Chemotherapy and exercise: The right dose of workout helps side effects

Researchers at the University of Rochester Wilmot Cancer Institute discovered something simple and inexpensive to reduce neuropathy in hands and feet due to chemotherapy – exercise.

The study, involving more than 300 cancer patients, is to be presented this weekend and honored as a “Best of ASCO” among 5,800 abstracts at the world’s largest gathering of oncologists, the American Society of Clinical Oncology (ASCO) annual meeting 2016. More than a dozen other Wilmot scientists also were invited to present data at the meeting.

Investigators in the exercise study directly compared the neuropathic symptoms in non-exercisers to the pain among patients who took part in a specialized six-week walking routine with gentle, resistance-band training at home.

The exercisers reported significantly fewer symptoms of neuropathy – which includes shooting or burning pain, tingling, numbness, and sensitivity to cold – and the effects of exercise seemed to be most beneficial for older patients, said lead author Ian Kleckner, Ph.D., a biophysicist and research assistant professor in Wilmot’s Cancer Control and Survivorship program. Kleckner also won an ASCO Merit Award in the pain and symptom management category, and was invited to give a talk about his work.

Not all chemotherapy drugs cause neuropathy, but 60 percent of people with breast cancer and other solid tumors who receive taxanes, vinca alkaloids, and platinum-based chemotherapies will likely suffer this type of side effect, Kleckner said. Neuropathy is more commonly associated with diabetes or nerve damage. No FDA-approved drugs are available to prevent or treat chemotherapy-induced neuropathy, he added.

Wilmot’s specialized exercise program, called EXCAP (Exercise for Cancer Patients), was developed several years ago at the UR by Karen Mustian, Ph.D., M.P.H., an associate professor in the Cancer Control program. In recent years she has copyrighted and evaluated EXCAP in several clinical trials. Last year at ASCO, Mustian presented data from a randomized, controlled study of 619 patients showing that EXCAP reduced chronic inflammation and cognitive impairment among people receiving chemotherapy. Kleckner’s study involved a subset of patients from Mustian’s trial, which is the largest phase 3 confirmatory exercise study ever conducted among cancer patients during chemotherapy. Their work is funded by the National Cancer Institute and Mustian’s PEAK lab.

Exercise – as a cancer prevention tool and potential treatment – is a hot topic among the nation’s oncologists and their patients.

Kleckner, a longtime drug-free body builder and former college rugby player, said he’s committed to understanding more deeply the benefits of exercise for cancer patients. “Exercise is like a sledgehammer because it affects so many biological and psychosocial pathways at the same time – brain circuitry, inflammation, our social interactions – whereas drugs usually have a specific target,” he said. “Our next study is being designed to find out how exercise works, how the body reacts to exercise during cancer treatment, and how exercise affects the brain.”

Mustian is also giving two talks at ASCO, about the use of exercise in geriatric cancer patients and how innovation can help exercise investigators reach their goals.

Our program at the University of Rochester, which now includes more than  half a dozen researchers, is becoming a real powerhouse in exercise oncology,” Mustian said. “Twelve years ago when we started this work a lot of people said it was not safe for most cancer patients to exercise. Now we know it can be safe when done correctly, and that it has measurable benefits. But more exercise isn’t always better for patients who are going through chemo – so it’s important to continue our work and find a way to personalize exercise in a way that will help each individual.”


Counseling patients at risk for cancer over the phone reduces costs and access burdens

Patients who receive results of genetic tests over the phone do not experience increased anxiety or depression.

Delivering genetic test results to patients at risk for cancer-causing genetic mutations over the phone helps to ease cost and transportation burdens and, compared to receiving results in person, does not cause patients additional stress, according to a new study from the Abramson Cancer Center of the University of Pennsylvania which will be presented at the American Society of Clinical Oncology (ASCO) Annual Meeting (abstract 1502). The findings suggest delivering results of complex genetic tests to at-risk patients over the phone may be an effective way to reduce burdens and costs for patients with cancer or at risk for cancer, according to the study’s lead author, Angela R. Bradbury, MD, an assistant professor of Medicine and Medical Ethics & Health Policy in Penn’s Perelman School of Medicine.

Genetic testing for cancer susceptibility is now an essential component of oncology care, but many patients have to travel to large centers to get genetic testing,” Bradbury said. “While health care providers deliver results for many tests over the phone, results of genetic tests have traditionally been delivered in-person because of the complexity, potential for increased levels of distress, or confusion over what the results could mean. However, our study shows that delivering results over the phone does not generate more distress, even for those with positive results and even now that we are using multi-gene testing.”

In the study, more than 900 patients who had received in-person counseling prior to undergoing genetic testing for cancer-causing mutations were randomly assigned to receive test results in person or over the phone. Test results were delivered over the phone by 22 genetic counselors across five participating sites. Participants were asked to report their feelings of anxiety and depression and knowledge about genetics both before and after test results were delivered.

Results showed that those who received results over the phone did not have any more anxiety, worry about cancer risk, or depression than those whose services were delivered in person, even among participants whose tests were positive for cancer-causing genetic mutations. Patients who received results over the phone also reported fewer barriers to accessing genetic counseling services than those who received results in person.

Delivering results over the phone allows us to provide services to patients at risk for cancer-causing genetic mutations for whom cost and access burdens might otherwise be prohibitive,” Bradbury said. “By providing services over the phone and removing the need to travel to a doctor’s office or hospital, we’re limiting the disruption to a patient’s daily routine, but maintaining the patient-provider relationship and delivering high-quality cancer genetic services.

Additional results of the study suggest there may be small differences in how well patients understand test results when receiving information over the phone as compared to in-person, though the clinical significance remains unclear. The authors say further data is needed to understand this finding before widespread adoption of phone disclosure of genetic test results is implemented.

The overall goal of this research is to decrease barriers to genetic testing while ensuring that at-risk patients receive appropriate and accurate information,” said senior author Susan Domchek, MD, executive director of the Basser Center for BRCA at Penn’s Abramson Cancer Center. “This study is a step in that direction, and shows that providers can deliver quality services in a way that is convenient for patients.

The American Society of Clinical Oncology (ASCO) annual meeting 2016, Chicago, Illinois

Hispanic and black young adult cancer patients more likely to die of their disease

Hispanic white and non-Hispanic black cancer patients between ages 15 and 29 may be more likely than same-aged white patients to die of their disease, according to a University of Colorado Cancer Center study presented at the American Society for Clinical Oncology (ASCO) Annual Meeting 2016.

The finding is partially but not wholly explained by socioeconomic status, meaning that in addition to the health risks associated with low socioeconomic status or stage of presentation, there are additional health risks associated specifically with these racial/ethnic identities.

As with many disparities, you have to identify the problem before you can fix it,” says Meryl Colton, MS, medical student at University of Colorado School of Medicine, who performed the analysis with Adam L. Green, MD, investigator at the CU Cancer Center and pediatric oncologist at Children’s Hospital Colorado.

The study used data from the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) database to compare the overall rate of death in the two years following cancer diagnosis for the three above-mentioned racial/ethnic groups, as well as people with Medicaid or no insurance compared to private insurance. For example, taking the chance of a young-adult white patient dying within two years of being diagnosed with liver cancer as a baseline of “1”, the chance of a similar Hispanic white patient dying is 1.77 and a non-Hispanic black patient’s chance of dying is 1.76.

“What this means is that black and Hispanic young adult patients are almost 75 percent more likely to die after being diagnosed with liver cancer than are white young adult patients,” Colton says.
This increased risk of mortality for black and Hispanic patients, as well as those without private health insurance, holds true across cancer types including germ cell tumors, soft tissue sarcomas, lymphomas, and leukemias.

Much of this disparity is explained by the overlap between low socioeconomic status and racial/ethnic minority status, meaning that the increased chance of dying after a cancer diagnosis is due in part to conditions associated with having less financial resources no matter one’s race/ethnicity. However, even after controlling for insurance status, an indicator of socioeconomic status, and stage of presentation, disparities in death rates after cancer diagnosis remained between these racial/ethnic groups, implying an influence of race/ethnicity independent of financial resources.

This is a starting point,” says Colton. “Part of an analysis like this is saying, ‘hey, this exists!’ And now the second part is trying to figure out why this is happening.”

Though additional study is certainly required, Colton points to three possible components of this continuing disparity: The possibility that residual socioeconomic factors could influence a patient’s diagnosis and/or care, the possibility for genetically distinct forms of these diseases to make cancers more dangerous in certain populations, or the possibility that the medical system fails to offer equal diagnosis and treatment across racial/ethnic groups.

This is a population that shouldn’t be getting cancer and it’s devastating when they do,” Colton says. “Knowing that a disparity exists allows us to ask questions that can help ensure everyone receives the best possible care.”

The American Society of Clinical Oncology (ASCO) annual meeting 2016, Chicago, Illinois