First things first. If cancer patients are having trouble tolerating chemotherapy after chemoradiation and surgery, then try administering it beforehand. Reordering the regimen that way enabled all but six of 39 patients to undergo a full course of standard treatment for rectal cancer, according to research to be presented at the American Society for Clinical Oncology annual meeting in Chicago.

Studies have shown that only about 60 percent of rectal cancer patients comply with postoperative chemotherapy, said lead researcher Dr. Kimberly Perez, assistant professor of medicine in the Warren Alpert Medical School of Brown University and a cancer physician at Rhode Island Hospital. In the phase II trial, "Complete Neoadjuvant Therapy in Rectal Cancer" (CONTRE), more than 90 percent of the patients were able to complete a regimen of mFOLFOX6 when it was moved to the front of the line.

"The thought was, what can we do to make it more tolerable and get the benefit that we wanted," said Perez, who will speak at 4 p.m. CDT on Saturday, May 31, 2014 at ASCO. "It's encouraging because we were able to get the numbers up of patients who were able to get all the chemotherapy indicated."

Findings suggest that there is a long-term benefit in screening survivors at elevated risk for congestive heart failure. 

One of the first studies to analyze the effectiveness of screening survivors of childhood cancer for early signs of impending congestive heart failure (CHF) finds improved health outcomes but suggests that less frequent screening than currently recommended may yield similar clinical benefit. The researchers, in a study published in the Annals of Internal Medicine, utilized a simulation-based model to estimate the long-term benefits associated with routine screening.

The study's findings suggest that the current CHF screening guidelines for survivors of pediatric cancer should be re-examined. The current guidelines recommend that survivors treated with chemotherapy agents known to affect long-term heart health be screened as often as every year, with a schedule dependent on their level of CHF risk. The new study suggests that screening survivors less often may be nearly as effective in detecting heart disease early. Some survivors might be better served by a different method of screening than the one currently used.

"It is important to monitor survivors so we can reduce the late effects of treatment whenever possible, but we may be asking them to be tested too often, which burdens both individuals and the health care system," says senior author Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children's Cancer and Blood Disorders Center. "We think it is worthwhile to review the current CHF screening guidelines."

"Our findings suggest that there is a long-term benefit in screening survivors at elevated risk for CHF," says lead author Jennifer Yeh, PhD, of the Center for Health Decision Science at Harvard School of Public Health. "Yet less frequent screening than currently recommended may be reasonable when other factors are considered. We hope these results can help inform the ongoing discussion about screening childhood cancer survivors."

As cure rates of pediatric cancers have risen, increasing numbers of survivors are at a substantially higher risk of heart disease, including congestive heart failure, compared to the general population. The increase in risk varies depending on several factors, including whether a patient was treated with anthracyclines, a class of drugs known to cause heart disease, and/or radiation to the heart. For instance, those who received no or low (<250 mg/m2) cumulative doses of anthracyclines have a relatively low lifetime risk of developing CHF, while those who received large (≥250 mg/m2) cumulative doses are at higher risk.

Higher sleep efficiency in women with advanced breast cancer is significantly associated with lower mortality

A new study reports that sleep efficiency, a ratio of time asleep to time spent in bed, is predictive of survival time for women with advanced breast cancer.

Results show that higher sleep efficiency was significantly associated with lower mortality over the ensuing six years, an effect that remained after adjusting for baseline prognostic factors such as age, estrogen receptor status and treatments received. Mean survival was 68.9 months for efficient sleepers compared with 33.2 months for participants with poor sleep efficiency. Further analysis found that a 10 percent increase in sleep efficiency reduced the estimated hazard of subsequent mortality by 32 percent. There was no association between sleep duration and survival.

"We were surprised by the magnitude of the relationship between sleep quality and overall survival even after we accounted for medical and psychological variables that typically predict survival," said lead author Oxana Palesh, PhD, assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University and research director of the Stanford Cancer Survivorship. "Good sleep seems to have a strongly protective effect, even with advanced breast cancer."

Study results are published in the May 1 issue of the journal Sleep.

Vitamin D deficiency was an indicator of aggressive prostate cancer and spread of the disease in European-American and African-American men who underwent their first prostate biopsy because of abnormal prostate-specific antigen (PSA) and/or digital rectal examination (DRE) test results, according to a study published in Clinical Cancer Research, a journal of the American Association for Cancer Research.

"Vitamin D is a steroid hormone that is known to affect the growth and differentiation of benign and malignant prostate cells in prostate cell lines and in animal models of prostate cancer," said Adam B. Murphy, M.D., MBA, assistant professor in the Department of Urology at the Northwestern University Feinberg School of Medicine in Chicago. "In our study, vitamin D deficiency seemed to be a predictor of aggressive forms of prostate cancer diagnosis in European-American and African-American men.

"The stronger associations in African-American men imply that vitamin D deficiency is a bigger contributor to prostate cancer in African-American men compared with European-American men," added Murphy. "Vitamin D supplementation may be a relevant strategy for preventing prostate cancer incidence and/or tumor progression in prostate cancer patients."

The most accurate way to measure how much vitamin D we have in our body is to measure levels of 25-hydroxyvitamin D (25-OH D) in our blood. The normal range of 25-OH D is 30 to 80 nanograms per milliliter (ng/ml).

In this study, European-American and African-American men had 3.66 times and 4.89 times increased odds of having aggressive prostate cancer (Gleason grade of 4+4 or higher), respectively, and 2.42 times and 4.22 times increased odds of having tumor stage T2b or higher, respectively, if their 25-OH D levels were less than 12 ng/ml at the time of prostate biopsy. In addition, African-American men had 2.43 times increased odds of being diagnosed with prostate cancer, if their 25-OH D levels were less than 20 ng/ml.

A new computational model that simulates bone metastasis of prostate cancer has the potential to rapidly assess experimental therapy outcomes and help develop personalized medicine for patients with this disease, according to data published in Cancer Research, a journal of the American Association for Cancer Research.

"Bone remodeling is a balanced and extremely well regulated process that controls the health of our bones and the levels of circulating calcium," said Leah M. Cook, Ph.D., postdoctoral fellow in the Department of Tumor Biology at the Moffitt Cancer Center in Tampa, Fla. "Active prostate cancer cells in the bone environment can speak the same language of the bone remodeling cells, and disrupt the delicate bone remodeling process. They promote extensive bone destruction and formation that in turn yields nutrients, allowing the prostate cancer cells to grow, thus creating a vicious cycle."

"The mathematical model we created simulates this vicious cycle, and allows us to predict the impact of potential therapies on cancer cells and normal cells of the bone," said Arturo Araujo, Ph.D., postdoctoral fellow in the Department of Integrated Mathematical Oncology at the Moffitt Cancer Center. "Unlike biological models, we can freeze the mathematical model at any time point in order to explore what each cell is doing at that particular point in time."

To create the computational model, which they call "hybrid cellular automata," Araujo, Cook, and colleagues created simulations of different cell types involved in bone metastasis of prostate cancer, including two types of bone cells called osteoclasts and osteoblasts, and prostate cancer cells. They then created algorithms to simulate the interactions of these cells among themselves and with other bone metastasis-related factors in the microenvironment, including the proteins TGF-beta, RANKL, and other bone-derived factors.

In the classic marriage vow, couples promise to stay together in sickness and in health. But a new study finds that the risk of divorce among older married couples rises when the wife—but not the husband—becomes seriously ill.

"Married women diagnosed with a serious health condition may find themselves struggling with the impact of their disease while also experiencing the stress of divorce," said Amelia Karraker, a researcher at the University of Michigan Institute for Social Research, who presents her findings May 1 at the annual meeting of the Population Association of America.

Karraker and co-author Kenzie Latham of Indiana University-Purdue University Indianapolis analyzed 20 years of data on 2,717 marriages from the Health and Retirement Study, conducted by the Institute for Social Research since 1992. At the time of the first interview, at least one of the partners was over the age of 50.

The researchers examined how the onset of four serious physical illnesses—cancer, heart problems, lung disease and stroke—affected marriages.

They found that, overall, 31 percent of marriages ended in divorce over the period studied. The incidence of new chronic illness onset increased over time as well, with more husbands than wives developing serious health problems.

"We found that women are doubly vulnerable to marital dissolution in the face of illness," Karraker said. "They are more likely to be widowed, and if they are the ones who become ill, they are more likely to get divorced."