Standard therapy prevails in head & neck cancer trial

Source: 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 [...]

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

Source: 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 [...]

Researchers take head and neck cancer by the throat

Source: 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 [...]

Towards the early detection of oral cancers

Source: 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”. THE TECHNOLOGY OF CANCER DETECTION Oral cancer can have a devastating impact on a person’s life – removing [...]

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

Source: 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 [...]

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

Source: 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 [...]

Perceptions of telemedicine among head and neck cancer patients

Source: 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 [...]

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

Source: 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 [...]

Cell by cell in focus

Source: 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 [...]

Should we be drinking less?

Source: 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 [...]

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