Cancer may drive health problems as people age

A new study indicates that cancer may have negative impacts on both the physical and mental health of individuals as they age. Published in CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that cancer increases the risk for certain health issues above and beyond normal ageing. This is likely due, in part, to decreased physical activity and stress associated with cancer diagnosis and treatment.

As the population of older adults grows, it is increasingly important for clinicians to understand the unique impact of cancer on the health of individuals as they age. To investigate, Corinne Leach, MS, PhD, MPH, of the American Cancer Society in Atlanta, and her colleagues analysed cancer registry data that were linked to Medicare surveys. The analysis included 921 Medicare beneficiaries with a breast, colorectal, lung, or prostate cancer diagnosis who completed initial surveys in 1998 and 2001 and follow-up surveys two years later. These patients were matched to 4605 controls without cancer.

Cancer groups demonstrated greater declines in activities of daily living and physical function compared with controls, with the greatest change for lung cancer patients. Having a cancer diagnosis increased risk for depression but did not increase the likelihood of developing arthritis, incontinence (except for prostate cancer), or vision/hearing problems. Having a cancer diagnosis also did not exacerbate the severity of arthritis or foot neuropathy.

This prospective analysis used a propensity score matched control group to cancer cases that enabled us to tease apart the effects of cancer and ageing in a novel way,” said Dr. Leach. “Decreased physical functioning among older cancer patients compared with older adults without cancer is an important finding for clinicians because it is also actionable. Clinicians need to prepare patients and families for this change in functioning levels and provide interventions that preserve physical function to limit the declines for older cancer patients.”

Leach et al. “Is it my cancer or am I just getting older?: Impact of cancer on age-related health conditions of older cancer survivors.” Cancer, 2016; DOI: 10.1002/cncr.29914 [Abstract]

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Two studies examine long-term outcomes in childhood and young adult cancer survivors

JAMA Oncology published two studies and a related editorial focused on long-term outcomes in survivors of childhood or young adult cancer.

In the first study, Kathrine Rugbjerg, PhD, and Jørgen Olsen, MD, DMSc, of the Danish Cancer Society Research Center, Copenhagen, examined the risk for hospitalization up to 34 years after a diagnosis of adolescent and young adult cancer survivors. The study included 33,555 five-year cancer survivors diagnosed from 1943 through to 2004 with a comparison group from the general population. The authors identified 53,032 hospitalizations in cancer survivors for one or more of 97 disease categories.

Cancer survivors had an overall increased risk of hospitalization compared with those in the general population. Cancer survivors at highest risk for hospitalizations were leukemia, brain cancer and Hodgkin lymphoma survivors.

Survivors of adolescent and young adult cancers face persistent risks for a broad range of somatic diseases requiring hospitalization. The morbidity pattern, which is highly dependent on the type of cancer being treated, underscores the need for further implementation of strict evidence-based sex-, age- and cancer-specific follow-up plans for survivors, thereby increasing the likelihood for early detection and ultimately prevention of treatment-induced morbidities.

In the second study, Kevin Krull, PhD, of St. Jude Children’s Research Hospital, Memphis, and coauthors examined neurocognitive and patient-reported outcomes in adult survivors of childhood osteosarcoma, a type of bone cancer. The study included 80 survivors of osteosarcoma who were an average age of nearly 39 years and almost 25 years past diagnosis. The cancer survivors were compared with 39 community members unrelated to the cancer survivors. Long-term survivors had lower average scores in reading skills, attention, memory and processing speed. However, plasma concentration of methotrexate following high-dose intravenous administration during chemotherapy was not associated with neurocognitive outcomes at nearly 25 years after diagnosis.

Long-term survivors of osteosarcoma are at risk for neurocognitive impairment, which is related to current chronic health conditions and not to original treatment with high-dose methotrexate. … Our results demonstrate the need for increased attention in this diagnosis, with prospective studies to delineate the evolution of impairment over the course of therapy and long-term survival,” the authors conclude.

In a related editorial, Karen E. Effinger, MD, MS, and Michael P. Link, MD, of the Stanford University School of Medicine, California, write: “Advances in cancer therapy have led to increased survival; there are more than 9 million 5-year survivors of cancer in the United States. As this number continues to grow, focus on improved health and quality of life becomes a priority. … Going forward, we must apply our knowledge of late effects to improve monitoring and interventions for patients. While the progress made in the management of cancer in children and young adults has been gratifying, we must remember the words of Giulio D’Angio, who reminds us that ‘cure is not enough.'”Rugbjerg et al. Long-term Risk of Hospitalization for Somatic Diseases in Survivors of Adolescent or Young Adult Cancer. JAMA Oncol. Published online November 19, 2015. doi:10.1001/jamaoncol.2015.4393 [Article]Krull et al. Neurocognitive and Patient-Reported Outcomes in Adult Survivors of Childhood Osteosarcoma. JAMA Oncol. Published online November 19, 2015. doi:10.1001/jamaoncol.2015.4398 [Abstract]

Many cancer survivors have unmet physical and mental needs related to their disease and its treatment

Even decades after being cured, many cancer survivors face physical and mental challenges resulting from their disease and its treatment. That’s the conclusion of a new study published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The findings could help clinicians and other experts develop interventions that are tailored to the specific types of problems and concerns that cancer survivors may experience.

Increasingly, cancer patients are living many years after cancer treatment, with the number of US survivors expected to top 19 million by 2024. While many survivors do well after treatment, some experience continuing problems that can significantly impair their quality of life well beyond the magical 5-year survival milestone. These problems and challenges can vary by the type of cancer patients had and the treatments they received.

To assess the unmet needs of cancer survivors, Mary Ann Burg, PhD, LCSW, of the University of Central Florida in Orlando, and her colleagues looked at the responses from an American Cancer Society survey, wherein 1514 cancer survivors responded to the open-ended question, ‘Please tell us about any needs you have now as a cancer survivor that ARE NOT being met to your satisfaction.’ “This study was unique in that it gave a very large sample of cancer survivors a real voice to express their needs and concerns,” said Dr. Burg.

Survivors most frequently expressed physical problems, with 38 percent saying they were an issue. (Problems related to sexuality and incontinence among prostate cancer survivors were especially common.) Financial problems related to the costs of treatment also persisted long after treatment for 20 percent of respondents, with Black and Hispanic survivors being especially hard-hit. Anxiety about recurrence was a common theme expressed by survivors regardless of the type of cancer they had or how many years they had survived cancer. The number and type of unmet needs were not associated with time since cancer treatment.

Overall, we found that cancer survivors are often caught off guard by the lingering problems they experience after cancer treatment. In the wake of cancer, many survivors feel they have lost a sense of personal control, have reduced quality of life, and are frustrated that these problems are not sufficiently addressed within the medical care system,” said Dr. Burg. She noted that improvements are needed concerning public awareness of cancer survivors’ problems, honest professional communication about the side effects of cancer, and the coordination of medical care resources to help survivors and their families cope with their lingering challenges.

Burg et al. Current unmet needs of cancer survivors: Analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer. 2015;EPub Ahead of Print [Abstract]

The Side Effects of Chemotherapy on the Body

Chemotherapy drugs are powerful enough to kill rapidly growing cancer cells, but they also can harm perfectly healthy cells, causing side effects throughout the body.

Cancer cells divide more quickly than healthy cells, and chemotherapy drugs effectively target those cells. Unfortunately, fast-growing cells that are healthy can be damaged too. There are many different chemotherapy drugs with the potential for many different side effects. These effects vary from person to person and from treatment to treatment.

Factors that play a role in side effects include other ongoing treatments, previous health issues, age, and lifestyle. Some patients experience few side effects while others feel quite ill. Although most side effects clear up shortly after treatment ends, some may continue well after chemotherapy has ended, and some may never go away.

Chemotherapy drugs are most likely to affect cells in the digestive tract, hair follicles, bone marrow, mouth, and reproductive system. However, cells in any part of the body may be damaged.

– See more at: http://www.healthline.com/health/cancer/effects-on-body#sthash.ZbSMeewY.dpuf

Health gap between adult survivors of childhood cancer and siblings widens with age

Long-term follow-up of adult survivors of childhood cancer reinforces need for lifelong health surveillance for childhood cancer survivors

Adult survivors of childhood cancer face significant health problems as they age and are five times more likely than their siblings to develop new cancers, heart and other serious health conditions beyond the age of 35, according to the latest findings from the world’s largest study of childhood cancer survivors. St. Jude Children’s Research Hospital led the research, results published online in the Journal of Clinical Oncology.

The federally funded Childhood Cancer Survivor Study (CCSS) found that the health gap between survivors and their siblings widens with age. Survivors who were 20 to 34 years old were 3.8 times more likely than siblings of the same age to have experienced severe, disabling, life-threatening or fatal health conditions. By age 35 and beyond, however, survivors were at five-fold greater risk.

By age 50, more than half of childhood cancer survivors had experienced a life-altering health problem, compared to less than 20 percent of same-aged siblings. More than 22 percent of survivors had at least two serious health problems and about 10 percent reported three or more. The problems included new cancers as well as diseases of the heart, lungs, liver, kidneys and hormones.

Survivors remain at risk for serious health problems into their 40s and 50s, decades after they have completed treatment for childhood cancer,” said first and corresponding author Gregory Armstrong, M.D., an associate member of the St. Jude Department of Epidemiology and Cancer Control. “In fact, for survivors, the risk of illness and death increases significantly beyond the age of 35. Their siblings don’t share these same risks.

Among survivors who reached age 35 without serious health problems, 25.9 percent developed a significant health problem in the next decade. In comparison, 6 percent of siblings developed their first serious health condition between the ages of 35 and 45.

The study involved 14,359 adult survivors who were treated for a variety of pediatric cancers at one of 26 U.S. and Canadian medical centers. The research also included 4,301 siblings. For this study CCSS investigators focused on 5,604 survivors who have now aged beyond 35 years. The results provide the broadest snapshot yet of how the first generation of childhood cancer survivors is faring as they age. The oldest survivors in this study were in their 50s.

The findings highlight the importance of lifelong, risk-based health care for childhood cancer survivors, Armstrong said. Depending on their cancer treatment and other risk factors, follow-up care may include mammograms and other health checks at a younger age than is recommended for the general public. These screenings are designed to identify health problems early when there is a greater chance to prevent illness and preserve health.

Today, St. Jude researchers are studying strategies to educate and empower survivors to ensure they receive recommended screenings. Screening guidelines were developed by St. Jude and other members of the Children’s Oncology Group (COG), which includes pediatric cancer researchers and institutions around the world.The importance of such efforts is expected to grow along with the nation’s population of childhood cancer survivors. The U.S. is now home to more than 363,000 pediatric cancer survivors. An overall long-term pediatric cancer survival rate of 80 percent means the number of survivors will increase.

The study also adds to evidence that some survivors experience accelerated aging, possibly due to their cancer treatment. Researchers are still trying to identify the cause. In this study, 24-year-old childhood cancer survivors and their 50-year-old siblings reported similar rates of severe, life-threatening or fatal health problems.

This study involved survivors whose cancer was diagnosed between 1970 and 1986 when they were age 20 or younger. All survived at least five years. Since then, cancer therapies have evolved and include less radiation and chemotherapy, both of which can have long-term health consequences. The CCSS is also studying the health of adult survivors from a more recent treatment era.

Armstrong et al., (2014). Ageing and risk of severe, disabling, life-threatening, and fatal events in the Childhood Cancer Survivor Study. J. Clin. Oncol., doi: 10.1200/JCO.2013.51.1055 [Abstract

Chemotherapy before radiotherapy for testicular cancer could reduce long-term side-effects

Giving men with testicular cancer a single dose of chemotherapy alongside radiotherapy could improve the effectiveness of treatment and reduce the risk of long-term side-effects, a new study reports.

As many as 96% of men with testicular cancer now survive at least ten years from diagnosis, but more advanced forms need to be treated with combination chemotherapy – which can have serious long-term complications. Researchers at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust have therefore been searching for new treatments that would reduce the risk of relapse after initial treatment and so spare as many men as possible from needing combination chemotherapy.

The new pilot study, published in the August issue of prestigious journal the Annals of Oncology, tested a new treatment in a pilot study of men with stage IIA and IIB testicular seminoma – where the cancer has spread to the lymph nodes in the abdomen.

The researchers showed that giving chemotherapy drug carboplatin before radiotherapy could reduce relapse rates compared with radiotherapy alone – cutting the numbers of men who would need follow-up treatment. It also allowed radiation doses to be reduced. The study was funded by The Institute of Cancer Research (ICR), the Bob Champion Cancer Trust and Cancer Research UK, as well as through the NIHR Biomedical Research Centre at The Royal Marsden and the ICR.

Researchers gave 51 men with stage IIA and IIB testicular seminoma a single cycle of carboplatin – a low toxicity form of chemotherapy – followed three to four weeks later by radiotherapy. Most of the men were aged below 50, over a range of 18-73 years.

Adding carboplatin to patients’ treatment plans allowed doctors to give a lower dose of radiation over a smaller area of the body for most of the men in the study. Some 39 of the men in the study had their prescription of radiation reduced from the standard 35 Grays (Gy) of radiation to 30 Gy, delivered to a smaller area of the abdomen.

After an average of 4.5 years of follow-up, there were no relapses of the cancer compared with a relapse risk of 5-11% after radiotherapy alone. The side-effects from treatment were mild and only lasted a short time.

Dr Robert Huddart, Team Leader in the Division of Radiation and Imaging at the Institute of Cancer Research, London, and Consultant at The Royal Marsden, who led the study, said:

“The results of this study show great promise. Men who have this stage of testicular seminoma are normally treated with just radiotherapy, or in some countries with intensive combination chemotherapy, where several anticancer drugs are given at once. Relapse occurs in 5-11% of men after radiotherapy alone, and these recurrences have to be treated with combination chemotherapy, which is associated with a risk of serious long-term complications such as cardiovascular disease or second cancers.

“The aim of the study was to develop an effective non-toxic treatment with low risk of long-term treatment complications, and our findings suggest that a single cycle of carboplatin before radiotherapy may reduce the chances of cancer reappearing compared with radiotherapy alone. This will reduce the risk that these patients would need combination chemotherapy. Not only that, but by adding carboplatin to the therapy, the radiation dose and volume can be lowered.”

As this was a small, single-centre study, the researchers are recommending the approach is evaluated more widely.

Horwich et al., (2013). Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann. Oncol., 24 : 2104-2107 doi:10.1093/annonc/mdt148 [Abstract]