Research Highlights from the 2017 Cancer Survivorship Symposium: Advancing Care and Research, with Lidia Schapira, MD, FASCO

January 23, 2017
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In today’s podcast, Dr. Lidia Schapira will discuss 3 new studies presented at the 2017 Cancer Survivorship Symposium: Advancing Care and Research, held January 27 and 28 in San Diego, California.

Transcript: 

ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

In today’s podcast, Dr. Lidia Schapira will discuss 3 new studies presented at the 2017 Cancer Survivorship Symposium: Advancing Care and Research, held January 27 and 28 in San Diego, California. This multidisciplinary meeting brings together primary care physicians, oncologists, patient advocates, and others to discuss ways to address cancer survivors’ unique concerns.

Dr. Schapira is the Associate Professor of Medicine at Stanford University School of Medicine, and Director of Cancer Survivorship at the Stanford Comprehensive Cancer Institute. She is also the Editor in Chief of Cancer.Net.

ASCO would like to thank Dr. Schapira for discussing this topic.

Dr. Schapira: Hello and welcome to this podcast. I'm Lidia Schapira, medical oncologist at Stanford, and today we'll be discussing abstracts presented at the 2017 Cancer Survivorship Symposium in San Diego.

The first abstract I'd like to discuss with you is one about the value of exercise and physical activity and the impact on quality of life for patients who are undergoing active treatment for cancer.

We typically think of exercise as something that is very important for us when we're in good health, but it's just as important to think about what exercise can offer people who are undergoing treatment for cancer.

In this study, done by Dr. Romero at Memorial Sloan Kettering Cancer Center, the researchers sent a survey to patients who were being treated for common cancers. They found that 75% of survey respondents reported decreasing their physical activity since they were diagnosed with cancer, and only a very small number, about 16%, maintained their pre-diagnosis activity level.

For those patients who reported decreasing their physical activity, about three-quarters of them said they had difficulty getting motivated, and about two-thirds said they had trouble remaining disciplined. Other contributing factors for patients reporting less physical activity were physical symptoms such as pain and fatigue.

This is really interesting, and the authors of the study have said, and reminded us that of course it's very important to treat fatigue and pain, because those will interfere with a person's ability and desire to exercise.

But what this study shows is that one of the main factors for people to decrease their level of activity is actually not physical, but psychological, and that is the failure of motivation, and the inability to just stay with it, which we sort of call discipline. And those issues are generally harder to address. Just thinking about my interactions with patients, we can sometimes provide some coaching and encouragement, but perhaps it's time to think about involving physical therapists, or occupational therapists, and even psychologists, in order to help people find that "oomph," that desire and motivation, and then to stick with it.

We know that physical activity can lead to many many beneficial effects: people feel better, perhaps eat and sleep better, and it may impact even on how they feel during their treatment for cancer, and may even impact the beneficial effect of treatment. So this is intriguing and interesting, and is very important, I think, for every one of us, whether we're patients being treated, or clinicians treating patients, to think about as people are moving through their cancer journey. And it's important, I think, to keep our eye on the need to remain as physically active as possible.

Now, turning our attention a little bit to psychological issues, is a very interesting study presented by Dr. Borstelmann from the group at Dana-Farber and Partners in Boston. And this looks at the psychological function, not of the patients treated for cancer, but their partners. In this case, Dr. Borstelmann surveyed the spouses or partners of women who were diagnosed with breast cancer when they were quite young, women who were diagnosed under the age of 40.

This is a large cohort that is being studied over many years now, over 10 years in the Boston area and other participating centers. So what these investigators did, is they also sent a mail survey to the partners of patients, trying to find out how they were coping, and whether or not they were coping well, and if they weren't coping well, what that possibly could mean for their state of health.

So looking at the partners, mostly male, mostly husbands, of these young women who had been diagnosed over time, they found that those who were not coping well actually experienced more anxiety. They assessed how well they coped using very good, validated scientific instruments, trying to see if they accepted the diagnosis, if they were able to ask for and receive emotional support, and if they could find a way of moving forward, even with this added crisis to the family.

And what they found was that those who were not able to cope well had higher levels of anxiety. So this again confirms something that we've all felt all along, and that is that it's really important to check in with the partners, with the spouses, of our patients.

So this again is something we all need to think about, both those undergoing treatment, patients, as well as the clinicians, we need to find a way of checking in and finding out if the partners, if the spouses, also perhaps could use some help. And that could be psychological help, some emotional support, perhaps some form of connection.

I think this research is really also sort of mind-expanding, in the sense that we need to be thinking about the needs of spouses and family caregivers throughout the cancer journey. This is very important, and may be particularly important to some of these young patients, and young families, who are faced with lots of issues at the same time, and perhaps the impact of cancer has also an effect on how these young families, and young couples, come together in their parenting, and their dealing with relationships, and perhaps even some household issues.

So, it's important in this area, to also think creatively, and think perhaps about sources of support and do so early on, after the diagnosis and while undergoing treatment. So this has an impact on both the person who's undergoing cancer treatment, his or her spouse, during treatment, and also after the end of active treatment, the area that we typically think of as the time of survivorship.

And with that, I'd like to turn our attention and our conversation now to the third abstract presented at this meeting, and this deals more with physical symptoms and long-term side effects of cancer treatment. This paper, presented by Dr. Brenna Blackburn from the University of Utah, looked at a large sample of over 4,000 patients in Utah, who were diagnosed with thyroid cancer when they were quite young, between the years of 1997 and 2012.

So they were tracking the long-term health effect of having received aggressive treatment with the intention of being cured for thyroid cancer. Now these survivors of thyroid cancer were quite young when they were diagnosed and treated. And what they found is that receiving this treatment before age 40 was associated with an increase in cardiac problems later on.

So let me give you some specific examples. They found that survivors diagnosed with thyroid cancer before the age 40 were 5 times more likely to develop swelling around the heart, and more than twice as likely to develop heart disease, compared and contrasted to patients who were diagnosed after the age 40. Also they found that the younger patients were 6 times more likely to develop a weakening of the bones called osteoporosis than older thyroid cancer survivors.

So they conclude that we typically think of younger patients as being so healthy that they will be better able to tolerate the treatment, but we now need to also acknowledge and think that perhaps as a result of these aggressive treatments, we are speeding up their aging, and we're increasing the chance or the likelihood that later on, many years later, they will develop problems with heart or blood pressure, or even weaker bones.

Why that is is not clear, and these researchers are appropriately doing a lot of physiological studies trying to see if there are some patients are perhaps are more vulnerable to these long-term side effects than others.

But it is a call to think, not just about the immediate ability to tolerate the treatment for cancer, but also perhaps the price this patient will pay later on, or the physical consequences and potentially harmful effects later on for having received these treatments for cancer.

So, these three abstracts tell you a little bit about what the scientific community is thinking about, and how we are, together, trying to think about all of the aspects of being treated, the impact on family members, and also thinking very carefully, with great respect, about the long-term effects of cancer, so we may be better able, hopefully going forward, to think about the pros and cons of some of these cancer treatments, and do absolutely everything we can, not just to treat the cancer effectively, but also to minimize long-term effects.

This ends our podcast about the 2017 ASCO Survivorship Symposium. I'm Lidia Schapira, thank you very much for your attention.

ASCO: Thank you, Dr. Schapira. More information on cancer survivorship can be found at www.cancer.net/survivorship. And for more expert interviews and stories from people living with cancer, visit the Cancer.Net Blog at www.cancer.net/blog.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net Podcast.