Many patients with advanced, incurable cancer do not receive any palliative care, reveals new research to be presented later this month at the ESMO 2014 Congress in Madrid, Spain, 26-30 September. The findings are astonishing as they come at the same time as 15 new oncology centres in Europe, Canada, South America and Africa are being awarded the prestigious title of 'ESMO Designated Centre of Integrated Oncology and Palliative Care.'

SR I Dr Alexandru Grigorescu, medical oncology consultant at the Institute of Oncology Bucharest, Romania, member of the ESMO Palliative Care Working Group, said: "The integration of palliative care in oncology is a challenge. This is especially the case for countries with few resources, where the healthcare budget is low, with insufficient palliative care specialists and some drugs are unavailable as hospitals do not have the funds to buy them."

"ESMO brings a new approach to palliative care, namely by integrating it with specific anticancer treatment conducted in medical oncology departments," continued Grigorescu. "In this context, we conducted a study to assess palliative care needs and delivery in patients with advanced, incurable cancer."

The research was conducted in five Romanian and one Swiss institutes. It found that 17% of patients received no palliative care interventions and 26% did not have their symptoms addressed. One-fifth of patients wanted to discuss end-of-life issues with a healthcare professional, but it occurred in just 15% of cases. Only 10% of patients had a care plan.

Grigorescu said: "Our study shows that there are significant gaps in the delivery of palliative care for patients with advanced, incurable cancer. Our findings argue for healthcare decision-makers to increase the budget for palliative care. We hope the study will make a point about the importance of treating patients during this period. In Romania we do not have an independent speciality of palliative care, so it should be the responsibility of medical oncologists."

Elsevier, a world-leading provider of scientific, technical and medical information products and services, today announced the publication of a position statement by the European Menopause and Andropause Society (EMAS) in the journal Maturitas on the topic of breast cancer screening.

Breast cancer is the most prevalent cancer in women, with slightly more than ten percent developing the disease in Western countries. Mammography screening is a well-established method to detect breast cancer. However there are concerns about over diagnosis with population-based screening programmes. Some tumors grow so slowly that they will not threaten the health of women during their lifetime. The women will die from another cause and thus it is argued that these tumors should not have been treated. Treatments can be invasive and painful, have major side-effects, especially in those with significant co-morbidities. While this is easy from an epidemiological standpoint, it is a dilemma for the treating physician dealing with individual women. It is virtually impossible to make the diagnosis of breast cancer and to predict the future behavior of that tumor. Thus individualization is proposed so that women may be categorized into 'low to moderate' and 'high' risk based on familial risk and the first screening mammogram so that further screening can be tailored.

Depypere et al., (2014). EMAS Position statement: Individualized breast cancer screening versus population-based mammography screening programmes. Maturitas, EPub Ahead of Print, DOI: 10.1016/j.maturitas.2014.09.002 [Article]

Worth considering micronutrient and drug combo for hard to treat cancers, say researchers

The findings prompt the researchers to suggest that adding 'nutraceuticals' to chemotherapy cycles may improve the effectiveness of conventional drugs, particularly in hard to treat cancers, such as pancreatic cancer. They base their findings on the effectiveness of extract of chokeberry (Aronia melanocarpa) in killing off cancer cells—a process known as apoptosis.

Chokeberry is a wild berry that grows on the eastern side of North America in wetlands and swamp areas. The berry is high in vitamins and antioxidants, including various polyphenols—compounds that are believed to mop up the harmful by-products of normal cell activity. 

The researchers chose to study the impact of the extract on pancreatic cancer, because of its persistently dismal prognosis: less than 5% of patients are alive five years after their diagnosis. They cultured a well known line of pancreatic cancer cells (AsPC-1) in the laboratory and assessed how well this grew when treated with either the chemotherapy drug gemcitabine, or different levels of commercially available chokeberry extract alone, and when treated with both.

A new study that surveyed physicians and nurses in hospitals within cancer centers in Germany suggests that many patients there do not experience a dignified death. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the study indicates the need for cancer centers to invest more in palliative care services, adequate rooms for dying patients, staff training in end-of-life care, and advance-care-planning standards.

Previous research has shown that hospitals are often ill-prepared to provide care for dying patients. To investigate whether the circumstances for dying on cancer center wards allow for a dignified death, Karin Jors, MA, of the University Medical Center Freiburg, and her colleagues surveyed physicians and nurses in 16 hospitals belonging to 10 cancer centers in Baden-Württemberg, Germany. The survey addressed topics regarding end-of-life care including structural conditions such as rooms and staff, education/training, working environment, family/caregivers, medical treatment, communication with patients, and dignified death.

Among 1131 survey respondents, 57 percent believed that patients could die with dignity on their ward. Half of the survey staff members indicated that they rarely have enough time to care for dying patients, and 55 percent found the rooms available for dying patients unsatisfactory. Only 19 percent of respondents felt that they had been well-prepared to care for dying patients (and only 6 percent of physicians felt so). Palliative care staff reported much better conditions for dying patients than staff from other wards, with 95 percent of palliative care staff indicating that patients die with dignity on their wards. Generally, physicians perceived the circumstances for dying patients much more positively than nurses, especially regarding communication and life-prolonging measures. While 72 percent of physicians reported that patients can usually die a dignified death on their ward, only 52 percent of nurses shared this opinion.

A newly developed antifungal, isavuconazole, is as effective as an existing drug, voriconazole, against invasive mold disease in cancer patients with less adverse effects, according to phase 3 clinical data presented at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy, an infectious disease meeting of the American Society for Microbiology.

"There is a growing need for new antifungal therapies like isavuconazole because serious fungal infections caused by Aspergillus and other molds are on the rise due to the increasing numbers of immunosuppressed patients, including those with active cancer. These infections are associated with high morbidity and mortality. If approved, isavuconazole has the potential to be an important new option for the treatment of these life-threatening fungal infections," says Andrew Ullman of Julius Maximilians University in Wuerzburg, Germany, one of the researchers presenting data.

Invasive fungal infections are important causes of morbidity and death for patients with hematological malignancies. Many leukemia and lymphoma patients receive high-dose chemotherapy, sometimes followed by stem cell transplantation, compromising their immune systems. The genus Aspergillus comprises several hundred species of mold that are ubiquitous in the environment but pose little threat to people with healthy immune systems. Immunocompromised patients, however, are more vulnerable to infection

Women who received trastuzumab, Herceptin, as part of standard treatment show greatest benefit

A new breast cancer vaccine candidate, (GP2), provides further evidence of the potential of immunotherapy in preventing disease recurrence. This is especially the case for high-risk patients when it is combined with a powerful immunotherapy drug. These findings are being presented by The University of Texas MD Anderson Cancer Center at the 2014 American Society of Clinical Oncology's Breast Cancer Symposium in San Francisco.

One of only a few vaccines of its kind in development, GP2 has been shown to be safe and effective for breast cancer patients, reducing recurrence rates by 57%. Further, women with the highest overexpression of HER2 (known as HER2 +3) had no cancer recurrences when they were administered the vaccine after completing trastuzumab (Herceptin), a type of immunotherapy drug known as a monoclonal antibody. HER2 is an oncoprotein that promotes tumor growth and is expressed to some extent in 75-80% of breast cancers.

"This is an important and different avenue in immunotherapy research, in that we are investigating ways to prevent cancer recurrence by stimulating the immune system to treat cancer," says principal investigator Elizabeth Mittendorf, M.D., Ph.D., associate professor of Surgical Oncology. "The ultimate goal is to develop a preventative tool that will minimize the risk of recurrence in women who have already had breast cancer and for whom standard therapies have failed."

The findings are the result of a phase II randomized trial that paired the GP2 vaccine, designed to stimulate the CD8+ cells, commonly known as "killer" or "toxic" T cells, with an immune stimulant known as granulocyte/macrophage colony stimulating factor (GM-CSF). The trial included 190 patients with varying levels of HER2; 89 women received the GP2 vaccine with a GM-CSF adjuvant and a control group of 91 patients received GM-CSF alone. Eight patients experienced early recurrence or developed a second malignancy and did not complete the vaccine trial. The vaccine is injected subcutaneously and the initial series consisted of monthly inoculations for six months, followed by four cycles of booster shots administered every six months thereafter. The patients were monitored for nearly three years.