with improved OS while NSAIDs were suggests that the cyclooxygenase mechanism may be a contributing factor to survival,” the authors continued. “This mechanism may be a combination of local recurrence reduction through cyclooxygenase inhibition and treatment of underlying cardiovascular disease.”

Prior research has suggested that PIK3CA variations may be a clinically useful marker to identify which patients with HNSCC will benefit from NSAID use; however, the investigators suggested that until such testing is routine, the current data indicates that giving daily aspirin to patients with HNSCC who are receiving CRT may be associated with improved survival.

Notably, though the researchers had access to patient comorbidity data, they did not have access to the reason why patients were prescribed regular NSAID use, nor were they aware of the duration of use. However, the majority of patients who were taking NSAIDs at the time of consultation noted that they were taking a “baby” (81-mg) aspirin, which was continued during CRT.

Iovoli AJ, Hermann GM, Ma SJ, et al. Association of Nonsteroidal Anti-inflammatory Drug Use With Survival in Patients With Squamous Cell Carcinoma of the Head and Neck Treated With Chemoradiation Therapy. JAMA Network Open.

Parking fees at cancer treatment centers can substantially impact costs of care

Author: John DeRosier

Parking costs at cancer treatment centers — including those with the highest standard of care — can be a source of financial toxicity for patients and caregivers, according to a research letter published in JAMA Oncology.

“When my husband was treated for cancer, we paid over $15 a day for parking,” Fumiko Chino, MD, radiation oncologist at Memorial Sloan Kettering Cancer Center, told Healio. “These costs were just a small fraction of our total costs for his care, but they seemed unusually cruel. I felt like we were being nickeled-and-dimed when we were at our most vulnerable.

“Many of my patients have told me similar stories; for some of them, parking costs can determine whether they will participate in a clinical trial or will get the recommended treatment for their cancer,” Chino added.

Chino and colleagues obtained parking fees from the 63 NCI-designated cancer treatment centers through online searches or phone calls between September and December 2019 to determine parking costs for the treatment duration of certain cancers.

Researchers documented city cost-of-living score — with New York City as the base city with a score of 100 — median city household income, center address transit score (0-24 = minimal transit options; 90-100 = world-class public transportation) and discount availability. They used a zero-inflated negative binomial model to evaluate associations between parking costs and city variables, and Pearson correlation for binary variables.

Researchers estimated parking costs for treatment of node-positive breast cancer (12 daily rates plus 20 1-hour rates), definitive head and neck cancer (35 1-hour rates), and acute myeloid leukemia (42 daily rates).

Results showed median cost of living score of 75 (interquartile range [IQR], 70.1-83.5), median city household income of $55,295 (IQR, 46,696-60,879) and median transit score of 61 (IQR, 50.8-72.5).

Twenty-five (40%) NCI-designated cancer centers did not provide comprehensive information about parking costs online.

Median parking costs were $2 per hour (IQR, 0-5) and $5 per day (IQR, 0-10).

Twenty centers (32%) offered free parking all day for all patients, and 23 offered free parking for at least the first hour. Forty-three centers (68%) offered free parking for radiation appointments and 34 (54%) had free parking available for chemotherapy appointments.

Median estimated parking costs, including discounts for a course of treatment, were $0 (range, 0-800) for breast cancer and $0 (range, 0-665) for head and neck cancer, and were $210 (range, 0-1,680) for hospitalization for AML.

Researchers found positive associations between daily parking costs — but not hourly parking costs — and city cost of living (coefficient = -0.1; standard error, 0.04; P = .03) and transit scores (coefficient = -0.04; standard error, 0.22; P = .04).

City cost of living appeared negatively correlated with free daily parking ( = -0.33; P = .02), as well as free parking during radiation treatment ( = -0.46; P < .001) or chemotherapy ( = -0.4; P = .003). Transit score also appeared negatively correlated with free daily parking ( = -0.31; P = .03) and free parking during radiation treatment ( = -0.33; P = .02) or chemotherapy ( = -0.34; P = .01).

Median city household income did not appear correlated with any assessed variables.

The potential inaccuracy of costs gathered through phone calls served as a limitation to the study.

“I really do believe that eliminating parking fees is a good way to move forward,” Chino said. “Free parking — or free metro or ride share in cities like New York — would do a lot to improve accessibility to care for some of our patients. It seems silly that something small like parking can make this big of a difference, but it really does cause financial toxicity for vulnerable families.”

For more information:
Fumiko Chino, MD, can be reached at Memorial Sloan Kettering Monmouth, 480 Red Hill Road, Middletown, NJ 07748; email:

Perceptions of telemedicine among head and neck cancer patients

Author: Kaitlyn D’Onofrio

The use of telemedicine has surged amid the COVID-19 pandemic, and it is likely to continue beyond the pandemic. It is important to understand how patients feel about telemedicine, and a full understanding cannot be ascertained through questionnaires. The subject of telemedicine and its perception among head and neck cancer patients was the topic of a recent study.

“The implementation of telemedicine is in general a disruptive process for both the physician and the patient. Throughout this transition, patient satisfaction is an important health care quality metric to study,” the researchers wrote. “While [surveys] are important to capture overall attitudes and information regarding the feasibility of video-based telemedicine visits, survey ranking systems do not capture the nuances of the patient experience.”

The present study included established patients who participated in video-based visits with an otolaryngology-head and neck surgery faculty member between March 25 and April 24. In addition to complete a patient satisfaction questionnaire (Telehealth Usability Questionnaire [TUQ]), patients took part in an unstructured telephone interview focused on their perceptions of telemedicine during the COVID-19 pandemic. Charts were retrospectively reviewed to collect patients’ demographic, disease, and treatment information.

Telemedicine: Good for Accessibility, Most Useful for Established Patients
A total of 100 patients completed the TUQ, and 56 also provided open-ended comments. The mean patient age was 61 years, and most patients (60.7%) were male. About a quarter of patients (n=13) talked about their experience leading up to the telemedicine visit; themes that emerged included anxiety and skepticism.

On the technical side, most patients said connecting was easy, although a few had connectivity and audio issues. Sixteen patients needed help from a family or caregiver.

Just over half of patients (n=29) talked about the doctor-patient relationship. Some patients said that having an established relationship with the doctor was important; others said that the use of video “added to the credibility of the visit.”

About a third of patients (n=18) talked about how the COVID-19 pandemic has affected their feelings on telemedicine. They expressed relief that they had an option that allowed them to communicate with their doctors, and said that telemedicine increased accessibility while not increasing their risk of exposure. It also eliminated barriers to care including “transportation and traffic, overall time required to see the doctor, the cost of gas and parking, and associated anxiety.”

Just under half of patients (n=25) talked about future use; emergent themes included: “the use of telemedicine for triage, patient preferences for in-person versus telemedicine visits, the appropriateness of telemedicine, and a desire for a patient-centered decision to conduct a telemedicine visit.” Again, the patients emphasized that ideally, telemedicine would be used in the case of an established doctor-patient relationship but were not sure how effective it would be for a new patient.

The study was published in Otolaryngology–Head and Neck Surgery.

“Patients identified convenience and cost savings as the primary benefits of telemedicine. Primary concerns included the ability to perform a physical examination. Patients held differing opinions of future use, with many noting they would find it acceptable but only if both patients and providers agree on the appropriateness of telemedicine or in extenuating circumstances, such as the current COVID-19 pandemic,” the researchers summarized.

Jay Aston, singer: ‘I have a leg scar and one on my neck, but it’s a small price to pay for life’

Author: Gabrielle Fagan

Jay Aston says she no longer stresses about “silly little things”. After being diagnosed with mouth cancer in 2018, the former Bucks Fizz star was left wondering whether she would ever sing again – or even survive.

The experience rocked her world. But Aston, part of the original band that stormed to victory in the 1981 Eurovision Song Contest and went on to sell millions of records, is still performing with Mike Nolan and Cheryl Baker in The Fizz, a new version of the group. Before lockdown hit, they’d been busy touring and promoting their latest album, Smoke And Mirrors.

The enforced break has given her time to reflect on the “incredibly tough” two-year journey, which “made me re-evaluate my life”, says Aston.

“Surviving an experience like that makes you realise the simple things and pleasures you took for granted.

“We all get so upset about minor things and miss the fact that whatever’s happening, if you’re here it is a good day.”

Aston (59) who’s among a host of celebrities taking part in The Smiling Sessions – online sing-alongs to entertain care homes residents and isolated elderly people, – recalls the moment doctors revealed she had cancer.

“The whole thing was such a shock and completely devastating. Also I had no idea what effect the surgery would have on my voice,” she recalls. “I’m from a show-business family and singing and dancing is in my DNA and part of my identity, and to have that threatened was demoralising.”

Aston, who lives in the Kent countryside with her husband, musician Dave Colquhoun and their daughter, Josie (17), adds quietly: “I wrote my will. I’ve always felt you have to be a realist and face up to things when they happen. So I decided to plan for the worst but hope for the best.”

Aston had originally been told she had lichen planus, a type of rash, by her dentist back in 2015. “It just looked like a tiny white cobweb on my tongue,” she remembers – but by January 2018, the rash had spread to the back of her tongue.

Lichen planus can affect any part of the body and is generally harmless. However, when certain parts of the mouth are affected, there can be a slightly increased risk of oral cancer, and an exploratory procedure found cancerous cells in Aston’s tongue. A few weeks later, she had a seven-hour operation to remove 40% of her tongue.

Although she shed “tears of joy” when she was told the surgery had left her cancer-free, the road to recovery has been long and painful.

Surgeons created a new tongue using tissue from Aston’s thigh, which was fed into her mouth through her neck.

She required months of physio to regain full speech and projection – although her singing voice was unaffected. Her band mates, Aston says, have been incredibly supportive. The years of acrimony around contractual disputes – she and Baker didn’t speak for 23 years – are clearly behind them.

“We’ve had our moments but we have something special that bonds us together. It was also very emotional to get hundreds of messages of support and good wishes from our fans,” says Aston.

“I recorded as many tracks as possible on our album before the surgery, in case the worst happened and I was never able to return.

“I was actually able to start singing again just three-and-a-half months after the operation. It was nerve-racking at first and I had a lisp, which has now gone, but wonderful to know I could still perform.”

Her surgeons took care with the siting of the tissue graft, to minimise the visible scarring on her leg.

Aston says with a smile: “That’s great, as the band’s still asked to perform that skirt-ripping routine – we’ll probably still be doing it when we’re on our Zimmer frames! I have that leg scar and one on my neck, but it’s a small price to pay for life.”

The relief that she’d survive and be around for her family was overwhelming, she says.

“My biggest fear was that I might leave my daughter, who’s my world. I want to be there for her and to see her grow up, get married and see my grandchildren,” she says.

“My husband was wonderful. He was our rock. Dave’s a Northerner who doesn’t show his emotions but he’s been so strong, which is just what I needed. It wouldn’t have helped me to see him upset. We’ve coped for each other.”

Emotionally, she admits it’s been complicated. “There’s this huge feeling of being so lucky and thankful to have come through it, but you also go through different stages as you recover, when you feel very down because of all you’ve been through, and then you go up again.

“Of course, l’ll always be so grateful that it was picked up early and was treatable. I’d urge anyone with any concern, no matter how small, to check it out with their doctor or dentist.”

She readily admits that having check-ups every three months can still be nerve-racking.

“I’m still dealing with the unknown, which you do when you’ve had cancer. You cannot know for certain it won’t come back. You just hope it won’t. The threat of Covid-19 has, of course, added another level of uncertainty to everyone’s lives,” says Aston.

Her resilience has been honed by her past experiences. In 1984, Aston survived a near-fatal coach crash while on tour with Buck’s Fizz, which left her with temporary paralysis and memory loss.

In the years that followed, she lost both her parents – her mother to bowel cancer and her father to Alzheimer’s.

“Ironically, lockdown’s given me time to step back a bit and chill out, which I think I’ve needed,” she says. “I was so anxious to show I was fine after the operation, I think I pushed myself a little too much physically early on.

There are days still when I don’t have too much energy and have to rest. I have to respect the fact my body is still healing.”

Reflecting on how her attitude to life has changed, she says: “After a lot of soul-searching, you realise there’s no point going over the past. Instead it’s about focusing on the present, and I’m now at the stage where I feel positive about the future.”

She says viewing “footage of the galaxy and recognising its enormity and our tiny place within it” helps her stay balanced. “It takes my mind off things and re-balances my perspective.”

Aston adds: “I’ve never forgotten, as a school girl on holiday with my parents, when a very old lady came up to me and pressed a card in my hand.

“The message on it was, ‘Take risks – chances are you’ll never regret them.’ That was the wisest advice. It told me to get out there and live my life to the full, which I have.”

Jay Aston, along with other celebrities, is participating in The Smiling Sessions – virtual sing a-longs for care home residents. They’re raising funds for tablets so more residents can take part and improve their health and wellbeing during such difficult times for the elderly community.

Cell by cell in focus

Author: Sven Döring

Progress can be measured in two steps in Tobias Meyer’s laser laboratory and can be seen at a glance. In the background is a silver trolley, on top of it two black boxes and a monitor. The matt black compact device on the optical table in front of it is not even a fourth of it in site. Two Medicars, version 2015 and version 2019: a compact microscope for rapid cancer diagnosis during surgery.

“Good news from German cancer research” was the announcement by the German government in August 2019, referring to the “precision through laser light” with which the microscope researched at Leibniz IPHT makes cancerous tissue visible, enabling surgeons to remove tumors even more precisely in the future. The black box contains a light-based tool that can be used to examine the chemical and morphological composition of the tissue. This information is evaluated with artificial intelligence and immediately indicates whether the tumor has been completely removed – in other words, whether the operation was successful.

Tobias Meyer and his team from Leibniz IPHT, Friedrich Schiller University Jena, Jena University Hospital and the Fraunhofer Institute for Applied Optics and Precision Engineering are already continuing their research. They are combining the imaging procedure with a minimally invasive surgical precision tool: for laser-based microsurgery – and a new way to treat cancer in a gentle way. “Our vision,” as Scientific Director Jürgen Popp describes it, “is to use light not only to identify the tumor, but to directly remove it.”

For this purpose, the research team combined CARS imaging with a femtosecond laser for tissue ablation for the first time. Femtosecond laser ablation in which tissue is ablated using pulsed laser radiation, i. e. vaporized, is currently the most precise surgical tool established in ophthalmology, explains Tobias Meyer. On the basis of high-resolution, label-free CARS imaging the researchers were able to selectively ablate smaller, pathologically altered areas in different tissue types with micrometer precision.

The research team is now further developing this approach together with long-standing partners from the University Hospital Jena, the Jena optics companies Grintech and Active Fiber Systems and the globally operating endoscope manufacturer Karl Storz. The aim of the Thera- Optik project (Multimodal Endoscopic Accompanied by the fiber technologists at Leibniz IPHT, the team is now researching solutions to increase the ablation rates and make the lasers even smaller.

At the end of the project, a device is to be developed which, using a combination of endoscope, ablation laser, and hyperspectral wide-field im- aging, will make it possible to treat tumors at sensitive sites gently and precisely. “With this method, we can achieve resolutions in the range of a single cell,” explains Tobias Meyer. “This means that we can selectively remove one cell layer without touching the next one and thus ablate the tumor layer by layer”. Especially in the case of tumors at functional sites in the head and neck area, for example on the vocal cords or along the nerve tracts, this could significantly improve current treatment options and the chances of cure for patients.

Source: Leibniz IPHT

Should we be drinking less?

Author: Anahad O’Connor

Can a daily drink or two lead to better health?

For many years, the federal government’s influential dietary guidelines implied as much, saying there was evidence that moderate drinking could lower the risk of heart disease and reduce mortality.

But now a committee of scientists that is helping to update the latest edition of the Dietary Guidelines for Americans is taking a harder stance on alcohol. The committee said in a recent conference call that it plans to recommend that men and women who drink limit themselves to a single serving of wine, beer or liquor per day. Do not drink because you think it will make you healthier, the committee says: It won’t. And it maintains that drinking less is generally better for health than drinking more.

That message is a departure from previous guidelines, which since 1980 have defined “moderate” drinking as up to two drinks a day for men and one for women. Government agencies have also long defined a standard drink as 12 ounces of regular beer, five ounces of wine, or one and a half ounces of distilled spirits (40 percent alcohol), amounts often exceeded in Americans’ typical “drink.”

Between 1990 and 2010, many editions of the guidelines, which are updated every five years, discouraged heavy drinking and warned pregnant women and people with certain medical conditions not to drink. But they also noted that moderate drinking was linked to fewer heart attacks and lower mortality. The 2010 guidelines mentioned that moderate drinking may even “help to keep cognitive function intact with age.”

The new recommendation would be a victory for experts who have long questioned the health halo around moderate drinking. They say that studies showing it can protect health are deeply flawed, and that any potential cardiovascular benefits would be outweighed by the fact that alcohol is a leading preventable cause of cancer. According to the National Cancer Institute, even one drink a day increases the risk of breast, esophageal and oral cancer.

“This is significant because the committee has finally gotten away from this idea that a small amount of alcohol is good for you,” said Thomas Gremillion, the director of food policy at the Consumer Federation of America, a public interest group that has pushed for cancer warnings on alcohol. “They’re really taking a stand and saying drinking less is always better. That’s the right message and I think they deserve credit for making that change.”

The new advice is not yet final. The advisory panel is expected to include it in a report that it will release publicly in mid-July and submit to the Department of Agriculture and the Department of Health and Human Services. Those two agencies are scheduled to publish the official dietary guidelines later this year.

If accepted, the new recommendation would make the United States the latest country to issue stricter guidelines on alcohol consumption. In recent years, Britain, Australia, France and other countries have issued new guidelines lowering their recommended limits on daily and weekly alcohol intake. Health authorities in those countries have said that recent evidence suggests consuming less alcohol is safer and that even one drink a day increases cancer risk.

The scientific debate over moderate drinking dates at least back to the 1970s, when researchers in California noticed that teetotalers seemed to have more heart attacks than people who drank moderately. In the decades that followed, many observational studies looking at large populations documented what is known as a J-shaped curve between alcohol and mortality from all causes, especially heart disease: Mortality rates dipped for moderate drinkers compared to nondrinkers and then climbed higher among people whose intake exceeded one or two drinks daily.

But observational studies can show only correlations, not causation. And they have other limitations. One major confounding factor is that socioeconomic status is a strong predictor of health and life span — and it tracks closely with drinking levels. Studies show that compared to heavy drinkers and abstainers, people who drink moderately tend to be wealthier and have higher levels of education. They tend to have better health care, exercise more, eat healthier diets, and have less obesity.

One study that compared nondrinkers to moderate drinkers — defined as having two drinks daily for men and one for women — found that 27 out of 30 well established risk factors for heart disease were “significantly more prevalent” among nondrinkers. Rather than causing better health, in other words, moderate drinking may be a marker for higher socioeconomic status and other lifestyle factors that promote a longer life.

Another problem with observational studies is selection bias. In some large studies, people categorized as “nondrinkers” may actually be former heavy drinkers, or they may have health issues that cause them not to imbibe. Studies have found that nondrinkers have higher rates of physical disabilities, psychiatric problems and pre-existing illnesses. When rigorous studies take these factors into account, they find that the protective effect of moderate drinking disappears.

“The appearance of protection vanishes like the mist on an autumn day as the sun comes up,” said Timothy Stockwell, an alcohol researcher and director of the Canadian Institute for Substance Use Research at the University of Victoria. “All of these thousands of studies, when you do a forensic examination of them, most of them have these horrendous flaws and are open to these systematic biases.”

One way to get around these limitations is through genetic studies. Some people carry a genetic variant that disrupts their ability to metabolize alcohol, causing them to develop skin flushing, irritation and other unpleasant symptoms when they drink alcohol. As a result, they tend to abstain or drink very little. If alcohol was good for heart health, these people should in theory have more heart disease compared to others. Instead, as one large analysis published in BMJ in 2014 found, they have “a more favorable cardiovascular profile and a reduced risk of coronary heart disease than those without the genetic variant.”

The study concluded: “This suggests that reduction of alcohol consumption, even for light to moderate drinkers, is beneficial for cardiovascular health.”

Not everyone agrees that the health benefits of moderate drinking are illusory. Alcohol has blood-thinning properties, and red wine in particular contains polyphenols that have beneficial effects on the microbiome, said Dr. Erik Skovenborg, a family doctor and member of the International Alcohol Forum, an international group of scientists who study alcohol and health. Alcohol also raises HDL cholesterol, often referred to as the “good” kind, though recent studies have cast doubt on it being cardioprotective.

Dr. Skovenborg said the observational data makes it clear that moderate drinking is more than a marker for a healthy lifestyle.

“In these studies you have many participants that have all the healthy lifestyle factors,” he said, “and if you add moderate alcohol consumption on top of that, it increases the benefits regarding longer life and fewer health problems.”

Dr. Skovenborg said his general advice to patients who drink is to follow the Mediterranean tradition: Have a little wine with your meals, drink slowly, enjoy it, and don’t drink to get drunk. Exercise regularly, avoid smoking, eat nutritious foods, and maintain a normal weight. “It’s a pattern of things you should be doing, not just one thing,” he added.

Showing definitively that moderate drinking protects heart health requires doing a lengthy clinical trial, one that randomly assigns some people to have a drink daily and others to abstain. In 2014, the National Institutes of Health launched a clinical trial designed to do just that. But it was shut down in 2018 after a New York Times investigation revealed that N.I.H. officials had lobbied beer and liquor companies for funding and suggested that the results of the trial would support moderate drinking. As it turns out, experts have long raised concerns about industry influence on alcohol studies.

Members of the advisory committee declined to comment on their recommendations until their report is released. Dr. Stockwell said he agreed with the one-drink-a-day recommendation but he would word it slightly differently. “I’d probably say seven drinks a week for men and women and no more than two drinks on one day,” he said. “I would have a little flexibility.”

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