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."

Older adults with cancer are more likely to have had a heart attack or stroke in the months prior to their cancer diagnosis compared with similar adults who do not have cancer during the same period, according to a report published online in Blood. Lung and colon cancers, as well as advanced-staged cancers, appear to be most strongly associated with an elevated risk of heart attack and stroke caused by blood clots in the arteries.

The study is the largest and most systematic evaluation of these events leading up to a cancer diagnosis, according to researchers at Weill Cornell Medicine, New York-Presbyterian, and Memorial Sloan Kettering Cancer Center in New York City.

"Our data show there is an associated risk of ischemic stroke and heart attack that begins to increase in the five months before the cancer is officially diagnosed and peaks in the month just before," said lead study author Babak Navi, MD, MS, an associate professor of neurology in the Department of Neurology and of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine, and a neurologist at NewYork-Presbyterian/Weill Cornell Medical Center. "These results suggest that cancer's effect on the clotting system may be what's predominantly driving the associated risk of heart attacks and stroke."

Cancers can take months and sometimes years to develop and be diagnosed, and some cancers may be exerting biological effects on the body, especially thromboembolic activity, before they come to medical attention, he explained.

Researchers used information from a Medicare database linked to the Surveillance, Epidemiology, and End Results (SEER) registry and retrospectively looked at the risk of heart attack and stroke in people 67 years and older who were newly diagnosed with breast, lung, prostate, colorectal, bladder, non-Hodgkin lymphoma, uterine, pancreatic, and gastric cancers from January 1, 2005, to December 31, 2013. Together, these cancers account for two-thirds of all cancer diagnoses in the United States. The study included 748,662 Medicare beneficiaries and compared patients with cancer to matched controls during the 360 days before the cancer diagnosis.
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Overall, the risk of having a heart attack and stroke jumped by 70 percent in the year before cancer diagnosis. The risk was most acute in the month immediately before cancer diagnosis. During this time, patients who were later diagnosed with cancer were more than five times more likely to have a heart attack or stroke compared with those who did not have cancer - 2,313 of cancer patients had an event compared with 413 of matched controls. Beyond five months before a cancer diagnosis, the risks of these events were similar in both groups. The rate of heart attack or stroke was highest in adults with lung and colorectal cancers and those with stage 3 or 4 disease. When analyzed separately, both heart attack and stroke risk were increased in the months before cancer diagnosis, although heart attack events were slightly more common than strokes. Secondary analyses of additional arterial thromboembolic event types (i.e., thromboembolism of arteries supplying the peripheral limbs or mesentery) further substantiated the primary findings.

A genomic duplication may help explain why esophageal adenocarcinoma is much more common in Caucasians and presents a potential target for prevention. A change in the genome of Caucasians could explain much-higher rates of the most common type of esophageal cancer in this population, a new study finds. It suggests a possible target for prevention strategies, which preliminary work suggests could involve flavonoids derived from cranberries.

"We've known for a long time that esophageal adenocarcinoma primarily affects Caucasians and very rarely affects African-Americans," says David G. Beer, Ph.D., the John A. and Carla S. Klein professor of thoracic surgery and professor of radiation oncology at Michigan Medicine.

"We wanted to see if African-Americans have something genetic that's protective. If we understand why people have low risk, that can lead to understanding how to prevent cancer in those at high risk."

About 17,290 Americans will be diagnosed with esophageal cancer this year. Adenocarcinoma represents about two-thirds of cases but is rarely seen in African-Americans.

In the study, published in Gastroenterology, researchers examined tissue samples from African Americans and European Americans, including both those with esophageal adenocarcinoma and those without. They measured gene expression and protein levels and found a difference in the enzyme called GSTT2. This was significantly higher in African-Americans compared to Caucasians.

Researchers found Caucasians have a duplication on a portion of the genome that appears to reduce the expression of GSTT2. This enzyme protects cells against oxidative damage, such as the type caused by reflux, a key risk factor for esophageal adenocarcinoma.

Many people who are diagnosed with cancer will undergo some type of surgery to treat their disease - almost 95 percent of people with early-diagnosed breast cancer will require surgery and it's often the first line of treatment for people with brain tumors, for example. But despite improvements in surgical techniques over the past decade, the cancer often comes back after the procedure.

Now, a UCLA-led research team has developed a spray gel embedded with immune-boosting drugs that could help. In a peer-reviewed study, the substance was successful half of the time in awakening lab animals' immune systems to stop the cancer from recurring and inhibit it from spreading to other parts of the body. A paper describing the work is published online in the journal Nature Nanotechnology.

The researchers, led by Zhen Gu, a professor of bioengineering at the UCLA Samueli School of Engineering and member of the UCLA Jonsson Comprehensive Cancer Center, tested the biodegradable spray gel in mice that had advanced melanoma tumors surgically removed. They found that the gel reduced the growth of the tumor cells that remained after surgery, which helped prevent recurrences of the cancer: After receiving the treatment, 50 percent of the mice survived for at least 60 days without their tumors regrowing.

The spray not only inhibited the recurrence of tumors from the area on the body where it was removed, but it also controlled the development of tumors in other parts of the body, said Gu, who is also a member of the California NanoSystems Institute at UCLA.
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The substance will have to go through further testing and approvals before it could be used in humans. But Gu said that the scientists envision the gel being applied to the tumor resection site by surgeons immediately after the tumor is removed during surgery.

The researchers traced approximately 9,000 grandparents and examined the mortality of their grandchildren, more than 11,000 individuals. "Paternal grandfather's access to food predicts all-cause and cancer mortality in grandsons" is published in the journal. Nature Communications.

The results are very clear when it comes to the correlation between a grandfather's access to food and his grandson's mortality. A previous Swedish smaller study, the Overkalix study, showed the same result. However, we have been unable to determine other correlations over the generations, says Denny Vågerö, one of the authors of the paper and professor at the Department of Public Health Sciences, Stockholm University.

Previous research has suggested that the pre-pubertal, slow growth period (ages 9-12) is particularly vulnerable to nutritional effects. Denny Vågerö and colleagues' new study confirms this is true when it comes to men. However, there is no difference in mortality risk between grandsons who's paternal grandfather had low or average access to food.

Accounting for social factors, such as education, family size and income, the correlation between access to food and mortality in grandsons was enhanced.
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The researchers do not claim to explain the causal relationship but believe that epigenetics might be the key.