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How much does drinking alcohol contribute to US cancer burden?

Source: www.medscape.com
Author: Kristin Jenkins

The first study to estimate the alcohol-related cancer burden on a state-by-state basis provides more evidence that the drinking habits of Americans account for a “considerable” proportion of cancer diagnoses and deaths, researchers say.

“In the United States, on average, alcohol consumption accounts for 4.8% of cancer cases and 3.2% of cancer deaths,” concludes Farhad Islami, MD, PhD, of the American Cancer Society (ACS) and colleagues.

However, the proportion was higher for specific cancer types, with alcohol consumption accounting for an estimated 12.1% of female breast cancers, 11.1% of colorectal, 10.5% of liver, and 7.7% of esophageal cancers, the study showed.

In addition, in 46 states, alcohol accounted for ≥ 45% of oral cavity/pharyngeal and ≥ 25% of laryngeal cancer diagnoses.

The study was published online January 19 in Cancer Epidemiology.

“Implementing state-level policies and cancer control efforts to reduce alcohol consumption could reduce this cancer burden,” the researchers comment.

They noted that restrictive policies on alcohol sales are associated with a reduction in cancer mortality rates and that a recent study showed increasing alcohol controls by 10% was associated with an 8.3% relative decrease in the oropharyngeal cancer mortality rate.

Separating Drinking From Smoking
The study is also one of a growing number to evaluate alcohol consumption and cancer risk in nonsmokers, said Mary Beth Terry, PhD, professor of epidemiology at Mailman School of Public Health, Columbia University, New York City, when approached for comment.

“This is important because the much larger effects of smoking and cancer risk have made it challenging in the past to evaluate the full impact of alcohol consumption,” she told Medscape Medical News. “In the past it was hard to calculate population-attributable fractions for alcohol because a large part of the population smoked and drank.”

“This was a very comprehensive analysis,” added Terry, who was not involved with the study. She pointed out that the authors used sales data in combination with self-reported alcohol consumption “to adjust for the fact that most alcohol consumption is severely underreported.”

For the study, researchers analyzed age-, sex-, and state-specific cancer incidence and mortality data (2013-2016) from the US Cancer Statistics database in adults 30 years of age and older. They also estimated state-level, self-reported age- and sex-stratified alcohol consumption using Behavioral Risk Factor Surveillance System surveys for 2003-2006 .

Large Variation Between States
The study also showed that state-specific estimates for incident cancer cases and cancer deaths varied widely, ranging from 2.1% to 5.0% in men, and from 1.4% to 4.4% in women.

The proportions of alcohol-attributable cancer tended to be higher in New England and the western states and lower in the midwestern and southern states, with two notable exceptions. Delaware had the highest number of alcohol-related cancer cases (6.7%) and deaths (4.5%) among men and women combined, and Utah had the lowest (2.9% and 1.9%, respectively).

The magnitude of the state-to-state variation in cancer burden left the researchers “a bit surprised,” Islami told Medscape Medical News.

“The proportion of cancer cases and deaths attributable to alcohol consumption among women was about three times higher in Delaware than in West Virginia,” he said.

He noted that in the last decade, alcohol consumption among women has increased. “This may make our results even more relevant,” Islami said.

Many adults have limited awareness of the cancer-related risks of alcohol consumption, Islami commented. Others may not take the association seriously but “many pay attention to their doctor’s health recommendations,” Islami said. “Clinicians could have an important role in increasing awareness of the cancer-related risks of alcohol consumption, which could result in a reduction in alcohol-related cancer burden.”

Overall, the proportion of alcohol-attributable cancer cases and deaths was not substantially different from that reported in their 2017 study of national-level estimates, the investigators said. That study was based on sales-adjusted 2013-2014 contemporary exposure data from the National Health Interview Survey. It showed that alcohol consumption accounted for an estimated 5.6% of incident cancer cases and 4.0% of cancer deaths.

“More research is needed to monitor alcohol consumption and the alcohol-related cancer burden to evaluate state-based policies and cancer control efforts,” said Islami. “Further research is also needed to fine-tune proven interventions to increase their efficacy and to identify other effective interventions.”

‘Best Not to Drink Alcohol’
In the meantime, a new, stronger directive on alcohol consumption was issued by the ACS last year (June 2020) in an update of its Guideline for Diet and Physical Activity for Cancer Prevention, the first since 2012.

That guideline recommends “it is best not to drink alcohol,” as previously reported by Medscape Medical News, although it also included the previous recommendation, that men should limit their daily intake to two drinks and women to one drink.

“Guidelines are based on the best available data, but risk does depend on many things, including underlying susceptibility,” Columbia’s Terry told Medscape Medical News. Emerging epidemiological data indicates that independent of daily alcohol consumption, binge drinking may be associated with increased risk of some common cancers, such as breast cancer.

“Alcohol metabolites are known carcinogens. It may be easier to convey a public health message focused on the harmful effects of binge drinking than in a specific daily amount,” Terry said.

Until then, evidence is growing for another disturbing trend: increased alcohol consumption to cope with the SARS-CoV-2 pandemic. Last spring, with many parts of the country in lockdown, 14% of Americans who participated in a national survey said they were drinking significantly more alcohol compared with the same time in 2019. As previously reported by Medscape Medical News, the results showed these increases were most evident in adults aged 30-59, women, and non-Hispanic Whites.

“Alcohol consumption can have significant negative health consequences, so this information suggests another way that the pandemic may be affecting the physical and mental health of Americans,” lead investigator Michael Pollard, PhD, sociologist at the RAND Corporation, said at the time.

More recently, a commentary for Medscape Medical News by F. Perry Wilson, MD, Yale School of Medicine in New Haven, Connecticut, also highlighted increased drinking. Published in the American Journal of Drug and Alcohol Abuse, a survey of 1928 affluent Americans who sheltered in place for an average of 4 weeks showed 60% who self-identified as binge drinkers reported significantly increasing their alcohol intake, as did about 30% of nonbinge drinkers. Depression was the only common factor statistically linked to increased drinking among binge drinkers.

“I think we need to consider that increased alcohol abuse is a potential harm of the social isolation that COVID-19 has forced upon us,” Wilson commented.

And what about physicians? Are they drinking more during the pandemic?

Apparently not. Nearly half of the 12,000 physicians surveyed for Medscape’s Physician Lifestyle & Happiness Report 2021 said they consume less than one drink of alcohol per week and 24% who said they never touch the stuff.

The study was funded by the ACS. Islami and colleagues were all employed by the ACS at the time of the study. The study authors and Terry have also reported no relevant financial relationships.

Cancer Epidemiol. Published online January 19, 2021. Abstract

University of Cincinnati research unveils possible new combo therapy for head and neck cancer

Source: www.eurekalert.org
Author: Research News, University of Cincinnati

Head and neck cancer is the sixth most common cancer worldwide, and while effective treatments exist, sadly, the cancer often returns.

Researchers at the University of Cincinnati have tested a new combination therapy in animal models to see if they could find a way to make an already effective treatment even better.

Since they’re using a Food and Drug Administration-approved drug to do it, this could help humans sooner than later.

These findings are published in the journal Cancer Letters.

Christina Wicker, PhD, a postdoctoral fellow in the lab of Vinita Takiar, MD, PhD, led this research which she says will hopefully extend the lives of patients one day.

“Head and neck cancer, like any cancer, is truly life-altering,” she says. “Head and neck cancer could impact your throat, tongue or nose, and patients often can’t swallow, talk or eat; it truly takes away some of the most social, enjoyable parts of life.”

Researchers in this study combined radiation therapy with a drug (telaglenastat) that stops a key enzyme in a cell pathway that becomes altered in cancer cells, causing those cells to grow rapidly and resist treatment. Wicker says this drug has already been studied in multiple clinical trials to see if it could improve treatment of various cancers.

“Until now, no one has examined if this drug has the potential to improve radiation treatment in head and neck cancer. Most importantly, this drug compound has been well tolerated by patients and causes minimal side effects,” she says.

Using animal models, researchers found that the drug alone reduced the growth of head and neck cancer cells up to 90%, and it also increased the efficacy of radiation in animals with head and neck tumors by 40%.

“With these results, and especially with previous clinical trials showing that the drug is well tolerated by patients, there is the potential to move more rapidly into head and neck cancer clinical trials,” Wicker says. “In the future, we hope this drug will be used to make radiation treatments for head and neck cancer even more effective.”

Currently, the most common treatment for that cancer is radiation therapy, but the cancer eventually returns in up to half of patients, Wicker says, and often it doesn’t respond as positively to treatment the second time around.

“When [traditional] drugs are less effective, cancer growth becomes difficult to control, which can lead to the cancer quickly spreading to other organs,” she says. “It is very important that scientists and clinicians develop new cancer treatments to improve treatment of this type of cancer, and hopefully our findings will provide one more option to help patients.”

Research applies Raman spectroscopy to oral cancer diagnostics

Source: www.photonics.com
Author: staff

According to research from the University Medical Center Hamburg-Eppendorf, Raman spectroscopy may provide early detection of oral squamous cell carcinoma. One of the most common cancers, oral squamous cell carcinoma is often undetected until a late stage.

Currently, clinically apparent, conspicuous mucosal lesions of the oral cavity require initial conservative treatment and monitoring. If they persist, surgical biopsy is used to make a diagnosis.

“Our study shows the potential of Raman spectroscopy for revealing whether a lesion is cancerous in real time,” said research team leader Levi Matthies. “Although it won’t replace biopsies any time soon, the technique could help reduce the lapse of valuable time as well as the number of invasive procedures.”

The researchers used a variation of Raman spectroscopy known as SERDS (shifted excitation Raman difference spectroscopy), which is capable of analyzing tissues that exhibit strong background fluorescence. To test the method, they designed a compact and portable Raman sensor consisting of a tunable diode laser, a fiber-coupled spectrometer, and a Raman probe. The scientists used the device to analyze unlabeled biopsy samples from 37 patients at 180 measurement locations.

To classify the raw data, the team trained and tested computer models, ultimately distinguishing oral squamous cell carcinoma from nonmalignant lesions with an accuracy of over 88%, and from healthy tissue with an accuracy of over 89%. The majority of spectral features used to distinguish malignant and nonmalignant lesions came from protein and nucleic acid molecules.

“Our results show that this approach is a promising candidate for objective, chair-side diagnosis of oral cavity lesions in real time without the addition of labeling agents,” Matthies said. “It could help reduce the diagnostic gap between clinical exam and invasive biopsy.”

With further development, the researchers say the approach could be expanded to aid in the classification of precancerous conditions, grading the severity of dysplastic tissue aberration and distinguishing various oral lesion subtypes. Currently, the researchers are working to increase the speed of the method to support real-time diagnosis.

The research was published in Biomedical Optics Express (www.doi.org/10.1364/BOE.409456).

Top cancer surgeon urges public to get mouth ulcers checked

Source: www.dentistry.co.uk
Author: staff

A top cancer surgeon is calling on people with mouth ulcers and neck lumps to get their symptoms checked. This follows fears from dentists that mouth cancer cases may have gone undetected as a result of the COVID-19 pandemic. Despite the fact that a new international study suggests patients undergoing surgery for head and neck cancers are at no extra risk when it comes to COVID-19 transmission.

Professor Richard Shaw is a consultant and head and neck cancer surgeon at Liverpool University Hospitals NHS Foundation Trust.

He is calling on the public to act fast if they notice any symptoms. These include neck lumps, mouth ulcers, mouth or throat lumps, difficulty swallowing and a hoarse voice.

Don’t delay
‘We know that it can be scary to come to a hospital or any healthcare setting at the moment. People are putting off that trip to the GP and waiting that bit longer to see if their symptoms go away,’ he said.

‘The findings of this study are really important because we can now assure people who need head and neck cancer surgery that it is safe, even during the pandemic.’

He added: ‘Time is of the essence with head and neck cancer. The sooner it is diagnosed the sooner we can treat it – and if we catch it early then the curative surgery required is much less invasive.

‘My message to anyone concerned about symptoms is to get them looked at by a health professional without delay. It could make all the difference.’

Drop in mouth cancer referrals
Last year, data from the Oral Health Foundation revealed oral cancer referrals have dropped 33% since the pandemic hit.

The number of patients referred for possible mouth cancer fell dramatically from the 2,257 in the six months before March 2020. In the six months after, the figure dropped to just 1,506.

Six out of the seven NHS trusts analysed witnessed a drop in referrals during this same period.

Timing and intensity of oral sex may affect risk of oropharyngeal cancer

Source: www.eurekalert.org
Author: Research News

Human papillomavirus (HPV) can infect the mouth and throat to cause cancers of the oropharynx. A new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society, has found that having more than 10 prior oral sex partners was associated with a 4.3-times greater likelihood of having HPV-related oropharyngeal cancer. The study also shows that having oral sex at a younger age and more partners in a shorter time period (oral sex intensity) were associated with higher likelihoods of having HPV-related cancer of the mouth and throat.

Previous studies have shown that performing oral sex is a strong risk factor for HPV-related oropharyngeal cancer. To examine how behavior related to oral sex may affect risk, Virginia Drake, MD, of Johns Hopkins University, and her colleagues asked 163 individuals with and 345 without HPV-related oropharyngeal cancer to complete a behavioral survey.

In addition to timing and intensity of oral sex, individuals who had older sexual partners when they were young, and those with partners who had extramarital sex were more likely to have HPV-related oropharyngeal cancer.

“Our study builds on previous research to demonstrate that it is not only the number of oral sexual partners, but also other factors not previously appreciated that contribute to the risk of exposure to HPV orally and subsequent HPV-related oropharyngeal cancer,” said Dr. Drake. “As the incidence of HPV-related oropharyngeal cancer continues to rise in the United States, our study offers a contemporary evaluation of risk factors for this disease. We have uncovered additional nuances of how and why some people may develop this cancer, which may help identify those at greater risk.”

Full Citation:
“Timing, number, and type of sexual partners associated with risk of oropharyngeal cancer.” Virginia E. Drake, Carole Fakhry, Melina J. Windon, C. Matthew Stewart, Lee Akst, Alexander Hillel, Wade Chien, Patrick Ha, Brett Miles, Christine G. Gourin, Rajarsi Mandal, Wojciech K. Mydlarz, Lisa Rooper, Tanya Troy, Siddhartha Yavvari, Tim Waterboer Nicole Brenner, David W. Eisele, and Gypsyamber D’Souza. CANCER; Published Online: January 11, 2021 (DOI: 10.1002/cncr.33346).

Factors identified for poor long-term survival in RT-treated patients with oropharyngeal cancer

Source: www.cancertherapyadvisor.com
Author: Susan Moench, PhD, PA-C

Specific patient- and treatment-related factors were identified as potential survival detriments for patients with a history of oropharyngeal cancer (OPC) who received radiation therapy (RT) and were alive for at least 5 years following diagnosis, according to findings from a retrospective database review published in Cancer. Specifically, older age at diagnosis (≥55 years; standardized mortality ratio [SMR], 3.68), status as a current or former smoker (SMR, 3.28 vs 7.43), and the presence of tonsil (SMR, 4.39) or base of tongue tumors (SMR, 3.10) or category T4 tumors (SMR, 5.43) correlated with a higher risk for death.

Previous research has demonstrated that patients with head and neck cancers who remain recurrence-free for 5 years following diagnosis have a very low risk of disease recurrence. However, less is known about the conditional long-term survival of this group of patients, represented by the 2-, 5- and 10-year overall survival (OS) probabilities for those without evidence of disease recurrence 5-years post-diagnosis. Furthermore, patient, disease-, and treatment-related factors associated with long-term survival in these patients are also not well understood.

Of the 1699 patients included in this analysis, all were newly diagnosed with squamous cell carcinoma OPC between 1980 and 2012, had no cancer event for the 5 years that followed OPC diagnosis, and had been treated with RT without surgery at the University of Texas MD Anderson Cancer Center in Houston, Texas.

Baseline characteristics of this patient cohort included a median age of 60 years. Most of the participants were men (>80%) and 55.9% of patients in the cohort were classified as a current/former smoker. Over 90% of patients were diagnosed with cancer at the base of the tongue or disease that involved the tonsil, and approximately two-thirds of patients had N2/N3 disease. Intensity-modulated radiation therapy (IMRT) was administered to 63.4% of patients. No evidence of disease recurrence was reported for 95% of the cohort at baseline.

At a median follow-up time of 6.7 years following 5 years of recurrence-free survival, the unadjusted 2-, 5-, and 10-year conditional OS rates for the overall patient cohort were 94%, 83%, and 63%, respectively. Of note, these conditional OS rates were lower than the survival rates of the general population.

The standardized mortality ratios (SMRs) for all-cause death, representing the ratio of the observed number of deaths in the study cohort and the number of deaths that would be expected in the general population, controlled for study year, age, and sex, was 3.95 for the full-study population (P <.0001). An analysis of SMRs for specific patient subgroups further revealed that the SMRs were 7.43, 3.28, and 2.75 for current, former, and never smokers, respectively (all P <.0001). The SMRs were 2.34 and 5.17 for patients treated with and without IMRT (all P <.0001). Regarding Gy doses, the SMRs were 2.43 for patients who received RT doses of 66 Gy or less, 4.40 for those who received doses of 66 to 70 Gy, and 4.97 for those who received doses exceeding 70 Gy, respectively (all P <.0001). Among those who received chemotherapy, the SMR was 3.65; in patients whose treatment regimen did not include chemotherapy, the SMR was 4.16 (all P <.0001). In their concluding remarks, the study investigators noted that “the overall 10-year conditional survival rate (15 years from diagnosis) was 63% among 1699 patients with OPC treated with radiation and cancer-free 5 years after diagnosis. Patients treated with IMRT and those with less tobacco exposure had better outcomes but still had poorer outcomes when compared with the general population.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry and/or the medical device industry. Please see the original reference for a full list of disclosures.

Reference
Dahlstrom KR, Song J, Thall PF, et al. Conditional survival among patients with oropharyngeal cancer treated with radiation therapy and alive without recurrence 5 years after diagnosis. Cancer. Published online December 11, 2020. doi:10.1002/cncr.33370

Providence performs first ‘Jaw in a Day’ surgery in Oregon

Source: www.kgw.com
Author: Brittany Falkers

The innovative procedure for patients with oral cancers offers a faster recovery and better cosmetic results.

Click here to watch

 

Terry Sambrailo is strolling into the new year with a new perspective on her health.

“The worst is all over now, it’s behind me,” she said.

Sambrailo lives in Idaho but is staying with friends in Hillsboro while she recovers from a first-in-Oregon procedure for oral, head and neck cancer patients.

“I think it’s wonderful and I’m just fortunate that I was a good candidate for it,” Sambrailo said. The 74-year-old was diagnosed with cancer in her left jaw last year. It started with a toothache.

“And then another toothache and that’s when we finally did the biopsy and we found out it was more than just tooth. It was the cancer in the bone,” she said.

She found a team of specialists and surgeons working through Providence Cancer Institute in Portland with an innovative new procedure called “Jaw in a Day.”

“It took a heck of a team to do it,” Sambrailo said.

Leading that team were Providence head and neck oncologic and microvascular reconstructive surgeons Ashish Patel, M.D., D.D.S., and Baber Khatib, M.D., D.D.S., F.A.C.S.

“I think for lack of a better medical word, it is really cool,” Dr. Khatib said. “The technology behind this is phenomenal.”

A diagnosis of oral, head or neck cancer can mean a series of surgeries to remove the tumor, rebuild the jaw and teeth and then implant new teeth. That can take one to two years.

During the process, the patient has no teeth for six months to a year. Not only does this severely affect their ability to talk and chew, but also their mental health and ability to interact with others.

“One of the devastating things with oral cancer is that – not only does it require this large removal of the area of the cancer, but this can affect the way patients look, speak, interact with people afterwards, and this is a lifelong, what used to be a disfiguring type of surgery,” Dr. Khatib said.

The “Jaw in a Day” procedure can accomplish what used to take about a year in a single day. The patient undergoes a complex procedure that removes the tumor, rebuilds the jaw using the patient’s fibula (calf bone) and implants new teeth within hours.

“I was able to use these cutting guides on the fibula, cut it into a shape that looked pretty natural to what her original jaw looked like and then put in these dental implants all at the time of the surgery,” Dr. Khatib said. “Being able to give them teeth does more than just give them a smile, which is a pretty significant thing in itself, but it offers them an ability to chew, to swallow and articulate so much better.”

Providence has used this procedure before on non-cancerous tumors, but now it is available for patients like Sambrailo. She was the first patient on the West Coast to receive it for her cancer treatment.

She’s still recovering and will need restorative dentistry in the months ahead but is excited about her prognosis.

“Your body, at 74, doesn’t turn around real fast,” Sambrailo said. “But I probably saved nine months to a year, rather than having it the old way.”

Learn more about oral, head and neck cancers and the latest treatments at Providence here: providenceoregon.org/hncancer

2020-12-31T07:48:53-07:00December, 2020|Oral Cancer News|

Is poor survivorship care driving high second-cancer risk?

Source: www.medscape.com
Author: Kristin Jenkins

In the United States, men and women who survive adult-onset cancers for at least 5 years are at significantly increased risk of developing and dying from new primary cancers, particularly those driven by smoking and obesity, a new study shows.

“This was disturbing but at the same time provides tremendous opportunities for cancer prevention and control, not only to mitigate the subsequent cancer risk but also to minimize comorbidities,” lead author Hyuna Sung, PhD, of the American Cancer Society in Atlanta, Georgia, told Medscape Medical News.

“The importance of smoking cessation, weight control, physical activity, and other factors consonant with adoption of a healthy lifestyle should be consistently emphasized to cancer survivors,” Sung said.

Results from a retrospective analysis of the most recent Surveillance, Epidemiology, and End Results (SEER) data from a cohort of 1.5 million survivors of first primary cancers (FPCs) show that male survivors — excluding those with prostate cancer — had a 45% higher risk of dying from any subsequent primary cancer (SPC) compared with men in the general population without a history of cancer.

Female survivors had a 33% higher risk of any SPC-related mortality, the study authors report in the Journal of the American Medical Association.

A significant proportion of the total incidence and mortality from SPCs was made up of smoking- or obesity-associated SPCs, the analysis shows.

“The risks of smoking-related SPCs were commonly elevated following many types of smoking-related FPCs, suggesting the role of smoking as a shared risk factor,” the researchers say.

Overall, four common smoking-related SPCs — lung, urinary bladder, oral cavity/pharynx, and esophagus — accounted for 26% to 45% of the total SPC incidence and mortality. Lung cancer alone accounted for 33% of the SPC-associated mortality in men and 31% of the mortality in women.

As previously reported by Medscape Medical News, second lung cancers occurring up to a decade after the first are on the rise, supporting long-term surveillance in survivors.

The current study also shows that in both men and women, four common obesity-related cancers — colorectal, pancreatic, uterine and liver — comprised 22% to 26% of the total SPC mortality.

“Survivorship care guidelines recommending health promotion need wider dissemination and implementation in oncology and primary care,” the study authors write about recommendations from the cancer society.

The investigators point out that in spite of evidence that a body mass index beyond the range of normal in survivors of breast and colorectal cancer increased risk of second obesity-associated cancers, many patients say they have never discussed with a doctor how to modify their lifestyle for a healthy body weight.

In 2018, the National Cancer Institute (NCI) reported that 67% of US cancer survivors were overweight or obese, Sung and colleagues note.

In an accompanying editorial, Patricia Ganz, MD, and Jacqueline Casillas, MD, of the David Geffen School of Medicine at UCLA, Los Angeles, California, agreed that the current study findings indicate “research and implementation of evidence-based interventions to promote smoking cessation and energy balance are a priority.”

The editorialists also point to issues of poor communication in clinical practice. “Among patients who survive a primary cancer, concern about recurrence, especially metastatic disease, is extremely common; however, information about future risk for subsequent primary cancers is seldom communicated to these patients, leading to missed opportunities to prevent or detect SPCs at an early stage.”

Close collaboration with primary care physicians during the early follow-up period is “a must,” Ganz told Medscape Medical News.

Oncologists should start the discussion right after initial treatment, when survivors are looking for ways they can prevent cancer recurrence or the development of new cancer, Ganz suggests.

“The ones I worry about the most are the young adults who could really benefit from the prevention outlook that primary care clinicians espouse,” she says, citing a 2016 study.

“If they continue to smoke or gain weight, that increases their risk of SPCs but also of comorbid chronic conditions…so it’s very important for them to get into the hands of a primary care physician. This issue is in the primary care provider court.”

Reorganization of Care and Payment Needed
For the study, Sung and colleagues analyzed data from 12 SEERS registries of FPC survivors diagnosed between 1992 and 2011. All patients had survived 5 years or more after initial diagnosis and had been followed to the end of 2017. Mean follow-up was 7.3 years.

The incidence and mortality of SPCs per 10,000 person-years were expressed as a standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with expected risk in the general population.

A total of 30 FPC types were identified, including 12 smoking-related cancers and 12 obesity-related cancers.

In men, the highest risk of developing and dying from any SPC was estimated among survivors of laryngeal cancer (SIR 1.75) and gallbladder cancer (SMR 3.82), and among female survivors of laryngeal cancer (SIR 2.48; SMR 4.56).

Compared with men in the general population without a history of cancer, male survivors had an overall risk of developing any SPC that was significantly higher for 18 of the 30 FPC types. Male survivors also had an overall mortality risk for any SPC that was significantly higher for 27 of 30 FPC types.

This increased risk pattern looked much the same in female survivors when compared with women in the general population without cancer. The overall risk of developing and dying from any SPCs was significantly higher in female survivors for 21 and 28 of 31 FPC types, respectively.

The most common SPCs — after lung cancer — included colorectal cancer (8.8% of male survivors); pancreatic cancer (8.5% of male and 9.4% of female survivors); non-Hodgkin lymphoma (6% of male survivors); and breast cancer (5.8% of female survivors).

The study also shows that the risk for alcohol- and infection-related cancers was significantly higher following a diagnosis of most alcohol- and infection-related cancers.

These findings also have implications for reducing the economic burden of care, Sung and colleagues say.

“With the growing number of long-term survivors, the costs of treating patients with multiple primary cancers will increase, amplifying financial burden for cancer survivors and their families, particularly among elderly persons who may be living on fixed incomes. This consideration also has implications for the Medicare program, the primary payer for the population aged 65 years and older, as well as other health care payers,” the authors write, citing related financial research.

When it comes to improving outcomes for cancer survivors, “SPCs are just the tip of the iceberg,” Ganz warns. We will need some reorganization of healthcare delivery and payment schemes to make it happen, I think.”

She notes that recommendations for long-term survivorship care after cancer treatment were summarized following the 2017 National Cancer Policy Forum Workshop. Since then, “there has not been much movement,” Ganz says.

Current NCI-funded studies of innovative survivorship care planning and implementation are important, but results will not be forthcoming for at least 5 more years, she points out. “We really need more immediate efforts to transform care delivery.”

This study was funded by the American Cancer Society. Sung, study coauthors, and editorialists Ganz and Casillas have disclosed no relevant financial relationships.

JAMA. Published online December 22, 2020. Full text

2020-12-30T11:53:06-07:00December, 2020|Oral Cancer News|

Study reveals low risk of COVID-19 infection among patients undergoing head and neck cancer surgery

Source: www.eurekalert.org
Author: news release

A recent international observational study provides important data on the safety of head and neck cancer surgery during the COVID-19 pandemic. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The study is part of the COVIDSurg Collaborative, an initiative to describe surgical practices during the early period of the pandemic, when many hospitals had limited capacity and when it was unclear whether it was safer to delay or continue in-hospital cancer treatments.

“The problems were particularly acute in head and neck cancer surgery because for many cases, cure is dependent on surgery, but there was great concern about spreading infection from aerosol-generating procedures in the airway,” said corresponding author Richard J. Shaw, MD, FDS, FRCS, of The University of Liverpool Cancer Research Centre, in the U.K.

Professor Shaw and his colleagues in the COVIDSurg Collaborative examined information on 1,137 patients with head and neck cancer undergoing potentially curative surgery in 26 countries. The most common sites were the oral cavity (38 percent) and the thyroid (21 percent). The death rate within 30 days after surgery was 1.2 percent, a rate that would be normally expected in this patient population, without a pandemic. Also, 29 (3 percent) patients tested positive for COVID-19 within 30 days of surgery; of these 13 (44.8 percent) developed severe respiratory complications and three (10.9 percent) died. According to Professor Shaw, clinicians now know that these risks can be minimized with precautions such as staff testing, infection control measures, and vaccination.

Patients were more likely to test positive for COVID-19 when they lived in communities with high levels of COVID-19, when they had oral tumors, and when they received a tracheostomy (an opening created in the neck to facilitate placing a tube into the windpipe).

“The early consensus was that head and neck surgery was very risky for patients, particularly less fit or elderly patients, or those who required complex procedures or reconstructive surgery,” Professor Shaw said. “Our data are reassuring in this regard, showing that there is no additional risk of COVID-19 for these groups.”

The investigators noted that insights from the study are especially important now, as many regions are experiencing a second wave of COVID-19 spread. “Data from the COVIDSurg Collaborative have clarified the measures required to make cancer surgery safe, and critically, to inform priorities for both patients and healthcare systems,” said Professor Shaw. “For patients with head and neck cancer, the tumors present a much greater threat to life than the risk of developing COVID-19, assuming precautions are taken.”

2020-12-21T21:32:31-07:00December, 2020|Oral Cancer News|

Agusta University Speech Therapy program helps cancer patients with speech and swallowing problems

Source: www.augustachronicle.com
Author: Jozsef Papp, Augusta Chronicle

After getting surgery in April for cancer of the oral cavity, Lenny Schaeffer was having problems opening his mouth wide enough to eat anything larger than a grape.

He went through the whole process: surgery, chemotherapy and radiation therapy. During that process, he lost his ability to open his mouth, and it even affected his speech.

An oncologist and his radiation therapist informed him of a new program, speech therapy, at the Georgia Cancer Center at Augusta University that could help him.

“What the speech therapy program did is basically give me exercises to do to increase the flexibility that I have in my mouth,” he said. “It allows me to eat better, more kinds of food and also improve speech.”

Dr. Sarah Smith, a speech pathologist at the Georgia Cancer Center, said the program is aimed at helping cancer patients like Schaeffer, patients who have cancer of the neck and mouth area and are suffering from exposure to radiation during their treatment. As a National Cancer Center Network Facility, the center was called to have a multidisciplinary approach to treating cancer, Smith said.

Smith was moved to the cancer center in the summer, mainly to keep cancer patients from walking from the center to the hospital because of COVID-19.

“Treating head and neck cancer is very different than treating other types of disabilities,” she said. “When cancer patients come to the cancer center, we offer a variety of providers, right on site, versus trying to drive all over Augusta and figure out how to get a hold of a dietitian or an occupational therapist that understands cancer or speech therapist that understands cancer.”

Smith said they try to engage patients before surgery or treatment so patients can understand what’s going to happen and have peace of mind knowing help is available. She said radiation in the neck and head area can get rid of the cancer, but a lot of patients don’t realize it can cause speech problems and difficulty swallowing.

“Somebody can survive cancer, but that doesn’t mean they’re going to be in the same condition as before the disease. The treatment options all have negative consequences, so we want to be there to restore quality of life,” Smith said. “The goal is that we would see them before they start treatment to discuss what the treatment is going to do to their speech and their swallowing.”

Smith said the reality is that the speech therapy program needs to be rigorous because treating cancer is rigorous. The program requires a lot of work from the patient’s side to combat radiation and all the changes that come from surgery.

Over the past four months, Schaeffer had three sessions with Smith.. He said he was given exercises that have allowed him to eat better and more kinds of food, and his speech has improved.

“After doing the exercises that were given to me, now I can open my mouth to a normal amount so I can pretty much eat any food that I want to, at this time,” he said. “It just helps me speak better because of the enhanced range of motion.”

Schaeffer said he has been very impressed with the program. He said Smith shows that she cares about her patients and is eager to help any of them achieve the results they want.

He encourages those who might have similar programs to learn about the program and get the help they need, just like he did.

“I would recommend anybody that has a need for speech therapy to contact the program at the Georgia Cancer Center and at least do a consult of what may available to them,” he said.

2020-12-20T20:37:18-07:00December, 2020|Oral Cancer News|
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