E-cig users develop some of the same cancer-related molecular changes as cigarette smokers

Source: EurekAlert!
Date: February 14, 2019

If you think vaping is benign, think again.

A small USC study shows that e-cig users develop some of the same cancer-related molecular changes in oral tissue as cigarette smokers, adding to the growing concern that e-cigs aren’t a harmless alternative to smoking.

The research, published this week in the International Journal of Molecular Sciences, comes amid a mushrooming e-cig market and mounting public health worries. On a positive note, recent research found vaping is almost twice as effective as other nicotine replacement therapies in helping smokers quit.

But among adolescents, vaping now surpasses smoking, and there’s evidence that e-cig use leads to nicotine addiction and future smoking in teens.

“The existing data show that e-cig vapor is not merely ‘water vapor’ as some people believe,” said Ahmad Besaratinia, an associate professor at Keck School of Medicine of USC and the study’s senior author. “Although the concentrations of most carcinogenic compounds in e-cig products are much lower than those in cigarette smoke, there is no safe level of exposure to carcinogens.”

Besaratinia emphasized that the molecular changes seen in the study aren’t cancer, or even pre-cancer, but rather an early warning of a process that could potentially lead to cancer if unchecked.

The researchers looked at gene expression in oral cells collected from 42 e-cig users, 24 cigarette smokers and 27 people who didn’t smoke or vape. Gene expression is the process by which instructions in our DNA are converted into a functional product, such as a protein. Certain alterations in gene expression can lead to cancer.

They focused on oral epithelial cells, which line the mouth, because over 90 percent of smoking-related cancers originate in epithelial tissue, and oral cancer is associated with tobacco use.

Both smokers and vapers showed abnormal expression, or deregulation, in a large number of genes linked to cancer development. Twenty-six percent of the deregulated genes in e-cig users were identical to those found in smokers. Some deregulated genes found in e-cig users, but not in smokers, are nevertheless implicated in lung cancer, esophageal cancer, bladder cancer, ovarian cancer and leukemia.

Besaratinia and his team plan to replicate his findings in a larger group of subjects and explore the mechanisms that cause gene deregulation. He’s also launching another experiment in which smokers switch to e-cigs; he wants to see whether any changes in gene regulation occur after the switch.

“For the most part, the participants are as curious as we are to know whether these products are safe,” he said.

In addition to Besaratinia, the study’s other authors are first author Stella Tommasi, Andrew Caliri, Amanda Caceres, Debra Moreno, Meng Li, Yibu Chen and Kimberly Siegmund, all of USC.

The research was supported by grants from the National Institute of Dental and Craniofacial Research of the National Institutes of Health (1R01DE026043) and the University of California Tobacco-Related Disease Research Program (TRDRP-25IP-0001 and TRDRP-26IR-0015).

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February, 2019|Oral Cancer News|

Pioneering surgery to regrow woman’s jaw hailed a ‘success’

Source: www.breakingnews.ie
Author: staff

A pioneering operation to regrow a woman’s jaw from her own skin and bone after she lost it from cancer has been branded a “significant success”.

Val had her entire lower jaw removed including her glands, chin, lower lip and part of her tongue after being diagnosed with cancer in 2015, leaving her unable to eat, drink or talk.

The 55-year-old from Wolverhampton eventually under went a pioneering surgical technique – known as distraction osteogenesis – to encourage her jaw to grow back after two previous attempts to reconstruct it failed.

This involved surgeons at trust’s maxillofacial service at Nottingham University Hospitals NHS Trust’s Queen’s Medical Centre (QMC) fitting her with a facial frame to act as “scaffolding” around which her own bone and tissue can grow back.

Val has had two further operations including one last month to remove the frame, and was discharged on Thursday.

Doctors said 90mm of bone had grown since the operation in January 2018 – and branded the procedure a “significant success”.

Val after the pioneering operation to regrow her jaw (Nottingham University Hospital)

Val said it had been a “leap of faith” to undergo the surgery – which was the first time it had been carried out in the UK.

She added: “Just over a year ago I was resigned to the fact I would have to wear a prosthetic chin for the rest of my life, but after one of our brainstorming sessions at my local hospital, when we joked about growing a new jawbone, it sparked an idea.

“It was a leap of faith as there were no guarantees it would work at all, but I had everything to gain and nothing to lose.

“It’s been a bumpy road, often painful and frustrating but throughout the maxillofacial team at QMC have given me their upmost support.

“Now there is an end in sight and although there is still a little way to go the results are more positive than I ever could have hoped for.”

Val hopes that following the success of her treatment, the procedure can be used for others with similar difficulties with confidence that it will change their lives for the better.

Dilip Srinvasin, clinical director for the Maxillofacial Service and Val’s surgeon, said: “The surgery was the first of its kind used in this way in the UK.

“Using pioneering techniques and specialist knowledge from both surgeons and the laboratory in Nottingham, we have managed to use a frame to reconstruct the lower jaw.

“Remarkably, 90mm of bone has grown back following Val’s surgery.”

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February, 2019|Oral Cancer News|

Scientists to test light therapy as relief from side effects of cancer treatment

Source: www.photonics.com
Author: staff

University at Buffalo (UB) researchers have received part of a $1.5 million grant to investigate light therapy as a replacement for prescription opioids in treating oral mucositis, painful ulcers, and swelling in the mouth that result from chemotherapy and radiation treatment for cancer.

Funded by the National Institutes of Dental and Craniofacial Research Small Business Innovation Research program, the grant will help the researchers determine the effectiveness of photobiomodulation in prevention and treatment of oral mucositis after cancer treatment.

At a high power, light, often in the form of a laser, is used in medicine to cut or destroy tissue. But at a low level, it has the ability to relieve pain and promote healing. Courtesy of Douglas Levere, University at Buffalo

The grant was awarded to Cleveland-based MuReva Phototherapy, a spin-off company of lighting solutions manufacturer Lumitex, to further develop the light technology. UB received $511,000 of the award to test the technology.

The research, led by Praveen Arany, DDS, assistant professor in the UB School of Dental Medicine, will be performed in collaboration with faculty from the Departments of Radiation Medicine and Oral Oncology at Roswell Park Comprehensive Cancer Center.

“The current epidemic of opioids has impacted cancer care, especially for cancer pain relief,” Arany said. “This treatment offers a simple, nondrug, noninvasive treatment approach to relieve pain and improve quality of life for cancer patients. The striking lab and clinical evidence for photobiomodulation treatments in supportive cancer care has demonstrated tremendous promise.”

Arany, who is president of the World Association for Photobiomodulation Therapy and co-chair of the committee on light therapy for supportive oncology care of the Multinational Association of Supportive Care in Cancer, is an advocate for wider use of photobiomodulation in the United States. He recently took part in the first congressional briefing on photobiomodulation before the House Science, Space, and Technology Committee in Washington, D.C. The briefing, held Oct. 11, 2018, invited a panel of international experts on the therapy to discuss the potential of photobiomodulation to improve health care and lower dependence on opioids.

“The ability of low-dose light therapy to promote healing has been established since the 1960s,” Arany said. “A major obstacle with its widespread use has been a lack of understanding of its precise biological mechanism. Recent work from our group has outlined both therapeutic and dose-limiting molecular pathways that are aiding development of safe and efficacious clinical protocols.”

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February, 2019|Oral Cancer News|

E-cigarette users show cancer-linked genetic changes

Source:news.usc.edu
Author: Leigh Hopper

If you think vaping is benign, think again.

While studies have indicated that vaping can help smokers quit, USC researchers say the health consequences of using a e-cigarettes may be worse than widely believed. (Photo/Pixabay)

A USC study in 93 people shows that e-cigarette users develop some of the same cancer-related molecular changes in oral tissue as cigarette smokers, adding to the growing concern that e-cigarettes aren’t a harmless alternative to smoking.

The research, published this week in the International Journal of Molecular Sciences, comes amid a mushrooming e-cigarette market and mounting public health worries. On a positive note, recent research found vaping is almost twice as effective as other nicotine replacement therapies in helping smokers quit. But among adolescents, vaping now surpasses smoking, and there’s evidence that e-cigarette use leads to nicotine addiction and future smoking in teens.

“The existing data show that e-cig vapor is not merely ‘water vapor’ as some people believe,” said Ahmad Besaratinia, an associate professor at Keck School of Medicine of USC and the study’s senior author. “Although the concentrations of most carcinogenic compounds in e-cig products are much lower than those in cigarette smoke, there is no safe level of exposure to carcinogens.”

E-cigs and cancer: Early warning in oral cells
Besaratinia emphasized that the molecular changes seen in the study aren’t cancer, or even pre-cancer, but rather an early warning of a process that could potentially lead to cancer if unchecked.

The researchers looked at gene expression in oral cells collected from 42 e-cigarette users, 24 cigarette smokers and 27 people who didn’t smoke or vape. Gene expression is the process by which instructions in our DNA are converted into a functional product, such as a protein. Certain alterations in gene expression can lead to cancer.

They focused on oral epithelial cells, which line the mouth. More than 90 percent of smoking-related cancers originate in epithelial tissue, and oral cancer is associated with tobacco use.

Both smokers and vapers showed abnormal expression, or deregulation, in a large number of genes linked to cancer development. Twenty-six percent of the deregulated genes in e-cig users were identical to those found in smokers. Some deregulated genes found in e-cig users, but not in smokers, are nevertheless implicated in lung cancer, esophageal cancer, bladder cancer, ovarian cancer and leukemia.

E-cigs and cancer: What’s next?
Besaratinia and his team plan to replicate his findings in a larger group of subjects and explore the mechanisms that cause gene deregulation. He’s also launching another experiment in which smokers switch to e-cigs; he wants to see whether any changes in gene regulation occur after the switch.

“For the most part, the participants are as curious as we are to know whether these products are safe,” he said.

In addition to Besaratinia, the study’s other authors are first author Stella Tommasi, Andrew Caliri, Amanda Caceres, Debra Moreno, Meng Li, Yibu Chen and Kimberly Siegmund, all of USC.

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February, 2019|Oral Cancer News|

The epidemic of throat cancer sweeping the industrialized world

Source: www.mercurynews.com
Author: Dr. Bryan Fong

Tonsils – Angina Pectoris

Over the past three decades, a dramatic increase in a new form of throat cancer has been observed throughout the industrialized world. The good news is that it’s potentially preventable — if parents get their children vaccinated.

The disease shows up primarily in men, typically between the ages of 45 and 70. Those who are affected often lead healthy lifestyles. They do not have extensive histories of smoking tobacco or consuming alcohol, which are risk factors for traditional throat cancers.

The rate of this new cancer has been increasing 5 percent per year and today, it is more than three times as common as in the mid-1980s. If you think this scenario sounds like a slow-moving infectious medical drama (think Contagion or World War Z), you would be right.

The source of this cancer is a virus, the human papillomavirus (HPV) — the same virus that causes most cervical cancer in women. It’s widely known that parents should get their girls vaccinated. Now, with the surge in oral HPV cancers, especially in men, parents should get their boys vaccinated too.

Currently, vaccination against HPV is recommended by the Centers for Disease Control for children and young adults ages 9-26. The vaccination includes a series of two or three injections; the side effects are mild.

Ideally, the vaccinations should be administered before someone becomes sexually active. That’s because HPV is spread via sexual activity. Risk of HPV infection and throat cancer increases with the number of lifetime partners.

Men have a lower immune response to the virus than women, which explains the predilection of this disease for men. It’s difficult to know if someone has an active oral HPV infection because there are no symptoms. Currently, there is no widely accepted test for HPV in men.

Chronic infection leads to cellular changes within the lymphatic tissues in the throat, specifically the tonsils and base of tongue. Over the course of 20-30 years, these changes can result in the formation of cancer.

Throat cancer caused by HPV is insidious. The primary tumor in the tonsil or base of tongue often causes little to no symptoms. Early signs of this cancer may be a mild sore throat, occasional blood-tinged oral saliva, or increased or new snoring.

Often, the first sign of the cancer is a lump in the neck after the cancer has spread into the lymphatic system. The lump may arise quickly and then shrink to varying degrees, lulling one into complacency.

Early stage cancer can be treated with surgery or radiation. More advanced cancers are treated with combined therapy such as surgery followed by radiation therapy, or chemotherapy in conjunction with radiation therapy.

Finally, some good news. Treatment for HPV-related throat cancer is successful in about 90 percent of cases and is significantly more successful than treatment of non-HPV related throat cancer.

But, as successful as medicine has been in treating this cancer, an even better alternative is prevention via vaccination. Initial studies have shown that vaccination produces an immune response to HPV and reduces the rate of HPV infection. Given time and good vaccination coverage, a decline in throat cancer is expected.

In summary, here are a few simple take-home messages: If you have a lump in the neck or a chronic sore throat, don’t procrastinate. Have your doctor check it out. If you are a partner of someone with these symptoms, strongly encourage your partner to see his or her doctor.

If you have children ages 9-17, talk to your pediatrician about HPV vaccination. If you are 18-26 years old, talk to your primary care doctor about vaccination. These simple steps may save your life or the life of your loved one.

Note: Dr. Bryan Fong is the senior practicing head and neck surgical oncologist for Northern California Kaiser Permanente.

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February, 2019|Oral Cancer News|

Minimally-invasive treatment option for early stage oral cancer reduces recovery time, improves survival

Source: www.newswise.com
Author: Henry Ford Health System

Henry Ford Cancer Institute is a leader in providing a minimally invasive procedure called a sentinel lymph node biopsy for patients with early stage oral cancer. The biopsy can be performed at the same time oral cancer is surgically removed, and it can determine if the cancer has spread to nearby lymph nodes.

For Henry Ford patient Marlene Calverley, the biopsy meant having three lymph nodes removed versus 30-60 lymph nodes, and a two-inch scar instead of a five-to-six-inch scar. It also meant no neck drains, no physical therapy, and a decreased risk of complications.

“We are one of the few – if not the first – medical center in the State of Michigan to adopt this new paradigm for treating early oral cavity squamous cell cancers,” says head and neck cancer surgeon Tamer A. Ghanem M.D., Ph.D., director of Growth, Access, and Service for the Department of Otolaryngology at Henry Ford Cancer Institute. This new paradigm is based on a standard treatment for breast cancer and melanoma skin cancer.

The early data shows that sentinel lymph node biopsy may improve patients’ survival rate. Research also demonstrates a significant decrease in recovery time, complications, and effects attributed to a treatment, says Steven Chang, M.D., director of the Head and Neck Oncology program and the Microvascular Surgery Division at the Henry Ford Cancer Institute.

Head and neck cancers are among the most common cancers in the U.S. and globally. At the time patients are first diagnosed with oral cancer, about 15-25 percent of them have hidden microscopic cancer cells in the lymph nodes of the neck.

During a routine dental exam, Calverley was told to watch a small spot on her tongue. Three years later, an oral surgeon discovered cancer. Knowing there was a significant chance of cancer spreading, the surgeon recommended a neck dissection to remove all the lymph nodes.

At Henry Ford, Dr. Chang would offer a new and more precise treatment approach.

Traditionally, when oral cancer is found, neck surgery is performed and all the lymph nodes are removed, whether they are known to be diseased or not. However, about 75-85 percent of the patients do not need this surgery. After surgery, patients may require neck drains, and some will experience shoulder and lip weakness caused by exposing and manipulating the nerves, says Dr. Chang. Also, patients will have a large scar and longer recovery time.

In the past, patients who had early oral cavity lesions and who were at risk for hidden cancer in the lymph nodes were routinely offered extensive neck surgery to find any diseased nodes. Now, we are offering a simple sentinel node biopsy to select patients to find diseased nodes, says Dr. Ghanem.

Calverley was one of those select patients. To eliminate the cancer, one-quarter of her tongue would need to be removed. When doctors at another medical center initially recommended having all of levels 1-4 removed – which could consist of 30-60 nodes in her neck – and grafting donor tissue onto her tongue, she sought a second and third opinion.

“Dr. Chang was the only one who offered to do the sentinel node biopsy and to have my tongue heal on its own,” says Calverley, a 72-year-old Rochester resident.

When Dr. Chang explained that the sentinel node biopsy is also done for women having a mastectomy, it was an easy decision for me, she said.

“I went home and prayed and spent two days talking to people about my decision,” she says. “Friends in the medical field agreed with me and asked, ‘Why would you have all the lymph nodes in your neck removed if they aren’t cancerous, and then deal with all the repercussions? It’s not necessary.’”

“I had my surgery in November, and my tongue is healing beautifully,” says Calverley.

“Only three nodes were removed, and my scar is only about two inches. It’s right in line with a wrinkle on my neck, and you can barely see it,” she says.

“Within three days, I was up and making pumpkin rolls for Thanksgiving,” says Calverley. She spent only one night in the hospital after the surgery.

The benefits of the biopsy are important. Compared to surgery that removes all the lymph nodes, sentinel lymph node biopsy lowers the risk of lymphedema, which causes a buildup of fluid and swelling in the body. Additionally, the biopsy involves mapping lymph nodes in the lower neck and opposite side of the neck – areas not typically included in the traditional approach. For cancer in the middle area of the head or neck, patients can avoid surgery on both sides of the neck.

The sentinel node biopsy procedure involves injecting into the oral cancer site a weak radioactive substance that marks white blood cells. The substance acts as a tracer and is picked up by the lymph vessels, travelling along the path most likely used by any cancer cells that might drain from the tumor to the lymph nodes. Depending on the patient, cancer cells may travel in different paths or patterns. The first lymph node that the substance goes to is called the sentinel lymph node. Imaging will find it and any other nodes containing the tracer.

The surgeon will remove the suspected lymph nodes along with the oral cancer, and a pathologist will immediately examine the tissue to determine if cancer is actually present in the nodes. If it is, the surgeon will perform a neck dissection to remove the diseased lymph nodes.

However, if the nodes are negative for cancer, then we will avoid a full neck surgery for the patient, says Dr. Ghanem. By using minimally-invasive procedures and personalized medicine, doctors at Henry Ford continue to advance their mission of improving patient outcomes.

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February, 2019|Oral Cancer News|

Merck’s Keytruda looks to zoom past Opdivo with fast head and neck cancer review

Source: Fierce Pharma
Date: February 11, 2019
Author: Carly Helfand

Merck & Co.’s Keytruda is duking it out with Bristol-Myers Squibb’s Opdivo in the head and neck cancer marketplace, but Keytruda just took one step toward a green light that would give it a big edge.

The FDA has tagged Merck’s approval application for the immuno-oncology superstar—alone or in tandem with chemo—with its priority review designation in previously untreated patients with head and neck cancer. The move, which Merck announced Monday, sets Keytruda up for a quick trip down the regulatory pathway; the agency expects to have a decision by June 10, Merck said.

FDA staffers based their decision on data Merck trotted out at last year’s European Society for Medical Oncology (ESMO) meeting in October. Results showed that solo Keytruda, when pitted against a standard-of-care regimen dubbed by doctors as “Extreme,” could cut the risk of death by 22% in patients testing positive for the biomarker PD-L1. In patients with high levels of PD-L1 in their tumors, that figure shot up to 39%.

And when paired with chemo, Keytruda pared down the risk of death by 23% regardless of patients’ PD-L1 status.

Based on “the limited interaction we’ve had with key opinion leaders, I think this is seen as practice-changing,” Roy Baynes, Merck SVP and head of global clinical development, said when the data were released. And in addition to shaping opinions on clinical practice, the results also confirmed Keytruda’s place in the second-line setting, where it had previously suffered a narrow trial miss.

If Merck can snag a go-ahead in new patients, it’ll be an option for the more than 65,000 patients diagnosed each year in the U.S., according to the company. It’ll also mean a major leg up on BMS, whose Opdivo only bears a second-line OK. And with untreated patients in line to get Keytruda, the number of patients eligible for Opdivo—because those who used Keytruda first wouldn’t be in line for a second round of PD-1 therapy—will presumably dwindle.

The two drugs have been battling it out in different tumor types since the early days of immuno-oncology, when both started off with FDA nods in melanoma. While Opdivo has held market leads in important areas including kidney cancer, it’s Keytruda that has the No. 1 position, thanks to its dominant status in lung cancer, the biggest arena for the medicines.

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February, 2019|Oral Cancer News|

Why salivary diagnostics for dental practices?

Source: www.dentistryiq.com
Author: Barbara Kreuger, MA, RDH

I recently had the opportunity to visit OralDNA Labs and learn more about the process of running salivary diagnostic tests. Admittedly, when I first heard about salivary diagnostics, I didn’t immediately embrace the tests and what they had to offer. I was not convinced that they were necessary, believing they would not change how we treat dental disease.

However, we’ve been fortunate to use salivary diagnostics in practice and see the benefits in our patients firsthand. These tests have proven to be a great addition to our prevention tool box. Salivary diagnostics can play an important role in helping us produce high quality outcomes for patients and create awareness of their oral-systemic risk factors.

Bacterial identification
There are numerous salivary diagnostic tests available. The most widely used test from OralDNA Labs is MyPerioPath, which tests for the 11 pathogens that are known to contribute to periodontal destruction.(1) Once the test reveals which pathogens are contributing to the patient’s periodontal disease, it also offers antibiotic recommendations that target these specific bacteria.

When combined with periodontal maintenance visits and patient homecare, this test can lower a patient’s bacterial load, thus increasing positive outcomes. Retesting has shown that this reduction in bacteria can have a dramatic effect. We’ve seen tough cases—patients who were compliant with homecare but still exhibited clinical signs of periodontal disease—that improved dramatically after being treated with the test’s recommended systemic antibiotic. Periodic monitoring with MyPerioPath combined with periodontal maintenance treatment can help keep patients’ oral health stable.

Genetic predisposition
In addition to bacterial profile testing, various tests from OralDNA labs can tell us a patient’s genetic predisposition toward inflammation. This can reveal one of the reasons why some patients continue to experience periodontal destruction after treatment despite compliance and lower quantities of periodontal pathogens. In addition, much of the research connecting oral health to systemic conditions reveals that it is a patient’s total inflammatory burden that puts someone at risk for a host of health problems.(2,3)

While the patient’s genetic profile cannot be changed, the knowledge that the person has an overactive inflammatory response can help the practitioner and patient understand that there is a need for more frequent continuing care, adjunctive therapies, or treatment with a periodontist. This information can also help patients manage and control their systemic health with the help of their physician.

Caries risk assessment
When we look beyond the patient’s periodontal health, salivary diagnostics can also test for the bacteria that are known to contribute to caries. When we have an objective measure of the quantity and types of cariogenic bacteria in the patient’s mouth, we can once again tailor treatments to reduce his or her caries risk and motivate the patient toward behavioral change. If we then combine the test with a caries risk assessment tool, we can use the test to monitor the effectiveness of these behavior changes. Knowing the patient’s risk allows us to encourage the person to use interventions, such as fluoride to re-mineralize teeth and xylitol to inhibit the bacterial metabolism.

Oral cancer screening
Finally, salivary diagnostics can also test for the presence of various human papillomavirus (HPV) strains that have been shown to cause oral cancer. According to the American Cancer Society, oral cancer will take the lives of 10,860 people this year, and HPV is now seen as the leading cause.(4,5) Early diagnosis is key and increases survival from a dismal 20% when discovered after it has metastasized to distant sites, to 93% when discovered early.(6)

Knowing a patient’s HPV status may prompt us to increase the frequency of someone’s oral cancer screenings, or to use adjunctive diagnostic tools such as oral anomaly detection devices to more closely monitor the patient and potentially catch the cancer at an earlier stage.

More and more research studies are correlating the various bacteria that cause periodontal disease to systemic conditions. The more we understand about a patient’s bacterial load and risk factors, the better equipped we can be to help manage periodontal disease and improve overall health. Salivary diagnostics can help us provide optimal care for patients, increasing our ability to provide them with positive outcomes through tailored treatment and patient education.

Barbara Kreuger, MA, RDH, earned a Bachelor of Science in dental hygiene from the University of Minnesota and holds a Master of Arts in organizational leadership from St. Mary’s University of Minnesota. She spent more than 18 years as a clinical dental hygienist before moving to her current role as dental hygiene senior specialist for Pacific Dental Services. Barbara is currently serving as president of the Minnesota Dental Hygienists’ Association.

References

1. Oral DNA tests. OralDNA website. https://www.oraldna.com/tests.html. Accessed February 1, 2019.
2. Hunter P. The inflammation theory of disease. The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. EMBO Rep. 2012;13(11):968-70.
3. Minihane AM, et al. Low-grade inflammation, diet composition and health: current research evidence and its translation. Brit Jour Nutrition. 2015;114(7):999–1012.
4. Key Statistics for Oral Cavity and Oropharyngeal Cancers. American Cancer Society website. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/about/key-statistics.html. Accessed February 1, 2019.
5. HPV/Oral Cancer Facts. Oral Cancer Foundation website. https://oralcancerfoundation.org/understanding/hpv/hpv-oral-cancer-facts/. Accessed February 1, 2019.
6. Survival Rates for Oral Cavity and Oropharyngeal Cancer. American Cancer Society website. https://www.cancer.org/cancer/oral-cavity-and-oropharyngeal-cancer/detection-diagnosis-staging/survival-rates.html. Accessed February 1, 2019.

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February, 2019|Oral Cancer News|

‘They needed something more after treatment’

Source: www.nursingtimes.net
Author: Claire Reed

Lesley Taylor wanted to examine the lack of support for patients at the end of treatment, so the decision was made to explore the impact of a wellbeing clinic on care, Claire Read reports.

When the results of the study came back, they confirmed what Lesley Taylor and her colleagues had long suspected. The patients for whom they cared were getting good support for their actual medical issues, but their post-treatment needs weren’t always being identified or met.

Ms Taylor is the Macmillan advanced oncology nurse specialist at NHS Tayside, as well as the head and neck cancer nurse specialist at the same organisation. It was on these patients which Ms Taylor’s study was focused.

“We could look down into their mouths and throats and say there was no evidence of any cancer, and that was great, they appreciated that. But what we didn’t have time to do in that medically-led clinic was look at things like dry mouth, and swallow, and the emotional aspects and the social aspects that come alongside what are often life-changing diagnoses and treatments,” she remembers.

“It became clear they needed something very much more at the end of treatment.” And so the decision was taken to instigate a nurse and allied health professional-led wellbeing clinic. The idea was to provide the sort of support that had been lacking; the holistic look at someone’s life in the immediate aftermath of the end of treatment.

The team worked together to reshuffle how they saw patients, and found a rare spot in the hospital in which they could hold appointments: a dental suite. The impact was soon felt. “The new cohort of patients that were coming through seemed to be getting better quicker,” according to Ms Taylor.

At the same time, there was the know-ledge that the service could be refined further. A priority was finding a non-hospital setting in which to hold the clinics. “We were aware there was this in-built anxiety about coming back to the hospital each time you had to be checked – there were all these reminders of what they’d been through and how that made them feel.”

It was felt a move into the community would make most sense, not least because, this is the main setting for individuals’ lives post-treatment. “We needed to rehabilitate them away from hospital and back to what was their own life, although it might be very different from what it was before.”

That became possible when a space was secured at a purpose-built health centre on the edges of Dundee. The shift to the new facility brought with it a shift in patient group. The service was opened up to colorectal and prostate cancer patients as well as those with head and neck cancers. In the longer run, the aim is to open the service to anyone who has been through any form of cancer treatment.

It means, staff hope, there is no longer the sense of abandonment some patients had reported feeling at the end of active treatment. “For head and neck cancer patients, they would have six weeks of daily treatment and then no contact – at a time when they were probably at the height of their treatment toxicity. So we now see them at two weeks, and we can see them earlier than that if there’s a problem.”

It is a major service design change. But ask Ms Taylor how she and her colleagues achieved it, and she is matter of fact: “We just thought: ‘We’ve got to do this’.”

And so they simply rearranged their diaries and made the new clinic work, not going down the route of trying to secure additional funding and the associated bureaucracy.

Ms Taylor argues there are virtues to that sort of evidence-based ‘get on and do it’ approach, but she also urges nurses who want to drive service redesign to pay attention to the effect their innovations have.

“Gather your information as you go, so that when somebody turns around and says to you: ‘Well, do you think you’ve made a difference?’, you don’t have to hack back through all this information, which is there but may not have been collated properly. Keep a strict eye on the data you’re producing, so that you can say – ‘Look at the difference we have made’.”

In the case of the clinics, there is now clear evidence of just such a difference. “It seems to be in this cohort of patients who’ve gone through these wellbeing clinics that they’ve gone from having their feeding tubes in for on average six months to having their feeding tubes in for an average of three months – a 50% reduction,” she reports. “So I just think it’s made a huge difference to the patients.”

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February, 2019|Oral Cancer News|

Symptom combos suggesting laryngeal cancer identified

Source: www.physiciansweekly.com
Author: staff

New symptom combinations that may indicate early symptoms of laryngeal cancer have been identified, according to a study published online Jan. 28 in the British Journal of General Practice.

Elizabeth A. Shephard, Ph.D., from the University of Exeter Medical School in the United Kingdom, and colleagues conducted a matched case-control study of patients aged ≥40 years to examine the clinical features of laryngeal cancer with which patients presented to their general practitioner in the year before diagnosis.

The researchers identified 806 patients who were diagnosed with laryngeal cancer between 2000 and 2009; the patients were matched with 3,559 controls based on age, sex, and practice. Significant associations were identified for 10 features with laryngeal cancer: hoarseness (odds ratio, 904); sore throat, first attendance (odds ratio, 6.2); sore throat, reattendance (odds ratio, 7.7); dysphagia (odds ratio, 6.5); otalgia (odds ratio, 5); dyspnea, reattendance (odds ratio, 4.7); mouth symptoms (odds ratio, 4.7); recurrent chest infection (odds ratio, 4.5); insomnia (odds ratio, 2.7); and raised inflammatory markers (odds ratio, 2.5). The highest individual positive predictive value (PPV) was 2.7 percent for hoarseness. The symptom combinations of sore throat plus either dysphagia, dyspnea, or otalgia are not currently included in the National Institute for Health and Care Excellence (NICE) guidelines; PPVs for these combinations were >5 percent.

“These results expand current NICE guidance by identifying new symptom combinations that are associated with laryngeal cancer; they may help general practitioners to select more appropriate patients for referral,” the authors write.

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February, 2019|Oral Cancer News|