Men still suffering debilitating sexual and urinary dysfunction more than 12 years after prostate cancer treatment

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Jang et al (2017) conducted one of the first long term follow-up on Prostate cancer (PCa) treatment 12 to 18 years after treatment. The study reveals lasting debilitating  sides effects for prostatectomy and radiation treatments.

The short side effects (2 years) for PCa treatment is well documented. However the long term quality  of men’s lives and the lasting side effects from treatments has not been reviewed until now. This is vital information for men with low to intermediate risk localised prostate cancer and are considering treatment over active monitoring or “watchful waiting”.

Highlights from Study

At 12 to 18 years after treatment, patients’ median ages were 75, 82, and 77 for RP (Radical Prostatectomy), EBRT (radiation beam therapy), and BT (Brachytherapy), respectively.

  • Patients urinary  and sexual function declined over time for all men in this study
  • Patients who underwent RP had significantly worse symptoms rating in the urinary incontinence  and sexual function over a decade later.
  • Patients that underwent EBRT had significantly worse current scores compared to baseline in the urinary incontinence and  urinary irritation/obstruction , bowel function and sexual function.
  • Patients who had BT had significantly worse current scores compared to baseline in the urinary incontinence  urinary irritation/obstruction and sexual function.
  • When comparing treatment modalities, change scores in the urinary incontinence domain were significantly worse for RP than for BT  and change scores in the urinary irritation/obstruction domain were significantly worse for EBRT or BT than for RP.

There were no significant differences between treatment groups in the bowel function domain, and all treatment groups experienced similarly large differences in sexual function scores.

 

Abstract 

Abstract Definitive treatment for prostate cancer includes radical prostatectomy (RP), external beam radiation therapy (EBRT), and brachytherapy (BT). The different side effect profiles of these options are crucial factors for patients and clinicians when deciding between treatments. This study reports long-term health-related quality of life (HRQOL) for patients in their second decade after treatment for prostate cancer. We used a validated survey to assess urinary, bowel, and sexual function and HRQOL in a prospective cohort of patients diagnosed with localized prostate cancer 14–18 years previously. We report and compare the outcomes of patients who were initially treated with RP, EBRT, or BT. Of 230 eligible patients, the response rate was 92% (n = 211) and median follow-up was 14.6 years. Compared to baseline, RP patients had significantly worse urinary incontinence and sexual function, EBRT patients had worse scores in all domains, and BT patients had worse urinary incontinence, urinary irritation/obstruction, and sexual function. When comparing treatment groups, RP patients underwent larger declines in urinary continence than did BT patients, and EBRT and BT patients experienced larger changes in urinary irritation/obstruction. Baseline functional status was significantly associated with long-term function for urinary obstruction and bowel function domains. This is one of the few prospective reports on quality of life for prostate cancer patients beyond 10 years, and adds information about the late consequences of treatment choices. These data may help patients make informed decisions regarding treatment choice based on symptoms they may experience in the decades ahead.

 

Source

Jang JW, Drumm MR, Efstathiou JA, Paly JJ, Niemierko A, Ancukiewicz M, Talcott
JA, Clark JA, Zietman AL. Long-term quality of life after definitive treatment
for prostate cancer: patient-reported outcomes in the second posttreatment
decade. Cancer Med. 2017 Jul;6(7):1827-1836. doi: 10.1002/cam4.1103. Epub 2017
May 31. PubMed PMID: 28560840; PubMed Central PMCID: PMC5504320.

Information empowers Men’s health: – Are you aware of all your treatment options for low-intermediate prostate cancer?

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You’ve been diagnosed with Prostate cancer , but before you decide to have a radical prostatectomy (removal of the prostate) do you understand all of the treatment options?

After decades of over treatment we now better understand the  treatments and non -treatments available for Low to intermediate risk localised prostate cancer (PCa).

However sadly new research and approaches can take years to be implemented despite a case for change. To avert the risk of making  ill-informed decisions  it makes sense to  ask our oncologists lots of questions and be informed about all the risks and consequences of our choices in treating PCa. However they might not be aware of recent studies and evidence that would open up more choices to you. If there’s even a slight risk we are receiving outdated advice it could result in regrettable outcome we can’t reverse.  To avoid this we can  do our own independent research and consult more than one specialist for a second opinion.  Here’s the latest information of treatments for localised low to intermediate risk PCa.

Treatments 

In a 10 year UK trial, three groups of men were assigned to either surgical removal of the prostate (553 men), radiation treatment (545 men) or active monitoring (545 men). After ten years, the total number of deaths due to any cause was 55, 55 and 59, respectively in each group.

Thus 90% of men were still alive after ten years, including those who did not receive any radical intervention. Although surgery delayed the development of metastases (or secondary cancers) in a small number of men, the number of deaths definitively attributable to prostate cancer in each of the groups was low, only three, four and seven deaths respectively. So the odds of dying specifically from prostate cancer in the first ten years is of the order of 1%.

Age is also a factor in treatment options. If your life expectancy is less than 10 years the advice now is do nothing because you are more likely to die from something else other than PCa.

However , as clear from the UK Trial, active monitoring / surveillance results in the same outcome as surgery or radiation treatment for localised PCa.

Source (Ian Haines, Professor, AMREP Department of Medicine, Alfred Hospital, Melbourne & Senior Medical Oncologist and Palliative Care Physician, Melbourne Oncology Group, Cabrini Haematology and Oncology Centre, Wattletree Road, Malvern, Monash University2017)

According to John Hopkins School of Medicine Radiation beam therapy is as effective as  radical prostatectomy for the treatment of low to intermediate risk localised prostate cancer (PCa).

Treatment Side Effects.

The side effects from surgery are more severe than radiation and often include permanent erectile  dysfunction (ED). About 80% of men have ED at 6 months and at 5 years and also potentially years of urinary incontinence  – 50% of men still need a pad at 6 months, 20% of men maybe wearing a pad at 5 years. 

For radiation therapy, incontinence is an infrequent problem. “Approximately 5% of men use a pad at 6 months after radiation therapy and that’s steady at about 5 years. A potential late side effect for urinary function can be the development of a stricture at 10 years or more after radiation, causing it difficulty in urination. After external beam radiation therapy approximately 75% of men have erectile dysfunction at 6 months and at 5 years.  ” Ken Panta, Professor of Urology and Oncology at the Johns Hopkins School of Medicine. 

What is localised PCa? –

Tumor has not spread outside the prostate.

The tumor can be on both sides or one side of the prostate but  has not breached the prostate  or entered the seminal vesicles or lymph nodes.

What is low risk PCa?

Low-risk prostate cancer is T1-T2a, Gleason score 6, PSA less than 10.

What is intermediate risk localised PCa?

Clinically Localised: Intermediate-Risk Prostate Cancer find as T2b-T2c or Gleason score 7 or PSA 10-20 ng/ml. The or here is very important, it means that a man is classified as having Intermediate-Risk Prostate Cancer by any one of these criteria. T2b refers to a cancer that is more than half of only one side of the prostate. T2c is cancer in both sides of the prostate.

What is active monitoring/surveillance? 

Active surveillance is when the patient choose no treatment and regular checks , which may includes all or some of these:  digital examinations , PSA tests and Biopsies  , ultra sound, MRI.

 

 

 

 

Information empowers men’s health: – Latest research shows surgery for Early Stage Prostate Cancer Doesn’t Save Lives

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Ian Haines
Monash University
July 31, 2017

From the 1980s, when prostate screening became available, many men over 40 were diagnosed with early stage prostate cancer even though they may not have had any symptoms. The word cancer understandably strikes fear into the hearts of many, and most would assume the best course of action would be to have the cancer removed, whatever the side effects may be.

But impotence and incontinence are no small side effects, especially when you consider, as two new studies have done, removing the cancer isn’t necessarily the best option, and the cancer may not in fact require treatment at all.

.Most prostate cancers take decades to exit the prostate, and most men will usually die with, but not from, prostate cancer. Autopsy studies reveal prostate cancer in up to 40% of men in their forties and 65% in their sixties, but a much smaller figure of 3-4% of Australian men actually die of prostate cancer at a median age of 82.

Two recent clinical trials undermine the categorisation of prostate cancer as a death sentence. They are unambiguous in their findings and seismic in their implications. Both found men with early stage abnormalities of the prostate who do not undergo surgery or radiation treatment, but whose condition is monitored for any progression of the cancer, live just as long as men who opted for complete removal of the prostate and now live with its immediate consequences, including incontinence, intimacy issues, bowel problems and intervention regret.

The hard evidence

In a UK trial, three groups of men were assigned to either surgical removal of the prostate (553 men), radiation treatment (545 men) or active monitoring (545 men). After ten years, the total number of deaths due to any cause was 55, 55 and 59, respectively in each group.

Thus 90% of men were still alive after ten years, including those who did not receive any radical intervention. Although surgery delayed the development of metastases (or secondary cancers) in a small number of men, the number of deaths definitively attributable to prostate cancer in each of the groups was low, only three, four and seven deaths respectively. So the odds of dying specifically from prostate cancer in the first ten years is of the order of 1%.

In a second study from the US published last week, two groups of men were assigned to either surgical removal of the prostate (364 men) or active monitoring (367 men). After nearly 20 years of follow up, the number of deaths due to any cause was 223 and 245 respectively in each group. So once again nearly the same number of men in each group were still alive after 20 years.

Surgery did not prevent death any more than active monitoring. Strikingly, the number of deaths definitively attributable to prostate cancer in the two groups was only 18 and 22 respectively. This means the odds of dying specifically from prostate cancer in the first 20 years after a cancer diagnosis from a prostate-specific antigen (PSA) test was about 5% for the surgical group and 6% for the active monitoring group.

The survival from prostate cancer is so high it’s not a question of deciding which treatment is best, but whether any early radical treatment is required at all. The current position has been clearly articulated by the Chief Medical Officer of the American Cancer Society Dr Otis Brawley, an expert on prostate cancer screening. He points out aggressive PSA screening and treatment has resulted in more than one million American men undergoing needless treatment.

This is not to mention that patients who have undergone surgery are four times more likely to require absorbent pads for incontinence and three times more likely to have erectile dysfunction. These are not issues that are routinely highlighted.

The future

The latest DNA research has had minimal impact on how to tell whether an early stage prostatecancer will grow slowly or whether it will become aggressive and spread outside the prostate, and lead to death. The current evidence is the future behaviour of any cancer is determined very early, and diagnosing it early and actively monitoring its progress will have no effect on the outcome.

The key problem in searching for genetic and DNA based markers is that most pre-clinical studies focus on human prostate cancer cells in dishes, or in mice. This is far removed from cells growing in a patient. Mice are not small humans and their prostates, hormonal balances, diet and genetics are quite different from our own.

Similarly, while MRI scanning means we can find sites in a prostate gland that are abnormal, we can’t yet distinguish between the potentially dangerous and the indolent cell populations. More research is needed to develop better screening techniques.

The current implications

For the moment, the first step must be to educate doctors so they can provide full disclosure to any patient of the results of these two trials. The second step is that in speaking to their own doctors about possible treatment options, patients should be active in asking them about the most up-to-date evidence. Surgery is a big step to take for any condition.

Similar to countless past treatments which the evidence has made redundant – such as lobotomy for mental illness and stomach surgery for ulcers – it’s now clear radical surgery removing the prostate should not be the go-to option.

Ian Haines, Adjunct Clinical Associate Professor, AMREP Department of Medicine, Alfred Hospital, Melbourne & Senior Medical Oncologist and Palliative Care Physician, Melbourne Oncology Group, Cabrini Haematology and Oncology Centre, Wattletree Road, Malvern, Monash University

Resistance Training relieves fatigue in Breast Cancer Survivors

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A news  study shows how regular resistance training improved fatigue and  quality of life in breast cancer survivors who were previously  sedentary.  Fatigue is common for women breast cancer survivors and it can be debilitating. If you feel fatigued it is hard to motivate yourself to do any exercise, but this can be the very activity that will give you more energy and motivation. This study proves that doing resistance exercise three times a week relieves the fatigue often experienced by breast cancer survivors.

Abstract 

The primary aim of this study was to evaluate the benefits of resistance training (RT) on quality of life (QOL) and fatigue in breast cancer survivors as an adjunct to usual care. We recruited 39 women who had survived breast cancer [mean age (y) 51.9 ± 8.8; time since diagnosis (m) 11.6 ± 13.2]. Primary outcomes were fatigue as assessed by the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT) scale and QOL as assessed by the Functional Assessment of Cancer Therapy – General (FACT-G) scale. ANCOVA was used to assess the change in the primary outcomes while controlling for baseline values, with effect sizes (ES) displayed as partial Eta squared. The experimental group received supervised RT 3 days per week in a university clinic for 16 weeks. Perceptions of fatigue improved significantly in the RT group compared to controls [mean (SD) 6.7 (7.5) points vs. 1.5 (3.7) points], (P = 0.006, ES = 0.20) as did QOL [6.9 (8.5) points vs. 1.6 (4.4) points], (P = 0.015, ES = 0.16). We demonstrated both statistically and clinically important improvements in fatigue and QOL in response to RT in breast cancer survivors.

Authors :Hagstrom A.D., Marshall P.W.M., Lonsdale C., Cheema B.S., Fiatarone Singh M.A. & Green S. (2016)European Journal of Cancer Care 25: 784–794 Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial

 

Millions of Australians are predicted to get colon cancer. Here’s some evidence on how to lower your risk.

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About_Bowel_Cancer_polyp_progression_770newMillions of Australians are predicted to get colon cancer. Here’s some evidence on how to lower your risk.

A while ago a new report released  by leading social demographer Bernard Salt, who said  by 2026, 4.6 million baby boomers and 4 million Gen Xers “ will be subjected to a bowel cancer lottery” purely because of their age. (Source. http://www.smh.com.au/national/millions-of-australians-at-risk-of-bowel-cancer-20160320-gnmlzr.html#ixzz43V3GG58M ).

 

This is concerning  for a preventable cancer. How then do we reduce the risk for ourselves and our families.

To start with there is some evidence that poor diet and nutrition, the amount of alcohol you drink and a sedentary lifestyle increase your relative risk of bowel cancer.  Diabetes and obesity really elevate the risk of bowel cancer and these modern chronic diseases are largely attributed to the same lifestyle choices associated with bowel (colorectal) cancer.

There is also one other major factor , chronic stress. Chronic stress is often associated  with development of chronic disease and cancer.  The stress-response involves many changes in the body as it is prepared to survive a threat. When this happens repeatedly everyday the normal functions of the body become disrupted. Repeated chronic stress causes unrelenting inflammation, which damages tissue in our blood vessels and  inside of our gastrointestinal tract. This inflammation is referred to as mucosal inflammation and this causes a great deal of problems. Mucosal inflammation damages the lining of your intestines (mucosa) and creates a hostile environment for healthy bacteria, which is not good because when your healthy bacteria population dwindle the unhealthy ones often move in.

Several studies implicate unhealthy bacteria and lack of healthy bacteria as a factor in the development of colon cancer. Such Finally stress is not only something that happens externally and you react to it. Your gut can get very distressed when you swallow something that it hadn’t evolved to use and to protect itself from toxic substances the gut immune function starts the inflammation process.  The inflammation makes cells vulnerable to DNA damage and it is also an environment where a cancer tumour thrives.

There is no proven silver bullet to avoid colorectal cancer , but we can change many habits to reduce  mucosal inflammation and create an gut environment that is hostile to bad bacteria. Both of these changes will reduce our risk of colorectal cancer.

Here’s a brief list of lifestyle changes that would help reduce your risk of mucosal inflammation and colon cancer: –

  • Probiotics
  • Fermented foods
  • Look at your comfort eating?  Are you? Why?
  • Don’t binge drink
  • Don’t eat  processed foods
  • Eat fibre
  • Eat some fruit and vegetables everyday or supplement with super food drinks
  • Cook whole foods as much as possible
  • Use eco-friendly toxic chemical free cleaning and household products
  • Eat less processed meats and eat less meat
  • Get a comprehensive blood test every year including inflammatory markers CRP, ESR and all essential vitamins and minerals, fasting glucose, insulin, blood fats and anything else relevant to your health. Then address any nutritional deficiencies and other concerns.
  • Balance your essential fats intake (as Omega 3,6,9)
  • Over 50 and family history of bowel cancer? Consult your doctor for whether you may benefit from test for bowel cancer.
  • Suffering from chronic constipation/diarrhoea/ or an IBD? Consult a integrative medicine practitioner for help.

And work on being less distressed. Bring down those stress levels

  • Find a way to slow down, relax and take time out. Sitting in front of the television is not relaxation, but listening to meditation music with absolutely  no distractions is.
  • Sweat! – do intensive exercise 3-5 times a week
  • Move! – get up from your office chair and move around for 5 minutes every hour

 

Comments

This is a brief and very incomplete explanation of cancer , which is incredibly complex. Never the less it is indisputable that most cancers are not a genetic destiny they are often a result of how we have lived our lives and perhaps some bad luck.

Some sources for this article

 

Gut microbiota and colorectal cancer – (PMID:27350830 PMCID:PMC4917993)

Schwabe RF, Jobin C. The microbiome and cancer. Nat Rev Cancer. 2013;13(11):800–12. doi: 10.1038/nrc3610.

A human colonic commensal promotes colon tumorigenesis via activation of T helper type 17 T cell responses – doi:10.1038/nm.2015

Chronic inflammation, colorectal cancer and gene polymorphisms.

(PMID:21088407 PMCID:PMC2997443)

Alcohol and Cancer Incidence – http://epic.iarc.fr/highlights/alcoholcancerincidence.php

Vitamin D and Colorectal Cancer – http://epic.iarc.fr/highlights/vitamindcolorectal.php

Older Men still being over tested for prostate Cancer – An NYT article

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Did you know in USA it is recommended that men over 75 do not have prostate PSA testing. Why? Because even if you have prostate cancer(a non aggressive type) it is so slow to progress  you will most likely  die from something else. Read this short article for more information on why testing in older men is not recommended.

 

If you can’t access this article, let me know and I will forward it to you.

The incidences of Brain cancer have not increased since mobile phone usage

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We have had mobiles in Australia since 1987. Some 90% of the population use them today and many of these have used them for a lot longer than 20 years. But we are seeing no rise in the incidence of brain cancer against the background rate (Simon Chapman, Emeritus Professor in Public Health, University of Sydney).

The Study

We examined the association between age and gender-specific incidence rates of 19,858 men and 14,222 women diagnosed with brain cancer in Australia between 1982-2012, and national mobile phone usage data from 1987-2012.

In summary, with extremely high proportions of the population having used mobile phones across some 20-plus years (from about 9% in 1993 to about 90% today), we found that age-adjusted brain cancer incidence rates (in those aged 20-84 years, per 100,000 people) had risen only slightly in males but were stable over 30 years in females.

There were significant increases in brain cancer incidence only in those aged 70 years or more. But the increase in incidence in this age group began from 1982, before the introduction of mobile phones in 1987 and so could not be explained by it. Here, the most likely explanation of the rise in this older age group was improved diagnosis.

Computed tomography (CT), magnetic resonance imaging (MRI) and related techniques, introduced in Australia in the late 1970s, are able to discern brain tumours which could have otherwise remained undiagnosed without this equipment. It has long been recognised that brain tumours mimic several seemingly unrelated symptoms in the elderly including stroke and dementia, and so it is likely that their diagnosis had been previously overlooked.

Next, we also compared the actual incidence of brain cancer over this time with the numbers of new cases of brain cancer that would be expected if the “mobile phones cause brain cancer” hypothesis was true. Here, our testing model assumed a ten-year lag period from mobile phone use commencement to evidence of a rise in brain cancer cases.

Our model assumed that mobile phones would cause a 50% increase in incidence over the background incidence of brain cancer. This was a conservative estimate that we took from a study byLennart Hardell and colleagues (who reported even higher rates from two studies). The expected number of cases in 2012 (had the phone hypothesis been true) was 1,866 cases, while the number recorded was 1,435.

Using a recent paper that had Davis as an author we also modelled a 150% increase in brain cancer incidence among heavy users. We assumed that 19% of the Australian population fell into this category, based on data from the INTERPHONE study an international pooled analysis of studies on the association between mobile phone use and the brain. This would have predicted 2,038 expected cases in 2012, but only 1,435 were recorded.

Our study follows those published about the United States, England, the Nordic countries and New Zealand where confirmation of the “mobile phones cause brain cancer” hypothesis was also not found.

In Australia, all cancer is notifiable. At diagnosis, all cases must by law be registered with state registries tasked with collecting this information. It has been this way for decades. So we have excellent information about the incidence of all cancers on a national basis.

The telecommunications industry of course also has information on the number of people with mobile phone accounts.

While touring Australia, Davis was confronted with the “flatline” incidence data on brain cancer. Her stock response was that it was far too early to see any rise in these cancers. She was here to warn us about the future.

Author: Simon Chapman, Emeritus Professor in Public Health, University of Sydney. This article was originally published on The Conversation. Read the original article.

New study says radiation therapy for DCIS reduces risk of breast cancer later – but this is not the full story 

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I read an article today about a study of women who had been treated for DCIS. It reported that a study has found radiation and surgery together reduces risk of breast cancer later. The patients who only had surgery had a higher incidence of breast cancer later.

However this article and study failed to mention that DCIS is overtreated and approximately half of the cases do not develop into invasive cancer. It is concerning that the article reported most women with DCIS undergo treatment when in many cases it is not needed.

This was an USA study so did some searches for Australian studies on DCIS treatment and could not find any that addressed the problem with over treatment that has been reported  in USA.
Copy of report below

Women who underwent treatment for ductal carcinoma in situ (DCIS), a noninvasive breast abnormality, were at higher risk of developing malignant breast tumours if they did not receive timely radiation therapy as part of their treatment, according to a study presented at the AACR Annual Meeting 2016.

DCIS is the most common premalignant breast lesion, with over 60,000 women diagnosed each year.
Not all DCIS will develop into invasive cancer, but because it is difficult to predict which cases will become cancerous, most women diagnosed with DCIS undergo treatment for it.
“According to the National Comprehensive Cancer Network guidelines, primary treatment options for DCIS include breast-conserving surgery plus radiation, total mastectomy, and breast- conserving surgery alone,” said the study’s lead author, Ying Liu, MD, PhD, instructor of surgery at Washington University School of Medicine and a research member at Siteman Cancer Center in St. Louis, Missouri. “This study shows that it is important for women to understand the benefits of timely receipt of radiation therapy after breast-conserving surgery.”
Liu and colleagues conducted this study by identifying 5,916 women in the Missouri Cancer Registry who were diagnosed with first primary DCIS between 1996 and 2011 and were treated with breast-conserving surgery.
Women who underwent treatment for ductal carcinoma in situ (DCIS), a noninvasive breast abnormality, were at higher risk of developing malignant breast tumours if they did not receive timely radiation therapy as part of their treatment, according to a study presented at the AACR Annual Meeting 2016.
DCIS is the most common premalignant breast lesion, with over 60,000 women diagnosed each year.
Not all DCIS will develop into invasive cancer, but because it is difficult to predict which cases will become cancerous, most women diagnosed with DCIS undergo treatment for it.
“According to the National Comprehensive Cancer Network guidelines, primary treatment options for DCIS include breast-conserving surgery plus radiation, total mastectomy, and breast- conserving surgery alone,” said the study’s lead author, Ying Liu, MD, PhD, instructor of surgery at Washington University School of Medicine and a research member at Siteman Cancer Center in St. Louis, Missouri. “This study shows that it is important for women to understand the benefits of timely receipt of radiation therapy after breast-conserving surgery.”
Liu and colleagues conducted this study by identifying 5,916 women in the Missouri Cancer Registry who were diagnosed with first primary DCIS between 1996 and 2011 and were treated with breast-conserving surgery.
POf those women, 1,053 (17.8 percent) received radiation therapy eight or more weeks after surgery, which the researchers defined as a delay.
Also, 1,702 (28.8 percent) did not receive any radiation therapy during the first course of treatment.
The remaining 53.4 percent of women received radiation within eight weeks of the surgery.
During the 72-month follow-up period, 3.1 percent of the women developed an ipsilateral breast tumour, which is an invasive or in situ tumour occurring on the same side as the DCIS.
After adjustment for propensity scores based on factors such as age, race, tumour size, and tumour grade, the risk of ipsilateral breast tumours was 26 percent higher for women who had delayed radiation therapy and 35 percent higher for women who did not receive any radiation therapy during the first course of treatment.

Women who underwent treatment for ductal carcinoma in situ (DCIS), a noninvasive breast abnormality, were at higher risk of developing malignant breast tumours if they did not receive timely radiation therapy as part of their treatment, according to a study presented at the AACR Annual Meeting 2016.

DCIS is the most common premalignant breast lesion, with over 60,000 women diagnosed each year.
Not all DCIS will develop into invasive cancer, but because it is difficult to predict which cases will become cancerous, most women diagnosed with DCIS undergo treatment for it.

“According to the National Comprehensive Cancer Network guidelines, primary treatment options for DCIS include breast-conserving surgery plus radiation, total mastectomy, and breast- conserving surgery alone,” said the study’s lead author, Ying Liu, MD, PhD, instructor of surgery at Washington University School of Medicine and a research member at Siteman Cancer Center in St. Louis, Missouri. “This study shows that it is important for women to understand the benefits of timely receipt of radiation therapy after breast-conserving surgery.”

Liu and colleagues conducted this study by identifying 5,916 women in the Missouri Cancer Registry who were diagnosed with first primary DCIS between 1996 and 2011 and were treated with breast-conserving surgery.

POf those women, 1,053 (17.8 percent) received radiation therapy eight or more weeks after surgery, which the researchers defined as a delay.

Also, 1,702 (28.8 percent) did not receive any radiation therapy during the first course of treatment.

The remaining 53.4 percent of women received radiation within eight weeks of the surgery.

During the 72-month follow-up period, 3.1 percent of the women developed an ipsilateral breast tumour, which is an invasive or in situ tumour occurring on the same side as the DCIS.

After adjustment for propensity scores based on factors such as age, race, tumour size, and tumour grade, the risk of ipsilateral breast tumours was 26 percent higher for women who had delayed radiation therapy and 35 percent higher for women who did not receive any radiation therapy during the first course of treatment.

Delays were more likely for certain groups

woman senior smiling 50s_oncology news australiaLiu and colleagues identified several groups who were significantly affected by delays in radiation therapy.

African-American women, single women, those who received Medicaid, those whose DCIS tumours were larger, and those who were diagnosed more recently were all more likely to have a delay in treatment.
“Among these groups, African-American women, those on Medicaid, and those with a large DCIS have a higher risk of recurrence, therefore, timeliness of radiation therapy should be improved,” Liu said.

Study data did not fully explain the reasons for delays among certain groups, but Liu said that the quality and accessibility of health care providers and facilities could be one possible cause.

She added that further research could provide insight into the factors influencing delays and help identify ways to encourage women to receive radiation therapy soon after DCIS surgery.

Liu said a limitation of the study is that during the 72 months of average follow-up time, the number of study subjects who developed ipsilateral breast tumours was small.
“Our preliminary finding needs to be confirmed in a large cohort of DCIS patients with a longer follow-up,” she said. “Future studies should also address the contributions of patient choice, healthcare providers, facilities, and neighbourhoods to therapy delay.”

AACR 2016: Delays in radiation therapy increase chance of breast tumour development in women treated for ductal carcinoma in situ

Being Married helps prolong survival in cancer patients

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Comments

There is no doubt that social support improves cancer patients outcomes. This report talks about a study of married and unmarried patients survival rates. It found unmarried males and females had higher death rates that those who were married.

 

New research has uncovered a link between being married and living longer among cancer patients, with the beneficial effect of marriage differing by race/ethnicity and place of birth.

Published early online in CANCER, the findings have important public health implications, given the rising numbers of unmarried individuals in addition to the growing aging population.

For the analysis, a team led by Scarlett Lin Gomez, PhD, of the Cancer Prevention Institute of California, and Marí­a Elena Martínez, PhD, of the University of California, San Diego School of Medicine, assessed information on nearly 800,000 adults in California who were diagnosed in 2000 to 2009 with invasive cancer and were followed through 2012.

The investigators found that unmarried cancer patients had higher death rates than married patients.

For males, the rate of death was 27 percent higher among those who were unmarried compared with those who were married.

For females, the rate was 19 percent higher among unmarried patients.

These patterns were minimally explained by greater economic resources among married patients, including having private health insurance and living in higher socioeconomic status neighbourhoods.

The beneficial effect of being married on survival differed across racial/ethnic groups. Among men and women, whites benefitted the most from being married while Hispanics and Asian Pacific Islanders benefitted less.

Also, Hispanic and Asian/Pacific Islander cancer patients who were born in the United States experienced a greater benefit than those born outside the country.

“While other studies have found similar protective effects associated with being married, ours is the first in a large population-based setting to assess the extent to which economic resources explain these protective effects,” said Dr. Gomez. “Our study provides evidence for social support as a key driver.”

The findings indicate that physicians and other health professionals who treat unmarried cancer patients should ask if there is someone within their social network available to help them physically and emotionally.

Also, with the number of unmarried adults growing in the United States and the number of cancer patients also growing due to the aging population, the results have important public health implications.

“Research is needed to understand the specific reasons behind these associations so that future unmarried patients can receive interventions to increase their chances of survival,” said Dr. Martinez.

Marriage may help prolong survival in cancer patients