Study explores correlation between Medicaid expansion and disease stage and time to treatment initiation in head and neck cancer

Source: www.docwirenews.com
Author: Kaitlyn D’Onofrio

A new study examined the relationship between Medicaid expansions as part of the Affordable Care Act (ACA) with stage at diagnosis and time to treatment initiation (TTI) for head and neck squamous cell carcinoma (HNSCC) patients.

“Medicaid expansions as part of the Patient Protection and Affordable Care Act (ACA) are associated with decreases in the percentage of uninsured patients who have received a new diagnosis of cancer. Little is known about the association of Medicaid expansions with stage at diagnosis and time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC),” the study authors explained.

The study authors performed a retrospective cohort study at Commission on Cancer-accredited facilities. A total of 90,789 HNSCC patients aged between 18 and 64 years who received a cancer diagnosis between Jan. 1, 2010, and Dec. 31, 2016, were identified using the National Cancer Database. The primary outcomes were health insurance coverage, stage at diagnosis, and TTI. The researchers figured out the absolute percentage change in health insurance coverage, crude and adjusted difference in differences (DD) in absolute percentage change in coverage, stage at diagnosis and TTI before (2010-2013) and after (2014-2016) the ACA took effect for Medicaid expansion and nonexpansion states.

Of the 90,789 HNSCC patients (mean [SD] age, 54.7 [7.0] years) included in the analysis, the majority (n = 70,907, 78.1%) were male, and most (n = 72,911, 80.3%) were non-Hispanic white. More than half (n = 52,142, 57.4%) were aged between 55 and 64 years, and about three-fifths (n = 54,940, 60.5%) lived in a Medicaid expansion state. Following the implementation of the ACA, the percentage of HNSCC patients with Medicaid, compared to nonexpansion states, increased more in expansion states (adjusted DD, 4.6 percentage points; 95% confidence interval [CI], 3.7–5.4 percentage points). In expansion states, compared to nonexpansion states, there was a greater increase in the percentage of patients with localized disease (defined as American Joint Committee on Cancer stage I-II) at diagnosis in the overall cohort (adjusted DD, 2.3 percentage points; 95% CI, 1.1–3.5 percentage points) as well as a subset of patients with nonoropharyngeal HNSCC (adjusted DD, 3.4 percentage points; 95% CI, 1.5–5.2 percentage points). In the entire study cohort, there was no significant different in mean TTI between expansion and nonexpansion states (adjusted DD, –12.7 percentage points; 95% CI, –27.4 to 4.2 percentage points), but improvements were observed in the nonoropharyngeal HNSCC subset (adjusted DD, –26.5 percentage points; 95% CI, 49.6 to –3.4 percentage points).

The study appeared in JAMA Otolaryngology-Head & Neck Surgery.

“Medicaid expansions were associated with a significantly greater increase in the percentage of Medicaid-insured patients with HNSCC, an increase in localized diseases at diagnosis for the overall cohort, and improved TTI for patients with nonoropharyngeal HNSCC. Selective state-level uptake of Medicaid expansion may exacerbate existing regional disparities in access to care and outcomes among patients with HNSCC,” concluded the study authors. “As data mature, additional research addressing the associations of Medicaid expansions with disparities and survival after diagnosis is warranted.”

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January, 2020|Oral Cancer News|

How Marijuana Accelerates Growth of HPV-related Head and Neck Cancer Identified

University of California San Diego School of Medicine researchers have identified the molecular mechanism activated by the presence of tetrahydrocannabinol (THC) — the ingredient that causes people to feel the euphoria or “high” associated with cannabis — in the bloodstream that accelerates cancer growth in patients with human papillomavirus (HPV)-positive head and neck squamous cell carcinoma.

“HPV-related head and neck cancer is one of the fastest growing cancers in the United States. While at the same time, exposure to marijuana is accelerating. This is a huge public health problem,” said Joseph A. Califano III, MD, senior author and professor and vice chief of the Division of Otolaryngology in the Department of Surgery at UC San Diego School of Medicine.

Head and neck squamous cell carcinoma is the sixth most common cancer worldwide. These cancers begin in the cells that line the mucous membranes inside the mouth, nose and throat. Approximately 30 percent of cases of this disease are related to HPV infection, and it is these cases, in particular that are on the rise. Califano suggested increased marijuana use may be a driving factor.

Previous studies have linked daily marijuana exposure to an increased prevalence of HPV-related throat cancer. However, a mechanism linking cannabis exposure to increased growth of the cancer was unknown.

Reporting in the January 13, 2020 online edition of Clinical Cancer Research, a journal of the American Association for Cancer Research, researchers outline how the presence of THC in the bloodstream activates the p38 MAPK pathway, which controls programed cell death called apoptosis. When activated, p38 MAPK prevents apoptosis from occurring, thus allowing cancer cells to grow uncontrollably.

Working with Chao Liu, MD, visiting scientist at UC San Diego and a physician at China’s Central South University, and other colleagues, Califano and team used animal and human cell lines to show that THC turns p38 MAPK on and were able to stop the growth of HPV-positive head and neck cancer by turning off the pathway.

The team then analyzed blood samples from patients with HPV-related throat cancer who had their genomes comprehensively mapped to define activated gene pathways. Similar to the cell lines, the blood samples showed p38 MAPK activation and loss of apoptosis in tumors from patients with THC in their blood.

The authors said studies and public opinion suggestions that THC and other cannabis products have cancer-fighting properties need additional, more critical evaluation. Past studies showing anticancer effects of THC and other cannabinoids often used levels of THC higher than those found with recreational use, but doses used recreationally clearly activate a cancer-causing pathway, said Califano.

“We now have convincing scientific evidence that daily marijuana use can drive tumor growth in HPV-related head and neck cancer,” said Califano. “Marijuana and other cannabis products are often considered benign, but it is important to note that all drugs that have benefits can also have drawbacks. This is a cautionary tale.”

According to the Centers for Disease Control and Prevention (CDC), HPV infections are responsible for approximately 35,000 new cancer diagnoses each year in the United States. Infection is so common that nearly all men and women will get at least one type of HPV at some point in their lives. Most clear up on their own, without the person ever knowing they’ve had it.

Several vaccines are available that can prevent the majority of HPV-related cancers. The vaccines work best when they are given before a person is exposed to the virus. The CDC recommends vaccinating boys and girls age 11 to 12 years old but it can be administered as early as age 9.

According to the National Institute on Drug Abuse, 15 percent of youth 12 to 17 years old and 47 percent of adults age 26 and older have used or tried marijuana.

Together, a low HPV vaccination rate and an increase in marijuana use among youth has the makings of a storm, said Califano, physician-in-chief and director of the Head and Neck Cancer Center at Moores Cancer Center at UC San Diego Health.

Moores Cancer Center is one of only 51 National Cancer Institute-designated Comprehensive Cancer Centers in the country and the only such center in San Diego County.

Treatment options for patients with early- or late-stage head and neck cancers include minimally invasive surgery, reconstruction and rehabilitation, proton therapy and other radiation therapy, innovative clinical trials and targeted therapy, including immunotherapy.

The Head and Neck Cancer Center provides comprehensive care that includes counseling, education and support groups, nutrition, dental rehabilitation, speech and language therapy and social workers to help patients through every step of the process beginning with diagnosis to support lifelong wellness.

Califano and team are now looking at whether cannabidiol, or CBD, has a similar effect to THC. CBD is another major chemical compound found in marijuana, but does not produce the “high” and is now commonly used in various over-the-counter products, such as lotions, ointments and edibles.

In addition, the team is investigating whether p38 MAPK can be targeted with drugs to stop HPV-related head and neck cancer from growing.

Co-authors include: Chao Liu, Sayed Sadat, Koji Ebisumoto, Akihiro Sakai, Bharat Panuganti, Shuling Ren, Yusuke Goto, Sunny Haft, Takahito Fukusumi, Mizuo Ando, Yuki Saito, Pablo Tamayo, Huwate Yeerna, William Kim, Jacqueline Hubbard, Andrew Sharabi and J. Silvio Gutkind from UC San Diego; and Theresa Guo from Johns Hopkins Medical Institutions.

Funding for this research came, in part, from the National Institute of Dental and Craniofacial Research and National Institute of Health (R01 DE023347, U01CA217885, R01HG009285, R01CA121941 and P30CA023100).

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January, 2020|Oral Cancer News|

Healthy diet may avert nutritional problems in head, neck cancer patients

Source: medicalxpress.com
Author: University of Illinois at Urbana-Champaign

At least 90 percent of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms—such as pain or difficulty chewing, tasting or swallowing foods and liquids—and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns—the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism—cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized—patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

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January, 2020|Oral Cancer News|

Alcohol use high among cancer survivors

Source: www.medwirenews.com
Author: Shreeya Nanda

Over half of cancer survivors report being current drinkers, including about a fifth who appear to engage in excessive drinking behaviors, finds a US study.

“Given that alcohol intake has implications for cancer prevention and is a potentially modifiable risk factor for cancer-specific outcomes, the high prevalence of alcohol use among cancer survivors highlights the need for public health strategies aimed at the reduction of alcohol consumption,” write the study authors in JNCCN—Journal of the National Comprehensive Cancer Network.

They used data from 34,080 participants of the US National Health Interview Survey interviewed between 2000 and 2017 who reported a history of cancer.

In all, 56.5% of the total cohort reported being current drinkers, including 34.9% who exceeded moderate drinking limits – defined as a daily intake of more than one drink for women and more than two drinks for men – and 21.0% who engaged in binge drinking, which was defined as at least five drinks per day on at least one occasion in the past year.

Researcher Nina Sanford (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues caution that for the blood alcohol concentration to reach the threshold for binge drinking, drinks generally need to be consumed within 2 hours, but the survey did not collect information on the duration of alcohol intake and therefore participants who reported binge drinking may not have reached the biologic threshold.

They also investigated factors linked to alcohol use, finding that younger age (18–34 years vs other age groups), current or former smoking status, and later survey period (2010–2014 and 2015–2017 vs 2000–2004) were significantly associated with a greater likelihood of current drinking, exceeding moderate drinking limits, and binge drinking.

For other factors, such as sex and ethnicity, associations were observed for some of the levels of current drinking but not all – for instance, female sex was significantly associated with exceeding moderate limits, but male sex was a significant predictor of reporting current drinking and binge drinking.

The prevalence rates and predictive factors were similar in sensitivity analyses that included just the 20,828 participants who had been diagnosed at least 5 years prior to survey administration.

“By reporting the demographic and socioeconomic variables associated with alcohol intake, our work begins to identify subgroups toward whom alcohol-based interventions could be targeted, and could serve as a benchmark for assessing changes in drinking behavior in the population of patients with cancer,” say Sanford et al.

Individuals with a history of cervical or testicular cancer were significantly more likely to report current drinking, exceeding moderate limits, and binge drinking compared with participants reporting other tumor types. Additionally, those with a history of head and neck cancer or melanoma were also significantly more likely to report binge drinking.

This finding is “likely a reflection of the predominant demographic characteristics—particularly younger age—associated with these cancer diagnoses, rather than an intrinsic association between cancer type and alcohol use,” comment the researchers.

Sanford and colleagues highlight the need for further research, “including large-scale systems-based research on alcohol use in cancer survivors.”

And they conclude: “For the time being, because oncologists have a responsibility to promote the overall health and well-being of their patients, efforts should be undertaken to accurately assess alcohol intake among cancer survivors and to inform these individuals of the potential harms associated with continued drinking.”

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January, 2020|Oral Cancer News|

New cancer treatment delivers weeks of radiation therapy in a second

Source: New Atlas
Date: January 9th, 2020
Author: Michel Irving

Radiation therapy is currently our best shot at treating cancer, but it’s far from a perfect solution. It takes a course of weeks or even months, during which time healthy cells often become unfortunate collateral damage. But what if the whole course of treatment could be over in under a second? Researchers at the University of Pennsylvania have now shown just how this might be feasible.

With the right tools, cancer cells on their own aren’t all that difficult to kill. Radiation or drugs can be administered to kill them off relatively easily – the problem is tumors like to hide in crowds, and whatever weapons we fire at them also tend to hit healthy cells around them. Because radiation therapy takes weeks, there are more opportunities for those healthy cells to be affected, leading to all kinds of health problems even if the cancer is destroyed.

That’s where FLASH radiotherapy comes in. This emerging form of treatment involves giving a patient in one second a similar amount of radiation as they would normally receive over weeks. Previous experiments have shown that the effect on the cancer itself is basically the same, but the collateral damage to healthy tissue is drastically reduced.

For the new study, researchers at Pennsylvania University found that by changing the type of fundamental particle used, they could make FLASH radiotherapy far more effective. Normally, electrons are the particles of choice for this method, but they don’t penetrate very deep into the body. That means they’re only really useful for shallower cancer types such as skin cancer.

In this case the researchers used protons, and showed that linear accelerators already in use in hospitals could be adapted to produce these particles. Since they can pass deeper into the body, they should be more useful against a wider range of tumor types.

The team tested it out on mice with pancreatic flank tumors, and found that the method did inhibit the growth of the cancers with roughly the same effectiveness as regular radiation therapy. Importantly though, the proton FLASH therapy reduced healthy cell loss and didn’t cause intestinal fibrosis, a common side effect of radiation therapy.

“This is the first time anyone has published findings that demonstrate the feasibility of using protons – rather than electrons – to generate FLASH doses, with an accelerator currently used for clinical treatments,” says James M. Metz, co-senior author of the study.

The researchers are currently working on how to translate the treatment to clinical trials. This includes designing a system that can deliver the proton radiation to humans.

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January, 2020|Oral Cancer News|

Cervical pre-cancer rates down 88% in decade since HPV vaccinations began – first findings

Source: The Conversation
Date: April 19, 2019
Author: Kevin Polluck

Cervical cancer is the third most common cancer among women in the UK under the age of 35 after breast and skin cancer. In the majority of cases, the cancer only develops if the patient is infected with human papillomavirus (HPV) types 16 or 18. This virus is mainly transmitted between people having vaginal, anal or oral sex. At some point in their lives, four in five people will be infected by HPV strains – as many as 14 can cause cancer in total. According to recent studies, other cancers heavily linked to HPV infections include head-and-neck, vulvo-vaginal and anal.

In an effort to reduce rates of cervical cancer, a number of countries launched immunisation programmes in the late 2000s, starting with Australia in 2006. The UK and its devolved governments launched a school immunisation programme in 2008 to vaccinate all girls aged 12-13. To speed up the time lag associated with achieving the benefits of vaccination, they also kicked off a three-year catch-up programme for girls aged up to 18 years.

A decade on, we are finally able to publish the first results. The data relates to Scotland, since it was cervically screening women from the age of 20 until 2016 – before falling into line with the minimum age of 25 used in the rest of the UK. This meant that Scotland obtained screening data for the 2008-09 cohort before the change in screening age. Scotland also has very detailed information about take-up rates, which have been very high: running to approximately 90% in Scotland for the routinely vaccinated girls and 65% for the older girls vaccinated as part of the catch-up programme.

For the first time, we can now confirm that the vaccination programme has begun to profoundly alter the prevalence of HPV 16 and 18 among Scottish women – and presumably elsewhere as well.

The study

My team performed an eight-year study of the women eligible for the Scottish national vaccination and cervical screening programmes. We looked at their vaccination status, year of birth, indicators of deprivation and whether they lived in urban or rural areas. Using complex statistical modelling, we were able to calculate the effect of vaccination on cervical pre-cancer. Though not all pre-cancer becomes cancer, all cancer requires pre-cancer. Cervical pre-cancer occurs quicker than cancer and therefore this focus has allowed us to see the impact of the vaccine earlier.

Among women born in 1995-96 – the first group to go through the regular vaccination programme in 2008/09 – there has been an 88% reduction in rates of cervical pre-cancer. This is a fall in incidence from 1.44% to 0.17%.

Not only that, women born in these years who had not received the vaccine were also less likely to develop cervical pre-cancer. This was because the high vaccine uptake meant that HPV incidence was much lower in their age group, thanks to a phenomenon known as “herd protection”. This is particularly good news, since this group is also less likely to attend cervical screenings.

The findings clearly show that the routine HPV vaccination programme for girls aged 12 to 13 has been a resounding success. This is consistent with the fact that we have also seen a big fall in high-risk HPV infection in Scotland in recent years. The obvious conclusion is that we are going to see far fewer cases of cervical cancer in years to come.

From September, the UK is going to extend the vaccination programme to boys – becoming one of numerous countries to do so. This is in response to the fact that rates of head and neck cancer are rising in men: approximately 60% of head and neck cancer is associated with HPV16 infection, and should therefore be mostly preventable through vaccination. This programme should also mean that high-risk HPV infections among the population should be eliminated more quickly, which should have knock-on benefits for rates of HPV-driven cancers.

Meanwhile, in parts of Canada, HPV vaccinations are now being offered to uninfected women as part of the cervical screening process. This may protect older women from developing cervical cancer. This process may be adopted internationally, including the UK. When we look at the picture as a whole, eliminating the HPV virus, and making huge inroads into the various cancers that it helps develop, is now becoming a realistic possibility.

 

 

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January, 2020|Oral Cancer News|

Single dose of HPV vaccine may be as effective as three

Source: www.laboratoryequipment.com
Author: Michelle Taylor, Editor-in-Chief

More than a decade after the introduction of a vaccine that has been proven to stave off 90 percent of human papillomavirus-caused cancers, only half of U.S. adolescents have completed the 3-shot series. While part of that can be attributed to adolescents and adults who question the validity of the vaccine, the majority is due to unawareness of or forgetting the need for additional doses, lack of insurance and non-frequent contact with the medical system.

But, a new study from researchers at the University of Texas Health Science Center at Houston, has revealed a single-dose regimen may be equally as effective as the current 2- to 3-dose system.

“Ensuring boys and girls receive their first dose is a big challenge in several countries and a majority of adolescents are not able to complete the recommended series due to a lack of intensive infrastructure needed to administer two or three doses,” said the paper’s senior author Ashish Deshmukh, assistant professor at UTHealth School of Public Health. “If ongoing clinical trials provide evidence regarding sustained benefits of a one-dose regimen, then implications of single-dose strategy could be substantial for reducing the burden of these cancers globally.”

Deshmukh’s study examined the difference in the prevalence of HPV infection in a total of 1620 women aged 18 to 26 of whom 1,004 were unvaccinated, 616 received at least 1 dose of HPV vaccine 106 received just 1 dose, 126 received 2 doses and 384 received 3 doses.

Compared with unvaccinated women who had a HPV infection (4-valent vaccine types [6,11,16 and 18]) prevalence of 12.5%, women who received at least one dose showed significantly less prevalence—2.4% for women with 1 dose, 5.1% for those with 2 doses and 3.1% for those who received all 3 doses.

According to the paper recently published in JAMA Network Open, there was no significant difference in prevalence for 1 dose versus 2 doses or 1 dose versus 3 doses. Additionally, differences were not statistically significant for cross protection (HPV types 31, 33, and 45), and other high-risk HPV types (HPV types 35, 39, 51, 52, 56, 58, 59, and 68).

Using a multivariable logistic regression model, the authors predicted the probability of HPV infection (types 6, 11, 16, 18) to be higher in unvaccinated women (7.4%) compared with women who received 1 dose (2.3%), 2 doses (5.7), or 3 doses (3.1%).

According to the CDC, 34,800 new cancer diagnoses are linked to human papillomavirus (HPV) annually. The virus is thought to account for more than 90% of all cervical and anal cancers, more than 60% of all penile cancers, and approximately 70% of all oral cancers. While the study authors stressed it is too early for people to rely on a single dose for protection against these cancers, they are encouraged by the results of their research.

“The current HPV vaccine dosing regimen can be cumbersome for people to understand. If one dose is proven effective in trials, the vaccine regimen will be simplified,” said lead author Kalyani Sonawane, also an assistant professor at UTHealth School of Public Health. “This will help improve the coverage rate among adolescents that are currently below the Healthy People 2020 goal and possibly will also increase the momentum of uptake in the newly approved age group.”

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January, 2020|Oral Cancer News|

Fewer side effects with proton beam vs traditional radiotherapy

Source: www.medscape.com
Author: Roxanne Nelson, RN, BSN

One of the main advantages claimed for proton beam radiotherapy is that it has fewer adverse effects than traditional radiotherapy. A new study suggests that that is so. The retrospective comparative effectiveness study involved 1483 patients with nonmetastatic cancer (various types, including brain, head and neck, lung, gastrointestinal, gynecologic) who were treated with curative intent. Slightly less than a third of these patients (n = 391) were treated with proton beam radiotherapy; the remaining patients (n = 1092) underwent traditional radiotherapy.

The results show that among the patients who were treated with proton therapy, there was a significantly lower risk for serious side effects: 11.5% experienced events of grade 3 or higher within 90 days of treatment, compared to 27.6% of patients in the traditional radiotherapy group.

“We know from our clinical experience that proton therapy can have this benefit, but even we did not expect the effect to be this sizeable,” said senior author James Metz, MD, chair of radiation oncology, leader of the Roberts Proton Therapy Center at the University of Pennsylvania, and a member of Penn’s Abramson Cancer Center.

Importantly, there was no difference in cancer outcomes between the two groups; both disease-free and overall survival were similar.

“It shows that proton therapy offers a way for us to reduce the serious side effects of chemoradiation and improve patient health and well-being without sacrificing the effectiveness of the therapy,” said lead author Brian Baumann, MD. He is an adjunct assistant professor of radiation oncology at Penn and an assistant professor of radiation oncology at the Washington University School of Medicine in St. Louis.

The study was published online December 26 in JAMA Oncology.

It provides a “compelling hypothesis that patients undergoing chemoradiotherapy for locally advanced cancer may benefit from the use of proton therapy, potentially leading to major cost savings for patients, payers, and society at large,” comment the authors of an accompanying editorial. The authors are Henry S. Park, MD, MPH, and James B. Yu, MD, MHS, both from Yale University School of Medicine, New Haven, Connecticut.

Need for Randomized Clinical Trials
The results from this study were initially presented at the 2019 annual meeting of the American Society of Clinical Oncology and were reported by Medscape Medical News at that time.

At the meeting, Baumann commented that, if the side effects are reduced, then it may be possible to intensify therapy, which in turn could improve survival.

But the “real take-home message here is that the 90-day toxicity is lower,” he said. “Grade 3 and higher toxicity usually requires hospitalization. It means a trip to the ER [emergency room], getting admitted, and a possibly worse outcome.”

Baumann emphasized that an important next step is to conduct randomized clinical trials of proton therapy vs proton chemoradiotherapy. “Efforts are already underway to do these studies for some cancers,” he said. “I think it’s important that we support these trials and encourage accrual on these trials.”

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January, 2020|Oral Cancer News|

Study: Healthy diet may avert nutritional problems in head, neck cancer patients

Source: news.illinois.edu
Author: Sharita Forrest

At least 90% of head and neck cancer patients develop symptoms that affect their ability or desire to eat, because of either the tumor itself or the surgery or radiation used to treat it. These problems, called nutrition impact symptoms, have wide-ranging negative effects on patients’ physical and mental health and quality of life.

However, patients who eat foods high in antioxidants and other micronutrients prior to diagnosis may reduce their risks of developing chronic nutrition impact symptoms up to one year after being diagnosed with head or neck cancer, according to a recent study led by researchers at the University of Illinois.

The scientists analyzed the dietary patterns of 336 adults with newly diagnosed head and neck cancers and these patients’ problems with eating, swallowing and inflammation of the digestive tract. This painful inflammatory condition, called mucositis, is a common side effect of radiation treatment and chemotherapy.

The mitigating effects of a healthy diet were particularly significant in people who had never smoked and in patients who were underweight or normal weight at diagnosis, who often experience the greatest eating and digestive problems during treatment, said Sylvia L. Crowder, the paper’s first author.

Crowder is a research fellow in the Cancer Scholars for Translational and Applied Research program, a collaborative initiative of the U. of I. and Carle Foundation Hospital in Urbana, Illinois.

“While previous work has established that the presence of nutrition impact symptoms is associated with decreased food intake and weight loss, no studies have examined how pre-treatment dietary intake may influence the presence of these symptoms later in the course of the disease,” Crowder said.

In the early 2000s, researchers hypothesized that consuming antioxidant supplements might protect patients’ normal cells from damage during radiotherapy, enabling them to better tolerate treatment and higher dosages.

Accordingly, prior research by Anna E. Arthur, a professor of food science and human nutrition at the U. of I. and the current study’s corresponding author, indicated that eating a diet of whole foods abundant in antioxidants and phytochemicals improved recurrence and survival rates in head and neck cancer patients.

Like Arthur’s prior research, the new study was conducted with patients of the University of Michigan Head and Neck Specialized Program of Excellence.

Data on patients’ tumor sites, stages and treatment were obtained from their medical records. More than half of these patients had stage 4 tumors at diagnosis.

Prior to starting cancer treatment and again one year post-diagnosis, the patients completed a questionnaire on their diet, tobacco and alcohol use, and quality of life. Patients reported whether they experienced any of seven nutrition impact symptoms – such as pain or difficulty chewing, tasting or swallowing foods and liquids – and rated on a five-point scale how bothersome each symptom was.

In analyzing the patients’ eating habits, the scientists found that they followed either of two major dietary patterns – the Western pattern, which included high amounts of red and processed meats, fried foods and sugar; or the prudent pattern, which included healthier fare such as fruits and vegetables, fish and whole grains.

Patients who ate healthier at diagnosis reported fewer problems with chewing, swallowing and mucositis one year after treatment, the scientists found.

“While the origin and development of nutrition impact symptoms are complex and varied, they generally share one common mechanism – cell damage due to inflammation,” said Arthur, who is also an oncology dietitian with the Carle Cancer Center. “The prudent dietary pattern has the potential to reduce inflammation and affect the biological processes involved in the pathogenesis of these symptoms.”

The scientists hypothesized that some patients may begin eating healthier after being diagnosed with cancer, potentially counteracting the pro-inflammatory effects of their previous dietary habits.

Reverse causation was possible too, they hypothesized – patients’ lack of symptoms may have enabled them to consume a broader range of foods, including healthier whole foods, before their cancer was discovered.

Notes:
Alison M. Mondul, Laura S. Rozek, Dr. Gregory T. Wolf and Katie R. Zarins, all of the University of Michigan, were co-authors of the study.

Additional co-authors were Kalika P. Sarma of the Carle Illinois College of Medicine, M. Yanina Pepino of the U. of I., and Zonggui Li and Yi Tang Chen, both then-graduate students at the U. of I.

In addition to the C-STAR program, an Academy of Nutrition and Dietetics Colgate Palmolive Fellowship in Nutrition and Oral Health, and the U.S. Department of Agriculture National Institute of Food and Agriculture supported the research.

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December, 2019|Oral Cancer News|

Test that looks at your spit to tell if you have mouth or throat cancer caused by HPV ‘could save thousands of lives if rolled out for doctors to use’

Source: www.dailymail.co.uk
Author: Connor Boyd, Health Reporter

A saliva test that diagnoses mouth and throat cancer caused by HPV could save thousands of lives each year, a study suggests. Scientists at Duke University in North Carolina discovered the test was 80 per cent accurate at spotting the killer diseases.

Doctors say it is able to detect the cancers early on, giving patients much higher hopes of surviving their battle. Before it can be used in hospitals around the world, further trials will be needed to confirm the technology works. But the researchers are hopeful, claiming the cheaper test – which gives results in as little as 10 minutes – has significant ‘potential’.

Rates of oral cancers are soaring in the Western world, with the number of patients diagnosed in the UK having doubled in a generation. US doctors have also seen a similar spike in the diseases, which can be caused by human papilloma virus (HPV).

The infection – spread through oral sex, as well as anal and vaginal intercourse – is thought to cause around 70 per cent of all cases. Other risk factors include drinking excessive amounts of alcohol over long periods of time and smoking cigarettes.

Professor Tony Jun Huang, study co-author, said there are around 115,000 cases of oropharyngeal cancers each year across the world. He said it is ‘one of the fastest-rising cancers in Western countries due to increasing HPV-related incidence, especially in younger patients’.

Orophayngeal cancer starts in the oropharynx, the back of the throat which includes the base of the tongue and tonsils. It sits under the branch of head and neck cancers, which also includes mouth cancer – another type that can be caused by HPV. Detecting the disease early can boost survival odds from 50 per cent to 90 per cent, according to the NHS. But patients are often not diagnosed until they become advanced, partly because their location makes them difficult to see during routine clinical exams.

The new test uses a chip developed to isolate tiny micro-particles, known as exosomes, in saliva.These particles are secreted into body fluids and several types of cancers are known to multiply their numbers. Exosomes are responsible for transferring molecules between cancer and various cells.

The new test isolates them by filtering out larger particles in the saliva and probing the exosomes for DNA shed by tumours. It also scans fluid in the mouth for HPV-16, one strain of the STI that can put people at risk of oropharyngeal cancer. The test takes five minutes to conduct and a further five to process the results. Experts also said it is cheap – but did not elaborate on the cost. In comparison, current biopsies take around eight hours because they need to be sent away to be assessed by a surgeon.

Professor Huang said: ‘It is paramount that surveillance methods are developed to improve early detection and outcomes.’ He added the successful detection of HPV from saliva ‘offers advantages including early detection, risk assessment, and screening’.

The test was a collaboration between Duke University, the University of California and University of Birmingham in Britain.

Orophayngeal cancer killed 2,722 Britons last year and took the lives of 9,750 people in the US, figures show. New cases of the disease in the UK have risen to 8,302 a year, a jump of 135 per cent compared with 20 years’ ago.

According to the researchers, this technology can also be used to analyse blood, urine, and plasma. The findings were published in the Journal of Molecular Diagnostics.

The Oral Health Foundation last month urged people to wise up to the causes of the ‘devastating’ disease, mainly HPV and alcohol. Dr Nigel Carter OBE, chief executive of the OHF, said: ‘While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate.

‘Traditional causes like smoking and drinking alcohol to excess are quickly being caught by emerging risk factors like the human papillomavirus (HPV).

‘We have seen first-hand the devastating affect mouth cancer can have on a person’s life.’

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December, 2019|Oral Cancer News|