Oral Cancer News

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

Source: www.healio.com
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: chinof@mskcc.org.

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Perceptions of telemedicine among head and neck cancer patients

Source: www.docwirenews.com
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.

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

Source: www.belfasttelegraph.co.uk
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.

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Cell by cell in focus

Source: www.biophotonics.world
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

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Should we be drinking less?

Source: www.nytimes.com
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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Surgery, radiation yield similar efficacy for early squamous cell carcinoma of lip

Source: www.healio.com
Author: Earl Holland Jr.

Both surgery and radiation therapy were beneficial methods of treating early-stage lip squamous cell carcinoma, according to findings presented at the American Academy of Dermatology virtual meeting.

Kevin Phan, MD, of the dermatology department at Liverpool Hospital, Sydney, Australia, and Mahmoud Dibas, MD, of Sulaiman Al Rajhi Colleges, College of Medicine, Saudi Arabia, sought to examine the survival rates in low-stage lip squamous cell carcinoma (SCC) between patients who had surgery alone and patients who had radiation therapy alone.

“Squamous cell carcinoma of the lip composes 25% to 30% of all oral cancers,” the authors wrote. “Lip SCC is often detected at an early stage, due to the highly visible location and slow growth pattern.”

Results from the Surveillance, Epidemiology, and End Results database between 2010 and 2014 were analyzed. Overall survival and cancer-specific survival were measured.

The researchers identified 900 patients with early-stage lip SCC who had received either radiation alone (36 patients) or surgery alone (864 patients).

Patients who underwent surgical procedures had better overall survival and cancer-specific survival rates compared with patients who had radiation alone, the study found. The treatment modality did not have a significant effect on either survival rate; the radiation-alone group had an adjusted hazard ratio of 1.94 (95% CI; 0.83-4.53), while the surgery-alone group had an adjusted hazard ratio of 1.04 (95% CI; 0.07-15.55).

“Our results support the notion that surgery and [radiation therapy] appear to be equally effective in treating early-stage lip SCC,” the researchers wrote.

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Engineered killer immune cells target tumours and their immunosuppressive allies

Source: medicalxpress.com
Author: eLife staff

Scientists have engineered natural killer immune cells that not only kill head and neck tumor cells in mice but also reduce the immune-suppressing myeloid cells that allow tumors to evade the immune response, according to a new study in eLife.

The engineered cell therapy could be used as an alternative approach for treating cancer in patients for whom previous immunotherapy based on the activation of T cells has failed. These findings are reported by researchers at the U.S. National Institutes of Health (NIH) in Bethesda, Maryland.

In recent years, treatments called T-cell therapy or CAR-T cell therapy have been approved to treat blood cancers, and many others are now in development for other forms of cancer. However, these T-cell therapies rely on the ability to reprogram a patient’s own T cells to express a chimeric antigen receptor (CAR) that targets tumor cells. This process of reprogramming a patient’s own T cells is expensive and laborious.

High affinity natural killer cells (haNKs) represent potential ‘off-the-shelf’ cell therapies that do not rely on reprogramming a patient’s own immune cells. The same cells could be produced in mass and potentially given to anyone. But the presence of immune-suppressing myeloid cells in the tumor microenvironment remains a barrier to effective immunotherapy, including haNK cell-based treatment.

To address this barrier, researchers from the NIH’s National Institute on Deafness and Other Communication Disorders (NIDCD) and National Cancer Institute have utilized haNKs expressing a CAR that targets a molecule called programmed death ligand 1 (PD-L1). PD-L1 is a well-known culprit that cancer and immunosuppressive myeloid cells produce in high amounts to dampen down the immune system.

Led by senior author Clint Allen, Principal Investigator, Section on Translational Tumor Immunology, NIDCD, the team tested the engineered PD-L1 haNKs versus ordinary haNKs against human and mouse head and neck cancer cells. They found that the haNKs expressing the PD-L1 CAR kill mouse and human tumor cells to a greater degree than haNKs without the CAR, and that this ability was retained even if they had already been exposed to cells carrying PD-L1 before. This is important because natural killer cells are known to become ‘exhausted’ after killing target cells.

In mice with head and neck tumors, the haNK cell-based therapy cured the mice in 30% of cases and slowed the growth of tumors in the rest of the mice, without causing toxicity. Treatment with haNKs also reduced the numbers of immunosuppressive myeloid cells that carry PD-L1 within the tumor, while having no effect on other immune-boosting white blood cells.

To investigate whether this effect on the immune cells also occurred in patients, the team incubated white blood cells from people with advanced head and neck cancer with the PD-L1 haNK cells. As they saw in the mice, the immunosuppressive myeloid cells that carry PD-L1 were significantly reduced after treatment with the PD-L1 haNK cells. This suggests that this treatment can both directly kill tumor cells and remove the immunosuppressive myeloid cells that prevent conventional immunotherapies from working.

These findings suggest that haNK cells expressing a PD-L1 CAR may overcome some of the limitations of conventional immunotherapy that relies on T-cell activation, and could be used in patients who are predicted to be insensitive to or have failed existing immunotherapy treatments. The researchers say the next steps would be to take this treatment into the clinic to explore the safety of PD-L1 haNKs in people with advanced or recurring cancer, and to see whether combining haNK cell therapy with other immunotherapies that activate T cells can enhance treatment response.

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E-cigarettes found to cause change in mouth bacteria – which could lead to gum disease or oral cancer

Source: theconversation.com
Author: Beth Daley

E-cigarettes are a popular alternative to smoking, but we still know very little about the effects of them on our health. While numerous studies have explored the effect of e-cigarettes on our lungs, heart, and overall health, one important and often overlooked consideration is what effect they have on our microbiome. But a recent study has found e-cigarettes change the bacteria in our mouths. These bacterial changes can lead to disease, if left unchecked.

Our microbiome is the living community of bacteria, fungi, and viruses that keep us healthy. We often hear a lot about our gut microbiome, but our oral microbiome is probably just as important to our overall health. It’s the second and most diverse microbiota next to the gut, home to over 1,000 species of microbes. It’s the gateway to the rest of our digestive system and plays a key role in helping us break down foods.

Our oral microbiome also wards off potentially harmful microbes by preventing them from reproducing. A healthy oral microbiome reduces the chances of developing infections or disease.

A recent study in Science Advances(1) investigating the effect of e-cigarettes on our oral microbiome found that e-cigarettes have a negative impact on the diversity of the bacteria present. They also cause an immune response from cells, which can lead to long-term damage to the surrounding cells.

Our oral microbes are not only the first to experience e-cigarette vapour, they’re also exposed to higher concentrations of the chemicals. This arguably makes them most likely of any of the body’s microbes to experience the negative effects of e-cigarettes. Changes in the balance of our mouth microbes can lead to some severe diseases, such as tooth decay and gum disease, or leave us susceptible to infections from localised gum disease that can trigger heart disease or respiratory infections or systemic infections like sepsis, which can be fatal. Some of these infections and diseases have also been associated with oral cancers.

For this particular study, 123 participants were recruited and split into five groups: smokers, non-smokers, e-cigarette users, former smokers currently using e-cigarettes, and those that use both. The team collected dental plaque samples to find out more about the microbes present and the genes they have, as well as fluid from the gums to know how the human body has reacted to these microbes. They also grew bacteria in the lab after exposing them to cigarette smoke and e-cigarette vapour.

Bacteria changes
The study found that those who used e-cigarettes had very similar species of microbes, suggesting e-cigarettes played a role in how the microbial community forms and exists. However, there were some significant differences in the smokers group, non-smoker group and e-cigarette groups, all of which had unique oral microbiomes.

When they looked at groups of people that switched from smoking to e-cigarettes and former smokers, they found their microbiota to be very similar – but they were still very different compared to non-smokers. Although this study didn’t specify which bacterial species were affected, even small changes from the healthy bacteria would likely result in negative effects overall. Gram negative bacteria, which are typically considered the “bad microbes”, were common between smokers and e-cigarette users.

This was also the case when the team did lab studies to see what effects e-cigarette vapour and cigarette smoke had on how bacteria grow. They found that the e-cigarette vapour (with or without nicotine) was able to change the way the bacteria grow, by increasing volume and the area covered by the bacteria, which can lead to infections if untreated.

The researchers also found that the microbes in the e-cigarette group had genes that lead to biofilm growth (such as dental plaque). Biofilms make microbes more resilient to the effects of drugs, toxic compounds and the immune system. This suggests that e-cigarettes vapours cause a stress response in the mouth’s microbes.

When stressed, microbes switch on their fight-or-flight genes, making them better able to survive in harsh environments. They do this by producing special enzymes that cause damage to other cells in order for the microbes to use their nutrients and get more space to reproduce. This leads to a cycle of more inflammation, causing a stronger stress response from other cells. However, if we can’t remove these stressed microbes, this sustained, long-term inflammation can lead to severe diseases.

It was also found that when e-cigarette users were compared with non-smokers, e-cigarette users had significantly higher levels of immune cell response chemicals than non-smokers. E-cigarettes users also had lower levels of chemicals that stop this stress response happening. This shows that the body is trying to fight off microbes present, much more so than in non-smokers.

The presence of a diverse microbiota is essential for healthy mouths, healthy bodies, and healthy people. But based on this study’s findings, the use of e-cigarettes has a negative impact on not only the number and types of oral microbes, but on how the microbes behave and how our body responds. Other studies have had similar findings. Though more research into the health effects of e-cigarettes is needed, current evidence suggests ditching them may be best for our overall health.

Source:
(1)Sukirth M. Ganesan et al, “Adverse effects of electronic cigarettes on the disease-naive oral microbiome”, Science Advances 27 May 2020: Vol. 6, no. 22,

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Scientists to develop pain-free device to detect oral cancer

Source: www.expresshealthcare.in
Author: EH News Bureau staff

£1 million in funding has been awarded to the partnership to develop a functional prototype of a new device that uses Electrical Impedance Spectroscopy (EIS) technology for the early detection of cancerous lesions

In partnership with Zilico, the University of Sheffield is working to develop a pain-free, non-invasive and instantaneous method to detect oral cancer, A research collaboration has been awarded £1million in funding from SBRI Healthcare – an NHS England initiative – to test and develop a pain-free, non-invasive and instantaneous method to detect oral cancer.

Once built and tested, the new device could enable doctors to detect oral cancer earlier and more accurately, reducing the need for patients to have invasive biopsies. This, in turn, could provide better outcomes for patients and significant cost savings for the NHS.

The pioneering device is to be developed with medical device diagnostics company Zilico, born out of a partnership between the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust – using the same patented technology as its ZedScan device, which is now in use in the NHS for the early and non-invasive diagnosis of cervical cancer.

Researchers from the University of Sheffield and Sheffield Teaching Hospitals previously demonstrated that the principle of its electrical impedance spectroscopy (EIS) technology, where normal, precancerous and cancerous tissue can be differentiated according to its electrical properties could be useful for detecting oral cancer. The ‘proof of concept’ study involved 47 patients who were recruited from the Charles Clifford Dental Hospital.

Typically, suspicious oral lesions are inspected and diagnosed visually, but the visual indicators of the disease can be misleading or non-apparent in some cases. Many other signs and symptoms of mouth cancer such as constant bad breath and difficulty chewing or swallowing can also be caused by other things than cancer, so a definitive diagnosis can only be made through a biopsy of the tissue.

The new device could enable patients to receive a real-time diagnosis at the primary point of their care and the University is now working with Zilico to develop a functional prototype to be assessed and trialled for use in the NHS.

It is anticipated that the prototype will be ready for testing on a group of volunteers, with the aim to progress the project to a full clinical trial in the next 12 months.

Dr Keith Hunter, Professor of Head and Neck Pathology, at the University of Sheffield’s School of Clinical Dentistry and Insigneo Institute for in silico Medicine, said, “Mouth cancer is on the increase in the UK and globally, and we need new tools to be able to diagnose it earlier, as the survival rate for oral cancer patients depends on how early the disease is diagnosed and treated.

“Electrical impedance spectroscopy could help us to diagnose oral cancer earlier and more accurately, even when these cell changes may not be visually apparent. This could reduce the need for biopsies where there is no disease indicated – helping us to reduce patient anxiety and improve patient comfort.

“Hopefully developing less invasive techniques of diagnosing oral cancer will encourage more people to come forward with oral problems.”

Jamie Healey, Lead Clinical Scientist at Sheffield Teaching Hospitals NHS Foundation Trust, said, “We have collaborated with Zilico on the technology developments which form the basis of ZedScan for many years, and we are delighted to see that the clinical applications of electrical impedance spectroscopy are broadening, offering the potential for many more patients to benefit from this novel technology.”

To further the scientific evidence and applications for EIS to be used in diagnosing oral cancer, the collaboration has included a diverse range of University departments, including clinicians and researchers from Insigneo, the School of Health and Related Research (ScHARR) and the Department of Computer Science.

This research included Dr Dawn Walker and Dr James Heath from the Department of Computer Science developing cellular and tissue-scale finite element (FE) models to inform the classification of different tissue types based on EIS measurements collected from normal and diseased oral tissue samples.

Jim Chilcott, Professor of Healthcare Decision Modelling at ScHARR, said, “Using a whole disease modelling approach we are bringing together the available evidence on oral cancer diagnosis, management and treatment to optimise the design of the new oral device and underpin its diagnostic efficacy.”

“An EIS device for the diagnosing of suspected oral cancer has the potential to make an important contribution to the care and management of the disease, quickly removing uncertainty and anxiety for those without cancer and improving the journey to early treatment for those with cancerous and precancerous lesions, Chilcott added.

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Aspirin against migraines and cancer

Source: www.swoknews.com
Author: staff

Aspirin never ceases to amaze us. For a medicine that has been around for over 120 years and remains one of the most inexpensive drugs in the pharmacy, we are surprised that there continue to be discoveries.

The latest review of aspirin has to do with its use in the prevention of migraine headaches (American Journal of Medicine, April 2020). One of the authors is Dr. Charles Hennekens. He is considered one of the world’s top scientists by his colleagues. He has contributed to three textbooks and over 750 medical publications.

Dr. Hennekens and his co-authors reviewed the aspirin data over the past several decades. They concluded:

“The totality of evidence, which includes data from randomized trials, suggests that high-dose aspirin, in doses from 900 to 1,300 mg, given at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, the totality of evidence, including, some but not all, randomized trials, suggests the possibility that daily aspirin in doses from 81 to 325 mg, may be an effective and safe treatment option for the prevention of recurrent migraine headaches.

“The relatively favorable side effect profile of aspirin and extremely low cost compared with other prescription drug therapies may provide additional clinical options for primary healthcare providers in the treatment of both acute and recurrent migraine headaches.”

Of course, no one should take high doses of aspirin without medical supervision. The same holds true for long-term use. Aspirin can cause stomach irritation and ulcers. And there is always a concern about bleeding.

New migraine medicines such as erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) could cost between $600 and $700 for a once-monthly injection. Health insurance may not always cover these new treatments. Bayer aspirin costs about 3 cents per pill.

What else can aspirin do? Surprisingly, many obstetricians now recommend aspirin for high-risk pregnancies (U.S. Preventive Services Task Force, Sept. 9, 2014). Low-dose aspirin, prescribed by a physician, may lower the risk of a serious condition called pre-eclampsia (Cochrane Database of Systematic Reviews, Oct. 30, 2019).

Most intriguing of all, aspirin continues to generate excitement with its anti-cancer activity. Scientists at Roswell Park Comprehensive Cancer Center have reported that patients taking low-dose aspirin have better survival statistics against head and neck cancer, as well as non-small-cell lung cancer.

There is also evidence to suggest that regular aspirin use reduces the risk of colorectal and other digestive tract cancers (Annals of Oncology, May 2020). Aspirin may also provide some protection against breast and prostate cancer.

Aspirin must be treated with respect because of the potential for serious adverse reactions. That is why a health professional should always monitor treatment and help weigh benefits and risks with this old OTC medication.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website:
www.PeoplesPharmacy.com.

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