Many physicians are not telling cancer patients about the cardiotoxicity risks of treatments and may not be fully aware of the dangers themselves. A new study reveals an urgent need to look after the hearts of these patients. 

"There was no mention that it could lead to heart disease. Would have been nice to know."

The growing number of cancer survivors and increasing number of over-65s needing chronic cancer therapy mean that the need for cardio-oncology services is rising. Heart failure caused by cancer therapy can occur up to 20 years after treatment. In 2012 over 32 million people worldwide were living with cancer.

"Depending on the type of chemotherapy and radiotherapy, between 1% and 25% cancer patients may develop heart failure due to cancer treatment," said study author Professor Robyn Clark, of Flinders University, Adelaide, Australia. "Risk also depends on cardiovascular risk factors such as smoking and obesity. Better monitoring of the heart and intervention before, during and after treatment can prevent or lessen the impact of this cardiotoxicity."

The researchers reviewed medical records of 46 randomly selected cancer patients with cardiotoxicity who attended one of three hospitals between 1979 and 2015. Just 11% were referred to a cardiologist before chemotherapy and less than half (48%) were referred to a heart failure clinic after cancer treatment. Almost 40% were overweight or obese, 41% were current or ex-smokers, 24% were regular consumers of alcohol, 48% had hypertension, and 26% had diabetes.
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In a subset of patients, practice was compared before (1994-2011) and after (2012-2015) the 2012 European Society for Medical Oncology guidelines were published.3 Referral to a cardiologist before chemotherapy rose from 0 to 23% and conducting a baseline echocardiogram of the heart increased from 57% to 77%.

Researchers examined if a mouth rinse to detect human papillomavirus (HPV) DNA might be associated with helping to predict risk of recurrence of head and neck squamous cell cancer and death.

This study included 396 adults with head and neck squamous cell cancer of the mouth or throat, of which 202 patients had HPV-positive cancers. The adults were tested for the presence of HPV DNA with an oral rinse at various times. After completing cancer treatment, the repeated detection of HPV DNA identical to their tumor type in oral rinses was associated with a higher risk of cancer recurrence and death. The typical follow-up time of about two years in this study may have underestimated the associations between the persistence of HPV and cancer recurrence. More research is needed but these findings suggest HPV DNA may be a promising biomarker to understand cancer treatment response and future risk of progression.

Fakhry et al. Association of oral human papillomavirus DNA persistence with cancer progression after primary treatment for oral cavity and oropharyngeal squamous cell carcinoma. JAMA Oncol. 2019. doi:10.1001/jamaoncol.2019.0439  [Abstract]

Leukemia treatments often leave girls infertile, but a procedure developed by researchers at the University of Michigan working with mice is a step toward restoring their ability to be biological mothers.
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Ovarian follicles are the "nests" that carry eggs and support them to grow and become viable. The researchers demonstrated that they could dramatically improve the rate at which follicles develop mature eggs by surrounding the follicles with adipose-derived adult stem cells in a 3D scaffold that mimics the environment of the ovary.

Adipose-derived stem cells can be obtained from readily available fat tissue in adults.
The researchers point out that utilizing this approach in women is a ways off, but it could offer hope for many.

"Once a patient is cancer-free and they want biologically related children, we hope we'll be able to take their ovarian follicles, grow them in vitro and obtain healthy eggs for these young, otherwise healthy women," said Ariella Shikanov, U-M associate professor of biomedical engineering.

The described approach increased follicle survival from less than 5 percent to between 42 percent and 86 percent depending on the size of the follicle. The research was recently published in Stem Cell Research & Therapy Journal.

"This is a huge step toward being able to preserve the fertility of women and girls undergoing chemotherapy and radiation for cancer since those treatments are toxic to the follicles," said Claire Tomaszewski, a U-M doctoral student in biomedical engineering and member of the research team.
At this time, a young female leukemia patient's hope for carrying and delivering a biologically related child is freezing ovarian tissue prior to treatment, and hoping technology can eventually make follicle growth and maturation a viable procedure.
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And historically, attempts to grow human follicles into eggs in two-dimensional petri dishes have failed.
"A follicle is a three-dimensional structure, which becomes a pancake, not the spherical structure surrounded by supportive cells, when placed on a flat surface in a dish," Shikanov said. "As a result, it loses the contact between the supportive cells and the germs cells and then it fails to grow."

Denmark has one of highest incidences of cervical cancer in the Western world. But once a person has turned 65, they are no longer automatically screened - even though older women are in fact those who have the highest mortality. This is shown by new research from Aarhus University and Aarhus University Hospital.

"Cervical cancer has become known as 'a young women's disease'. But it's a myth that it only affects young people. In fact, the mortality rate among women above the age of 65 is 25-30 per cent higher than previously thought," says medical doctor and postdoc Anne Hammer from the Department of Clinical Medicine, Aarhus University and Aarhus University Hospital.

Anne Hammer is behind the new study which has just been published in the scientific journal Acta Obstetricia et Gynecologica Scandinavia. The researchers looked at cervical cancer mortality rates in Denmark between 2002-2015 and found that the over 65s stood out here. For example, the mortality rate was five times higher among woman aged 75-79 compared to those aged 40-45.

Advanced cancer
The research results support a study from November 2018 in which Anne Hammer and her research colleagues found that older women were very often diagnosed so late that the cancer was already too big to be surgically removed. In such cases patients are instead treated with radiotherapy and chemotherapy - a treatment that is associated with side effects such as pain and urination and defecation discomfort.
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More than half of the older women with cervical cancer who had followed the screening programme on a regular basis until it expired are diagnosed with cancer that is so advanced that surgery is no longer possible.

"When people are screened, the cancer can be discovered in its initial stages or at such an early stage that surgical treatment is still possible. This significantly reduces the risk of dying," says Anne Hammer.

When people with serious illness have conversations with their doctors and nurses about their personal values, goals, and what might be ahead with their illness, they are more likely to receive the care they want, feel less distress and report better quality of life. However, only a third of patients in their last year of life report having these conversations and, often, they happen too late in the course of illness to fulfill their most important wishes. Experts agree that all patients with serious illness should have these conversations; we need a new approach to assure that all patients are able to reap these benefits.

A new study shows that an innovative communication program developed by Ariadne Labs and tested at the Dana-Farber Cancer Institute resulted in more, earlier and better conversations between patients and their oncology clinicians, and led to significant reductions in emotional suffering for patients with advanced cancer. On average, patients and clinicians had a serious illness conversation 2.4 months earlier -- almost five months before death. The conversations were centered on what matters most to patients, with 90 percent of patients discussing goals and values.
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As a result of the intervention, the proportion of patients with moderate to severe anxiety and depression was reduced by half, and the anxiety improvements were sustained for at least 24 weeks. The study was unable to demonstrate whether the conversations resulted in care that aligned with patient goals, or brought about greater peacefulness at the end of life. The intervention did not impact survival rates.

It has long been thought that stress contributes to cancer progression. Scientists from the University of Basel and the University Hospital of Basel have deciphered the molecular mechanisms linking breast cancer metastasis with increased stress hormones. In addition, they found that synthetic derivatives of stress hormones, which are frequently used as anti-inflammatory in cancer therapy, decrease the efficacy of chemotherapy. These results come from patient-derived models of breast cancer in mice and may have implications for the treatment of patients with breast cancer, as the researchers report in the scientific journal Nature.

One major obstacle in the treatment of metastatic breast cancer is the phenomenon of tumor heterogeneity. As the disease progresses, the tumor becomes more diverse, and the difference between the cancer cells may lead to inadequate treatment.

Because the underlying mechanisms of this phenomenon remain unclear, the research group of Prof. Mohamed Bentires-Alj from the Department of Biomedicine at the University of Basel and University Hospital of Basel has been studying the cells of a highly metastatic form of cancer known as triple-negative breast cancer. This cancer type is resistant to standard therapies leaving patients with fewer treatment options.

One major obstacle in the treatment of metastatic breast cancer is the phenomenon of tumor heterogeneity. As the disease progresses, the tumor becomes more diverse, and the difference between the cancer cells may lead to inadequate treatment.
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Because the underlying mechanisms of this phenomenon remain unclear, the research group of Prof. Mohamed Bentires-Alj from the Department of Biomedicine at the University of Basel and University Hospital of Basel has been studying the cells of a highly metastatic form of cancer known as triple-negative breast cancer. This cancer type is resistant to standard therapies leaving patients with fewer treatment options.

"At the clinical level, we've known for some time that heart dysfunction from chemotherapy is a major issue, but at the scientific level, we've only recently begun to look at signalling pathways that may be implicated in this condition," said Gopi Sutendra, Alberta Innovates Translational Health Chair in Cardio-Oncology at the U of A.
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"This is the first targeted therapy at the preclinical level to actually prevent the side-effects of chemotherapy on the heart and simultaneously enhance tumour regression."

​The heart resides in an oxygen-rich environment, compared to a tumour which resides in an oxygen-poor environment.

The team found that the oxidation of proteins--a process that requires oxygen--was preferentially increased in the heart. By stabilizing a specific metabolic protein called pyruvate kinase M2 (PKM2)--also preferentially oxidized in the heart--with a drug compound, the researchers completely prevented heart damage from the chemotherapy, and enhanced the potency of the chemotherapy against lung tumours in preclinical mouse models.

 A new British Journal of Clinical Pharmacology review examines the impact of cancer therapies on the skeleton and how to limit bone loss and fractures in cancer patients treated with these therapies.

The review notes that efforts to limit the effects of cancer therapies on bone have nearly universally employed anti-resorptive agents that reduce bone turnover, and studies have not typically assessed whether these medications reduce patients' fracture risk. In addition, despite clearly written and straightforward guidelines, vulnerable eligible patients are often neither identified nor provided with appropriate treatments to limit the skeletal impact of their cancer therapies.
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"While providers of cancer therapies are rightfully focused on optimising care approaches for cancer treatment, it is important that providers also recognize that many of these same therapies have effects that extend beyond the cancer itself," said co-author Dr. Matthew T. Drake, of the Mayo Clinic. "The skeleton is one of the most important organs affected by cancer therapies, and the early judicious use of approaches to limit these off-target skeletal effects is critical to long-term patient health."

Bedatsova and Drake. The Skeletal Impact of Cancer Therapies. British Journal of Clinical Pharmacology, 2019,  https://doi.org/10.1111/bcp.13866  [Article] 

In a Psycho-Oncology study of 28 women who were being treated for breast cancer and were participating in focus groups, White participants noted that having other breast cancer survivors in their support network was essential for meeting their social support needs. Black participants did not reference other breast cancer survivors as part of their networks, however.

Notably, both White and Black participants used the focus group environment to provide social support to each other. The findings point to the importance of knowing and understanding the nuances of patients' support needs. Interventions should address these needs by facilitating connections among survivors, offering more avenues to receive support from clinicians, and encouraging women to invite family and friends to be active contributors in their care.

Paladino et al. A qualitative exploration of race‐based differences in social support needs of diverse women with breast cancer on adjuvant therapy. Psycho-Oncology, 2019; https://doi.org/10.1002/pon.4979 [Abstract]

Cancer patients are often prescribed pain medications, for example during recovery from surgical procedures. However, for many cancer patients, the use of opioid pain medications during treatment can be a gateway to misuse or addiction once treatment ends. Now with cancer patients living longer than ever before, protecting quality of life in the months, years, or decades after treatment is becoming increasingly important, including guarding against the risk of opioid addiction.
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"We felt like it was long term problem for some of our head and neck cancer patients, but didn't know how much of problem," says first author Jessica McDermott, MD, investigator at CU Cancer Center and assistant professor at the CU School of Medicine.

To discover the extent of opioid use and abuse in head and neck cancer patients, McDermott and colleagues searched the SEER/Medicare database to identify 976 patients treated between 2008 and 2011 for oral or oropharynx cancer. In all, 811 of these patients received prescriptions for opioid pain medications during treatment. Three months after treatment ended, 150 of these patients continued to have active opioid prescriptions. Six months after treatment, 68 patients or 7 percent of the total population continued to use opioid pain medication. Results are published online ahead of print in the journal Otolaryngology-Head and Neck Surgery.

"You shouldn't need opioids at the six-month point," McDermott says. "We hope that we can use this data to help patients manage pain better."