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One in four deaths in the United States is attributable to cancer, and one in three Americans will eventually develop some form of cancer. Each day, 3,400 people in America are diagnosed with cancer, and another 1,500 die from the disease. But the burden of cancer is too often greater for the poor, ethnic minorities, and the uninsured than for the general population. Source.
The Annual Report to the Nation on the Status of Cancer 1975-2000, Featuring the Uses of Surveillance Data for Cancer Prevention and Control was released in September 2003. The report shows that:
Overall, cancer death rates neither increased nor decreased from 1998 to 2000, and cancer incidence rates were stable from 1995 to 2000. However, mortality rates of the four most common cancers (lung, colorectal, breast, and prostate) continued to decline. Researchers believe the drop in lung cancer mortality reflects similar declines in tobacco smoking.
Improvements in breast cancer incidence and mortality rates appear to result from increased use of mammography and the availability of improved therapies. Yet, the report also calls attention to some worsening cancer health disparities:
For example, a growing difference in death rates between White and Black populations for colorectal and breast cancers suggests that Black men and women may not have experienced the same benefits from screening and treatment services as their White counterparts. In addition, higher rates of late-stage breast cancer in some population groups and geographic areas may reflect delayed access to care, often among women who lack health insurance and among recent immigrants.
The report concludes that further reductions in cancer incidence and death rates will require strong Federal, state, local, and private partnerships to apply evidence-based control measures (e.g., screening), improve the delivery of quality cancer care, and develop more effective screening strategies that reach all segments of the population.
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Although the role of socioeconomic factors as determinants of such major chronic diseases as heart disease, stroke, diabetes, and respiratory disease is well established, the relationship with cancer has been less clear.
NCI has released a monograph that provides, for the first time, a comprehensive population-based analysis of the role of socioeconomic factors in U.S. cancer incidence, mortality, disease stage, treatment, and survival for all cancers combined and for six major cancers: lung, colorectal, breast, uterine, and cervical cancers, and melanoma of the skin. This monograph explores socioeconomic-related cancer disparities for the total population as well as for the major racial and ethnic groups in the United States. The report concludes that:
- Despite overall improvements in mortality and patient survival, substantial socioeconomic disparities in cancer persist.
- The specific characteristics of these disparities vary by type of cancer, and in some cases the disparities appear to be widening over time.
This document provides an important resource to public health researchers and policymakers interested in addressing the Nation's progress toward reducing both the cancer burden and health disparities among various segments of the U.S. population.
While exploring possible anti-cancer effects of beta carotene as a dietary supplement, NCI-supported researchers discovered that people taking the supplements who also smoke cigarettes and/or regularly consume alcohol tended to have an increased risk of developing lung cancer. They reported recent findings from a large clinical trial exploring the relationship among beta carotene supplementation, smoking and drinking behaviors, and the recurrence of colon polyps, a precursor condition to colorectal cancer. Findings include:
- Beta carotene supplementation substantially decreased the recurrence of polyps in the study population among patients who neither smoke nor consume alcohol.
- In contrast, beta carotene supplementation slightly increased the risk of polyp recurrence in people who smoke or consume one or more alcoholic beverages a day, with the greatest risk elevation seen in people who both smoke and drink regularly.
These findings are similar to those of a previous study showing that beta carotene increased the risk of melanoma in smokers but not in nonsmokers. This varying effect of beta carotene supplementation on cancer risk, depending on patient behaviors, suggests the need for caution in choosing cancer prevention interventions for general use, especially when mechanisms of action and interactions with other lifestyle factors have not been clearly defined.
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While researchers increasingly discover genetic and environmental risk factors for many types of cancers, the causes of brain tumors in adults remain poorly understood. Well-established risk factors, such as high doses of radiation and certain rare genetic disorders, account for only a small number of brain tumors.
In a recent study, investigators hypothesized that differences in the make-up of some genes - those that code for proteins that help break down harmful chemicals such as solvents, pesticides, and ethanol - may affect brain tumor risk.
- These researchers tested the blood of nearly 800 adult brain tumor patients, and a similar number of control patients, for genetic polymorphisms in two such genes, GST and CYP2, that have been implicated in brain tumor risk.
- A number of the polymorphisms were indeed associated with the development of brain tumors.
If these findings are validated in other studies of a similar scale, the next step would be to pool samples from multiple epidemiological studies and examine interactions of genotypes with specific occupational exposures. Defining the risk of brain tumor development by specific gene/environment interactions will help the cancer community to identify appropriate interventions and precautions for people at high risk.
"My wife worries about all the chemicals I have to work with. She talks about cancer. I tell her not to worry. But sometimes I wonder myself."
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Although many of the almost 221,000 U.S. men diagnosed with prostate cancer in 2003 will be cured, almost 29,000 will die from this disease in the same year.
Prostate cancer is the most common malignancy, and the second leading cause of cancer death, among men in the United States and in most Western countries. A number of risk factors are implicated in the development of prostate cancer, including age, family history, ethnicity, hormonal factors, smoking, high consumption of animal fat and red meat, and low consumption of fruits and vegetables. Even so, the etiology of prostate cancer remains largely unknown.
Since farming is the most consistent occupational risk factor for this disease, scientists have been seeking to clarify the potential risks associated with pesticide use. Investigators of the Agricultural Health Study, a cohort study of over 55,000 male pesticide applicators with no prior history of prostate cancer, discovered two unexpected relationships between the use of certain pesticides and prostate cancer risks:
- Men who reported occupational use of the fumigant methyl bromide (one of 45 common agricultural pesticides examined in the study) had a slightly higher risk of developing prostate cancer than the cohort overall.
- Exposure to several widely used insecticides seemed to increase the risk of prostate cancer, but only in men with a family history of the disease.
In addition to these novel findings, evidence suggests that the use of chlorinated pesticides may have been related to increased prostate cancer risk, especially in men over 50 years of age. If further validated, this new knowledge about the hereditary and environmental etiology of prostate cancer risk may help scientists develop interventions to prevent, detect, and treat this disease in the farming community and in other populations.
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Biobehavioral factors such as stress, depression, and social support are known to influence how well the immune system responds to disease, including cancers. Scientists have documented the effects of biobehavioral factors on the function of immune cells (such as white blood cells), cytokines (proteins that heighten immune activity), and hormones that help regulate immune activity.
For the first time, a team of investigators has extended this research to vascular endothelial growth factor (VEGF), a stress-related cytokine that stimulates new blood vessel growth (angiogenesis) in growing tumors. In this study, women with ovarian cancer who had a greater sense of social well-being had markedly lower blood levels of VEGF. This research suggests that biobehavioral effects on VEGF levels, and consequent stimulation of angiogenesis, may be one way in which biobehavioral factors affect the progression of ovarian cancer. Further research is needed to validate this mechanism and to explore ways to target it through prevention and treatment interventions.
"When my doctor told me I had cancer - Hodgkin's Disease - that was pretty scary. Thankfully, the treatment worked. But I'm told I may have a greater risk of developing other cancers, like breast cancer, later in life. Scary again." |
Breast cancer is the second leading cause of cancer death among women in the United States. Approximately 40,000 women are expected to die from this disease in 2003.
Hodgkin's disease, a once deadly cancer of the lymphatic system, is now highly curable, with 85 percent of patients surviving at least 5 years after diagnosis. However, with this success comes an increased risk of second cancers, including leukemia, sarcoma, and breast, lung, and thyroid cancers. Among female survivors, breast cancer is the most likely tumor to develop, especially in women who are age 30 or younger when treated with radiotherapy.
An international team of scientists recently analyzed data from over 3,800 Hodgkin's survivors in this subgroup to identify specific risk factors. They discovered that:
- The higher the radiation dose to the breast, the more likely the women were to develop breast cancer.
- Conversely, higher concentrations of alkylating agents given in chemotherapy and higher radiation doses to the ovaries were associated with lower future breast cancer risk. Researchers suspect that premature menopause induced by damage to the ovaries is at the root of this risk reduction, since premature menopause by surgery is also known to reduce breast cancer risk.
Because of improvements to Hodgkin's disease treatments over time, women treated more recently may be at lower risk for breast cancer development than the women included in this study. However, current female survivors of Hodgkin's disease will require programs to enhance clinician and patient awareness, lifetime surveillance, and breast cancer prevention strategies. Despite the risks of future breast cancers highlighted by these investigators, the benefits of radiotherapy and chemotherapy for Hodgkin's disease patients far outweigh the treatment-related risks.
Few would argue that cancer is a major stressor for anyone diagnosed. Recent research reveals that family members of cancer patients also are subject to trauma. Investigators applied the posttraumatic stress (PTS) model to siblings of childhood cancer survivors. Among the findings:
- Adolescent siblings of pediatric cancer survivors reported more PTS symptoms than did a reference group of unaffected teens with similar levels of general anxiety.
- Among the survivors' siblings, about half (47 percent) reported mild PTS, 32 percent indicated moderate to severe levels, and 25 percent said they thought their brother/sister would die during treatment.
These data remind us that cancer is often a family disease. Consequences to siblings can include uncertainty about the future, distress over witnessing physical and emotional pain, sudden and extended separation from parents, and changes in family members' roles and responsibilities. Identifying those at risk and intervening early to reduce emotional distress may be critical for the subsequent health and well-being of both the cancer patient and his or her siblings and other family members.
- Genetics of programmed cell death
- Genetic subtypes of breast cancer
- Imaging molecular interactions in cells
- Genetics of smoking cessation
- Imaging nicotine receptors in the brain
- ADHD and tobacco marketing
- Discoveries in energy balance research
- Assessing quality of cancer care
- Genetics of neuro-cognitive late effects
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Some cancers, like esophageal cancer, can be treated successfully if detected early. Unfortunately, for many such cancers, we do not have good early detection tests. Researchers are using genomics and proteomics to develop tests to screen for hard-to-detect cancers.
Esophageal cancer incidence has been rising at a rate faster than that of any other malignancy. With no good test for early detection, patients are usually diagnosed in the advanced stages of disease, and mortality is high.
Investigators recently discovered that an artificial intelligence technique called "artificial neural networks" (ANNs) can accurately analyze microarray data to detect esophageal cancer. In this study, investigators identified ANNs as the best of several artificial intelligence techniques for distinguishing between esophageal cancer and a precancerous condition, Barrett's Esophagus (BE).
- Investigators first "trained" the ANNs to recognize the difference between biopsy samples from patients with BE or esophageal cancer. To train the ANNs, researchers had it analyze eight tissue samples from BE patients and four from patients with esophageal cancer. The ANNs thus "learned" the difference in what the microarray data of cancer and precancer "looks" like.
- Once fully trained, the ANN correctly classified 10 new samples as BE or esophageal cancer.
This research shows ANNs as a promising technique that can extract and analyze microarray data. With further development, this technology may have a far-ranging impact on cancer detection, diagnosis, and management. Furthermore, the ANN-identified differences in gene expression discovered in this study may provide biomarkers for development into early detection techniques for esophageal cancer.
Researchers have repeatedly shown the effectiveness of the Pap smear for early detection of cervical cancer. Though limited in both sensitivity and reproducibility due to the slow-growing nature of cervical cancer, the Pap smear is effective if women are screened on a regular basis and is considered the standard screening test for this disease. In light of its shortcomings, U.S. healthcare providers favor annual over less frequent Pap smear testing to ensure early detection.
Scientists recently conducted a large clinical trial to investigate whether testing for human papillomavirus (HPV) infection, in addition to Pap smear testing, could safely lengthen the screening interval. Almost 21,000 women received a baseline Pap smear as well as a test for HPV. The investigators monitored the women for up to 10 years for development of cervical cancer or precancer. Findings include:
- Women who were negative for both Pap smear and HPV testing at the onset of the study had a low risk of developing cervical cancer.
- Women who tested positive for either test had a much higher risk.
This proof-of-principle research provides evidence that HPV testing in combination with Pap smear testing may safely permit longer screening intervals among patients who are negative for both measures. However, neither Pap smear nor HPV testing alone would provide this reassurance. Positive results from either test would identify a subgroup of women requiring more frequent surveillance.
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Papillary thyroid cancer is the most common and most curable type of thyroid cancer, with approximately 95 percent of patients cured if treated appropriately. However, scientists believe survival rates could be further improved if clinicians had better tools for early detection. Tumors are usually detected after a patient or family member notices a lump in the neck, and a physician recommends a clinical needle biopsy. However, these needle biopsies are often not definitive, and patients undergo unnecessary surgery or delayed diagnosis.
Scientists have now discovered a genetic mutation that may assist physicians in identifying tumors earlier. In a recent study, investigators screened tumors from six different disease sites for a cancer-related genetic mutation prevalent in melanoma cancers. This mutation of the BRAF gene was detected in the majority (24 of 35 tumors, or 69 percent) of papillary thyroid tumors. In addition to providing a potential aid for early detection, this discovery provides clues about the molecular pathways that may be involved in the development and progression of this cancer. Further research into these molecular mechanisms may lead to new treatments for people who do not respond to current therapies.
Hepatocellular carcinoma (HCC or liver cancer) is an extremely aggressive disease of high mortality that is common in Asia and Africa, with incidence rising in Europe and North America. Metastasis within the liver causes most of the mortality from this disease.
Researchers used gene expression microarrays to identify genes that affect both tumor metastasis and patient survival for HCC. These investigators identified, for the first time, a molecular signature to distinguish between metastatic and nonmetastatic hepatocellular cancers. Of special note, the gene osteopontin was overexpressed in metastatic HCC compared to nonmetastatic tumors.
Correlative laboratory experiments were encouraging. Investigators were able to block the metastatic behavior of HCC cells in vitro with an antibody that inhibits the action of the osteopontin protein. The same antibody prevented HCC metastasis to the lungs in a mouse model.
Further research is needed to refine and validate the clinical usefulness of this promising biomarker. If developed for early detection of metastatic HCC and for therapy to prevent metastasis, this discovery could improve long-term survival of patients who ordinarily succumb to this disease.
Cancer researchers are working to define the molecular pathology of ovarian cancer, hoping to find new treatments for this most lethal of all gynecologic malignancies. Serous carcinoma, the most common type of ovarian cancer, can occur as either high- or low-grade tumors. Low-grade serous tumors, called invasive micropapillary serous carcinoma (MPSC), in particular, do not respond well to conventional chemotherapy.
Researchers examining tissue samples from about 180 ovarian tumors discovered that certain mutations in two genes, BRAF and KRAS (formerly implicated in the development of other cancers), were often found in MPSC tumors but not in high-grade serous tumors. These findings suggest that low- and high-grade serous ovarian carcinomas develop via malfunction of different molecular pathways. Researchers are hopeful that this new knowledge will lead to molecularly targeted treatments that block the function of BRAF and KRAS proteins in MPSC patients, thereby thwarting this difficult-to-treat ovarian carcinoma.
Testing for the presence or absence of lymph node metastasis is an important element in the care of men diagnosed with prostate cancer. Men with local prostate cancer are usually given the choice of treatment by radical prostatectomy, radiotherapy, or watchful waiting. However, the standard of care for men with lymph node metastasis is a more aggressive treatment with adjuvant androgen-deprivation therapy with radiation. Currently, lymph nodes near the prostate gland must be surgically removed and examined in the laboratory for metastasis. No imaging technique has proven sufficiently sensitive to replace this invasive biopsy procedure.
Recently, researchers tested a type of nanoparticle called lymphotropic superparamagnetic nanoparticles (LSNs) to enhance imaging of lymph nodes in prostate cancer patients. LSNs, small enough to enter individual cells, actively accumulate in lymph nodes once injected into the body and are sufficiently magnetic to be detected by magnetic resonance imaging (MRI). Animal studies have shown that MRI using LSNs can distinguish between normal and metastatic lymph nodes.
Investigators have used LSNs in conjunction with MRI to correctly identify lymph node metastasis in 100 percent of 33 patients known to have metastatic prostate cancer. This test also correctly classified 96 percent of patients with nonmetastatic cancer. Large prospective clinical trials are needed to determine the clinical utility of this promising new procedure.
Scientists have found immune therapies to be useful in treating blood cancers such as leukemia and lymphoma, but have suspected that breast cancers would be resistant to such therapies. Now, for the first time, researchers have demonstrated that genetically matched immune cells transplanted from donors will attack and shrink metastatic breast cancer cells.
Thirteen women who had received multiple prior treatments for metastatic breast cancer participated in this study. After receiving conventional chemotherapy, the women were injected with T cells (a type of white blood cell responsible for seeking and destroying invading cells) isolated from the stem cells of siblings with the same HLA (human leukocyte-associated antigens) blood type. The researchers were able to directly correlate the immune response against the cancer cells to the donor cell therapy. Over half of the patients studied experienced some level of tumor shrinkage attributable to the "graft-versus-tumor effect" of transplanted donor cells. Although the immune therapy did not completely eliminate tumors in patients, this breakthrough nonetheless brings us closer to the development of new, effective immunotherapies for metastatic cancers.
"How am I going to tell my family about my lung cancer diagnosis? The doctor says standard treatments don't cure many patients with this type of lung cancer, although it might buy me some extra time. Time is precious. The doctor did tell me about a clinical trial. But I don't know. Is there really hope?" |
Lung cancer is the leading cause of cancer death in both men and women in the United States. Close to 92,000 men and 80,000 women will be diagnosed with lung cancer in 2003. In the same year the disease will kill over 88,000 men and close to 69,000 women. Non-small cell lung cancer is the most common form of lung cancer.
Investigators studying non-small cell lung cancer (NSCLC) recently built on findings that a vaccine containing genetically modified irradiated tumor cells is highly active against tumors in a number of mouse models as well as in some melanoma patients. In a Phase I clinical trial, researchers produced patient-specific vaccines by isolating, genetically modifying, and irradiating tumor cells taken from patients with metastatic NSCLC. The genetic modification caused the cells to produce granulocyte macrophage colony-stimulating factor (GM CSF), a protein known to activate the immune system to attack tumor cells. The radiation rendered the tumor cells in the vaccine unable to replicate.
The investigators discovered that:
- The vaccine caused only low-level toxicities, and 18 out of 25 vaccinated patients showed at least some immune response.
- The disease of five patients was stabilized for up to 3 years after treatment.
- Of patients whose tumors were surgically removed before vaccination, 2 were still cancer free 42 months later.
While the response was not uniform across all patients, this study adds to accumulating evidence that GM CSF-based vaccines activate the immune system to attack tumors in many cancers and could perhaps be combined effectively with other treatment strategies. The prolonged response of some patients suggests promise for this vaccine strategy in early-stage NSCLC patients.
Pancreatic cancer is a high-mortality disease with an overall 5-year survival rate for patients with adenocarcinoma, the most common form of this disease, at less than 5 percent. Only about 10 percent of adenocarcinoma patients are diagnosed while the cancer is confined to the pancreas. These patients are eligible for surgical resection, and their 5-year survival rate increases to about 20 percent.
Recently, a team of investigators accessed data from NCI's Medicare-linked Surveillance, Epidemiology, and End Results (SEER) registries to examine the prognostic factors that influence survival in this group of patients. This retrospective cohort analysis of 396 adenocarcinoma surgical patients revealed the following:
- The strongest predictor of improved survival was postoperative adjuvant chemoradiation therapy.
- A trend toward more patients being treated in teaching hospitals was leading to a gradual improvement in survival over time.
- Other predictors of improved survival included tumor size of less than 2 centimeters in diameter, no detection of cancer in nearby lymph nodes, well-differentiated histology, and high socioeconomic status.
- African Americans tended to have lower overall survival rates than other racial/ethnic groups.
- Of special note, socioeconomic status was shown to affect the likelihood of receiving adjuvant treatment, the most powerful predictor of survival. This finding warrants further investigation into a possible relationship between disparities in quality of care and survival outcomes for this disease.
- Ovarian cancer screening test
- Genetic prognosis of ovarian cancer tumors
- Recent research on cancer and viruses
- Immune therapy for metastatic melanoma
- Prostate cancer and diet
- Improving cervical cancer screening
- Classifying diffuse large B-cell lymphoma subtypes
- Chemoprevention of prostate cancer
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While the mortality rate for breast cancer is decreasing, the number of women diagnosed with this cancer has been rising for the past two decades, making prevention a top research priority. Investigators in NCI's Women's Health Initiative (WHI) Observational Study discovered that regular use of ibuprofen and aspirin, already known to help prevent the development of precancerous colon polyps, may be protective against breast cancer. Findings from the WHI Observational Study indicate that:
- Weekly doses of nonsteroidal anti-inflammatory drugs (NSAIDs) had a significant effect in reducing the risk of breast cancer, even for those women considered at high risk.
- Women taking two or more NSAIDs per week for 5 to 9 years reduced their breast cancer risk by as much as 21 percent. By extending the use to 10 or more years, their risk was reduced by 28 percent.
Researchers considered breast cancer risk factors such as age, body mass, estrogen use, family history, and exercise along with the use of NSAIDs when determining risk. Study investigators observed that ibuprofen was more effective than aspirin in reducing risk, and regular use of low-dose aspirin had no effect. Additional studies are needed before usage guidelines for NSAIDs as a preventive for breast cancer can be implemented.
Survival outcomes for children with acute lymphoblastic leukemia (ALL) have improved dramatically over the years. The number of young patients who survive 5 or more years has risen from less than 5 percent in the early 1960s to more recent rates of about 85 percent. This improvement is a testament to the success of sequential clinical trials that have progressively identified more effective treatment regimens.
Recent conventional therapy for childhood ALL has included chemotherapy with mercaptopurine, accompanied by treatment with the steroid prednisone to help kill the cancer cells. Researchers have now discovered that replacing prednisone with a different steroid, dexamethasone, further improves survival. In a clinical trial of more than 1,000 standard-risk ALL patients younger than 10 years of age:
- Eighty-five percent given dexamethasone survived at least 6 years without evidence of relapse, versus 77 percent of patients treated with prednisone.
- Fewer children treated with dexamethasone experienced central nervous system relapses, an important cause of treatment failure for children with ALL.
- There was a trend toward fewer bone marrow relapses.
These findings change the standard of treatment for ALL patients younger than 10 years of age by making dexamethasone, rather than prednisone, the steroid of choice. Additional research is needed to evaluate the use of dexamethasone in the treatment of older children and adolescents with ALL.
Idiopathic hypereosinophilic syndrome (IHS) is a condition in which the body produces an overabundance of eosinophils, a type of white blood cell involved in ridding the body of foreign substances. The cause of this anomaly is unknown. Current treatments focus on controlling deadly damage to vital organs that become infiltrated by eosinophils, but mortality nevertheless is extremely high.
Researchers recently treated 11 IHS patients with an experimental trial of Gleevec, a molecularly targeted drug used to treat chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). In 9 of 11 patients, eosinophil levels returned to normal, in treatment responses lasting 3 or more months. Based on knowledge of Gleevec's mechanism of action, investigators searched for and identified the genetic mutation causing IHS in the majority of these patients.
In addition to survival benefits for IHS patients, this work sheds light on the molecular origins of IHS, which may lead to a better understanding of this disease and still better ways to treat it. This study also points to a perhaps even greater number of cancers that may respond to Gleevec and encourages continued searching for molecular targets for this drug in a variety of disease sites.
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Survival of HIV-positive patients with AIDS-related lymphoma (ARL) has improved since treatment with highly active antiretroviral therapy (HAART) for AIDS patients has become standard practice. However, prognosis remains poor with the standard treatment for ARL, the CHOP5 regimen - ARL still causes death in up to 20 percent of HIV-positive patients.
Researchers recently developed a treatment regimen known as dose-adjusted EPOCH (DA-EPOCH) that substantially improves survival for ARL patients. Three factors make DA-EPOCH effective in these patients:
- Given in low concentrations over long periods, this drug combination can overcome the drug resistance encountered with CHOP therapy.
- The patients receive individualized dosages to minimize certain toxicities.
- Antiretroviral therapy can safely be suspended during chemotherapy to boost the effectiveness of the treatment.
Out of 39 patients treated with DA-EPOCH in this study:
- Twenty-nine experienced complete remission, and five achieved partial remission.
- Over the long term, 60 percent of the patients survived at least 53 months; 92 percent of these were disease free.
These survival rates are dramatically better than for patients given standard CHOP therapy. Researchers expect DA-EPOCH therapy to greatly boost survival of ARL patients, with the exception of those with central nervous system involvement, who did not respond well to DA-EPOCH therapy.
Although close to 61 percent of new cancer cases occur among persons 65 years of age and older, and approximately 71 percent of all cancer deaths are in this population, only 25 percent of the patients enrolled in cancer clinical trials are from this age group. NCI-supported researchers examined the reasons behind this disparity by conducting a retrospective analysis of patient and trial characteristics for 59,300 patients enrolled in 495 NCI-supported trials. Their findings include the following:
- Of all the criteria used for excluding participation in a trial, exclusions based on organ system abnormalities and functional status limitations were found to be associated with the lowest participation by older patients. This is not surprising since older patients, overall, have more disqualifying medical conditions than younger patients.
- Investigators noted that while insurance coverage for clinical trials for the aging has improved access to trials for this population group, changes in study design and in protocol exclusions are needed to improve overall enrollment opportunities.
Results from this study suggest that if protocol exclusions were relaxed, participation by this age group in cancer trials could be as high as 60 percent. The investigators emphasized that clinical trials must have exclusion criteria. For example normal renal function may be required in trials that use agents that can cause kidney toxicity. However, these investigators suggest that, when designing a clinical trial, researchers must examine each exclusion criterion to ensure it is scientifically justified.
Researchers examining data from the population database of NCI's Surveillance, Epidemiology, and End Results program discovered disparities in survival rates, probably related to treatment, between Black and White breast cancer patients. Stage-specific 6-year survival rates for patients under the age of 50 were found to be poorer for Blacks than for Whites. Researchers were able to rule out other causes and attribute the survival to disparate access to and utilization of effective breast cancer treatments.
These findings highlight the need for all population groups to have access to insurance coverage, medical facilities, and treatment staff as well as good information resources. The study also showed that:
- Black and White women aged 65 and older do not have significantly different breast cancer survival rates, suggesting that programs such as Medicare may help to overcome treatment disparities.
- Black women are less likely than White women to be diagnosed in the first stage of cancer development, emphasizing the need for early detection and diagnosis of breast cancer among all women.
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"As a doctor, it isn't easy when I have to tell my patients they have cancer. This was one of the easier cases. With quality surgery and adjuvant therapy for his rectal cancer, he has a good chance of full recovery." |
Incidence and mortality rates for cancers of the colon and rectum are the third highest in the United States for both men and women. Statisticians predict that in 2003, more than 144,000 people will be diagnosed with, and more than 57,000 will die from, colorectal cancer.
For many cancers requiring surgery, patient survival and quality-of-life outcomes are better when patients are treated at hospitals that perform a large number of the surgeries ("high-volume" hospitals). A recent study of over 7,000 rectal cancer patients has revealed that rates for permanent colostomy and postoperative mortality were lower and overall survival higher for rectal cancer patients undergoing surgery at high- compared to low-volume hospitals.
It is particularly important to understand the relationship between hospital volume and patient outcomes for rectal cancer, because scientists have found surgical management of this disease to markedly affect tumor control and quality of life. This research suggests that the morbidity and mortality of rectal cancer could be substantially reduced if all patients were to receive the same quality of care found at high-volume hospitals.
Researchers recommend additional investigation to identify processes of care that contribute to these differences in patient outcomes. Many factors, including but not limited to quality of imaging, anesthesia support, surgical technique, and nursing care could be examined. Such information would help scientists to design clinically meaningful approaches to assessing and improving quality of care for all patients with rectal cancer.
Researchers analyzed the results of the Prostate Cancer Outcomes Trial to identify prostate cancer patients' level of satisfaction with their treatment decisions. Findings show that:
- The majority of men (about 60 percent) who received treatment for prostate cancer expressed satisfaction with their treatment decision.
- Among treated men overall, the type of treatment chosen did not affect their perception of health-related quality of life two years later. However, Hispanic men who chose radical prostatectomy or androgen deprivation therapy were less satisfied (50 percent) than their non-Hispanic White counterparts (58 percent).
- For all population groups, the men who were most satisfied were those who perceived themselves as cancer-free, maintained their social relationships, and had good urinary and bowel control, normal erectile function, and good general health.
- Men with sexual and, especially, urinary dysfunction tended to report lower health-related quality of life.
- Men who chose "watchful waiting" (about 50 percent) were less satisfied with their decision than those who chose active treatment.
Further research is needed to find ways to improve treatment-related outcomes and help patients better cope with post-treatment urinary or sexual dysfunction.
"I eat my fruits and vegetables, but I've never exercised much. It's so hard to get started, and there always seemed to be something else that needed doing. I just never got to it. I figured I was too old for it to make a difference now, but my doctor says walking just a half hour a day would help." |
Abundant evidence now links diet, physical activity, and weight to cancer risk, development, and progression. NCI and partners support programs such as 5 A Day for Better Health and Men: Shoot for 9 for Better Health to deliver the message of cancer prevention through more healthful lifestyle choices. With increasing evidence of the role that lifestyle factors can play in reducing the cancer burden, NCI has begun placing even greater emphasis on this area of research. (See Optimizing Energy Balance to Reduce the Cancer Burden.)
Data from the Women's Health Initiative (WHI) Observational Study, a large prospective cohort study of postmenopausal U.S. women aged 50 to 79 years, demonstrate a protective role for physical activity on breast cancer risk:
- Risk reductions were higher in healthy weight than overweight women, with decreasing benefit with increasing obesity.
- Women who reported engaging in strenuous activity at earlier ages had the greatest reductions in risk, with current physical activity also protective.
- Investigators noted the lowest risk levels in women who were the most physically active, although even moderate activity was protective. This finding may be especially encouraging to older women who may be able to achieve moderate, but not strenuous, exercise levels. For example, breast cancer risks were 18 percent lower in women who walked briskly for a total of 1-1/2 to 2-1/2 hours weekly than in inactive women. The walking did not have to be done all at once, but could be spaced throughout the week.
Another promising finding is that physical activity reduced risk among women on hormone replacement therapy (HRT). Since HRT is known to slightly increase breast cancer risk, physical activity may provide a countermeasure for women who wish to continue HRT for menopausal symptoms.
- Improved survival for Ewing's sarcoma patients
- Celecoxib and cancer prevention
- Nicotine, dopamine metabolism, and tobacco cessation
- Assessing dietary intake measures for clinical trials
- Recent patterns of care studies
- Recent childhood survivorship research
- Avastin™ and renal cell and colorectal cancer treatment
- Velcade™ proteasomes, and multiple myeloma treatment
- Improved survival for breast cancer patients
- Improved survival for endometrial cancer patients
- Aspirin and colorectal cancer prevention
- Tamoxifen and benign breast disease prevention
The quotes in Highlights of Progress are represeFnotentative of many people's experiences with cancer.
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