ASCO20 Virtual Scientific Program: Effect of Quitting Smoking on Lung Cancer Survival, Maintenance Therapy for Recurrent Ovarian Cancer, Geriatric Assessments, Medicaid Expansion and Overall Cancer Mortality, and Videoconferencing for Caregivers

ASCO20 Virtual Scientific Program: #ASCO20
May 13, 2020
Leslie Fannon Zhang, ASCO staff

This month, thousands of oncology professionals from around the world will gather virtually to learn about the latest research in the treatment and care of people with cancer. The ASCO20 Virtual Scientific Program will take place online from Friday, May 29, through Sunday, May 31, and will feature over 250 presentations by experts in the field.

The ASCO20 Virtual Scientific Program will highlight promising research that may make a difference in patients’ care. Today, some early research highlights will be announced:

  • Quitting smoking at any point, even soon before a lung cancer diagnosis, helps patients live longer

  • Maintenance therapy with olaparib extends life by 1 year in people with recurrent ovarian cancer and BRCA mutation

  • Personalized care using geriatric assessments provides several benefits for older adults with cancer

  • States that expanded Medicaid under the ACA had greatest declines in deaths from cancer

  • Supportive videoconferencing approach helps reduce anxiety and distress for long-distance caregivers

Quitting smoking at any point, even soon before a lung cancer diagnosis, helps patients live longer

A large study of international data shows that people who quit smoking at any time, even less than 2 years before a lung cancer diagnosis, have a better chance of living longer after the diagnosis. The benefits of quitting tobacco use are well known, and quitting smoking at any time can be helpful. This study found that:

  • People who quit less than 2 years before their diagnosis had a 12% reduced risk of dying

  • People who quit between 2 and 5 years before their diagnosis had a 16% reduced risk of dying

  • People who quit more than 5 years before their diagnosis had a 20% reduced risk of dying

The researchers used data from 17 different studies from the International Lung Cancer Consortium, an international group of lung cancer researchers. Of the 35,428 people with lung cancer represented in the data, just over 47% were current smokers, 30% were former smokers, and just over 22% had never smoked at the time of diagnosis.

For all former smokers, the data showed a trend of lowered risk of death from any cause. The study also specifically compared data for long-term heavy smokers with current smokers. Heavy smokers are defined as those who smoked more than 30 pack-years. A pack-year is defined as smoking 20 cigarettes (the size of a standard pack of cigarettes) every day for 1 year. For former heavy smokers with more than 30 pack-years, the study found:

  • Those who quit less than 2 years before diagnosis had a 14% lower risk of dying, compared to current smokers.

  • Those who quit between 2 and 5 years before diagnosis had a 17% lower risk of dying, compared to current smokers.

  • Those who quit more than 5 years before diagnosis had a 22% lower risk of dying, compared to current smokers.

What does this mean? Quitting smoking is one of the best things you can do for your health, no matter when you quit. Even those who are diagnosed with lung cancer soon after they quit have a better chance of living longer.

“This research shows that if you’re a smoker and you quit, no matter when you quit, you will be more likely to survive after being diagnosed with lung cancer, compared to someone who continues smoking. The study’s message is simple: quit smoking now.”

—   lead study author Aline Fusco Fares, MD
Princess Margaret Cancer Centre
Toronto, Canada

The abstract number for this study is 1512. View this study abstract and the authors’ full disclosures on the ASCO website.

Maintenance therapy with olaparib extends life by 1 year in people with recurrent ovarian cancer and BRCA mutation

A randomized phase III clinical trial, called SOLO2, showed that maintenance therapy with a targeted therapy called olaparib (Lynparza) helped people with platinum chemotherapy-sensitive, recurrent ovarian cancer and a BRCA genetic mutation live nearly 13 months longer.

Maintenance therapy for ovarian cancer is used to slow the growth of the cancer and lengthen a person’s life, not necessarily to cure the cancer. Olaparib is a PARP inhibitor that helps stop damage caused by a BRCA mutation by binding to a specific enzyme.  Ovarian cancer that begins to grow or spread to other parts of the body during maintenance therapy is called recurrent cancer or relapsed cancer, and it is challenging to treat.  

There were 295 people with recurrent ovarian cancer in this study, all with a BRCA mutation who had previously received at least 2 treatments with chemotherapy and whose cancer responded to platinum chemotherapy. Of those, 196 patients received additional treatment with olaparib, and 99 patients received a placebo. After a median follow-up period of 65 months, over 28% of those who received olaparib were still alive and did not need more treatment, compared to about 13% of patients who received a placebo. The median is the midpoint, meaning half of the patients were followed less than 65 months and half were followed more than 65 months. The patients who received olaparib had a 26% reduction in their risk of death. Because the olaparib treatment was working so well, slightly more than 38% of the patients in the placebo group switched over to the group receiving olaparib.  

What does this mean? This study confirms that olaparib plays an important role as a maintenance therapy for recurrent ovarian cancer for people with a BRCA mutation.

“A median overall survival improvement of nearly 13 months is impressive in ovarian cancer and brings a powerful benefit to our patients. With the addition of overall survival data, this study helps usher in a new era of personalized medicine for women with this difficult-to-treat cancer.”

—   lead study author Andrés Poveda, MD
Initia Oncology, Hospital Quirónsalud
Valencia, Spain

The abstract number for this study is 6002. View this study abstract and the authors’ full disclosures on the ASCO website.

Personalized care using geriatric assessments provides several benefits for older adults with cancer

Results from a new clinical trial called INTEGERATE show that older adults with cancer see meaningful improvements in their quality of life and functional status when doctors use an approach called comprehensive geriatric assessment and management (CGAM) to create a personalized care plan.

Functional status is a person’s ability to perform the daily activities of life. A geriatric assessment is a comprehensive evaluation that gives the cancer care team a better understanding of their patient’s overall health and well-being, including their physical, emotional, nutritional, social, and practical needs. This includes a review of common health conditions that may have an impact on cancer care and a person’s quality of life, such as high blood pressure, thinking and attention problems, fall risk, and diabetes. These assessments also cover potential mental health and daily living concerns that can be helpful to know when planning cancer treatment for older adults.

The 154 patients in this study were older than 70 and set to receive chemotherapy, targeted therapy, or immunotherapy. The study participants were randomly assigned among 2 groups to receive either usual care alone or usual care plus CGAM. Those within the CGAM group worked with a geriatrician and had a specialized care plan developed based on the results of their geriatric assessment. A geriatrician is a doctor who specializes in the care of older adults.

To measure the effectiveness of the CGAM plus usual care treatment, researchers used an assessment tool called the Elderly Functional Index (ELFI) score and by giving participants questionnaires from the European Organisation for Research and Treatment of Cancer (EORTC) and the Quality of Life of Elderly Cancer Patients. These assessments look at different aspects of a patient’s well-being, including physical well-being, the burden of illness, future worries, and social functioning. Participants completed these assessments 4 times: at the beginning of their participation and then again at 12, 18, and 24 weeks during their treatment and follow-up care.

The participants in the CGAM group had significantly better ELFI scores, and the biggest difference between the 2 groups was seen during the assessment at 18 weeks. In addition, their health-related quality of life assessment scores showed improvement in physical function, mobility, burden of illness, and future worries.

In addition to improvements to the overall well-being of these patients, this study showed that this treatment approach significantly reduced unplanned hospital visits. Participants also had a 39% decrease in visits to the emergency room, a 43% reduction in unplanned hospital admissions, and a 38% reduction in how many patients had to stop cancer treatment because of side effects.

What does this mean? Adding geriatric assessment and specialized geriatric care to the cancer treatment plan can reduce unplanned hospital admissions, emergency room visits, and improve the quality of life and well-being for older adults with cancer, allowing more patients to continue or complete their cancer treatment.  

“The comprehensive geriatric assessment is a powerful tool because it helps optimize care for older cancer patients.”  

—   lead study author Wee-Kheng Soo, MBBS, FRACP
Eastern Health
Melbourne, Australia

The abstract number for this study is 12011. View this study abstract and the authors’ full disclosures on the ASCO website.

States that expanded Medicaid under the ACA had greatest declines in deaths from cancer

A nationwide study shows that states that expanded Medicaid under the Patient Protection and Affordable Care Act (ACA) had a 29% reduction in the rate of cancer death, compared to a 25% reduction in states that did not expand Medicaid.

Medicaid is a program that covers health care costs for people with disabilities or very low incomes. After the ACA was passed in 2010, researchers began studying how this change in federal law affected cancer treatment in individual states in the United States. Through the ACA, state governments were allowed to expand their Medicaid coverage starting in 2014 to cover more people. There were 27 states and the District of Columbia that chose to expand Medicaid coverage, and those regions saw large increases in Medicaid enrollment.

Using data from the Centers for Disease Control and Prevention in the years immediately before expansion (2011 to 2013) and the years immediately after expansion (2015 to 2017), researchers in this study compared overall cancer death in regions that expanded Medicaid to the 23 states that did not.  

Overall, from 1999 to 2017, deaths from cancer declined nationwide. However, results from this study concluded that areas that expanded Medicaid had a 29% reduction in their cancer death rate, from 65.1 cancer deaths per 100,000 people to 46.3 per 100,000. Among states that did not expand Medicaid, the cancer death rate dropped by 25%, from 69.5 per 100,000 to 52.3 per 100,000. When researchers specifically looked at the changes after 2014, they estimated that expanding Medicaid amounted to 785 fewer cancer deaths in 2017 alone.

The researchers also analyzed the data for specific patient groups, including how the changes affected Hispanic and black patients. Overall, Hispanic patients showed the greatest improvement in cancer mortality in states that expanded Medicaid, likely because of their higher uninsured rates before the expansion. Black patients did not see any additional reduction in cancer mortality due to Medicaid expansion, but the death rates were consistently worse for them in states without Medicaid expansion (63.4 deaths per 100,000 people) compared to states with Medicaid expansion (58.5 per 100,000). Previous research presented at ASCO meetings has shown that the ACA and Medicaid expansion reduced some racial disparities and improved access to cancer care for many people in the United States.

What does this mean? While overall cancer death has declined across the United States from 1999 to 2017, states that expanded Medicaid saw a greater decrease in the rate of cancer deaths.

“This is the first study to show the benefit of Medicaid expansion on cancer death rates on a national scale. We now have evidence that Medicaid expansion has saved the lives of many people with cancer across the United States.”

—   lead study author Anna Lee, MD, MPH
Memorial Sloan Kettering Cancer Center
New York, New York

The abstract number for this study is 2003. View this study abstract and the authors’ full disclosures on the ASCO website.

Supportive videoconferencing approach helps reduce anxiety and distress for long-distance caregivers

A study found that using videoconferencing to expand access to guidance from a health care provider significantly lowered levels of anxiety and distress among family caregivers who live more than 1 hour away from the patients they support. These caregivers are called “distance caregivers.” These findings have particular relevance during the COVID-19 pandemic, as social distancing practices have increased the number of caregivers providing remote support for their loved ones with cancer.

In this study, researchers looked at how different supportive interventions for distance caregivers impacted the caregivers' self-reported anxiety and distress levels. These caregivers often report more anxiety and distress than local caregivers because they feel more uncertain about their loved one’s condition. They are often unable to attend clinic visits and receive information secondhand instead of directly from the health care team. This anxiety and distress can negatively affect the caregivers’ physical health, employment, and overall quality of life.

Study participants were 441 distance caregivers who were randomly divided into 3 groups with different levels of access to 3 supportive interventions. The first group received monthly videoconference coaching sessions with a nurse practitioner or social worker, and they were able to participate in oncology clinic visits by videoconference. They also received access to a website that provided information tailored to the unique needs of distance caregivers. The second group was given access to just the videoconference clinic visits and the website. The third group only received access to the website.

The researchers then looked at changes in levels of anxiety and distress before and after the interventions, using a questionnaire completed at the beginning of the study and again 4 months later. Comparing the scores, the study found that the first group had significantly lower levels of both anxiety (19.2%) and distress (24.8%).

The average age of the distance caregivers was 47 years, 71% were female, and 63% were children of the patient. The average age of patients was 65 years, 60% were female, 30% had gastrointestinal cancer, and 18% had blood cancers. Of the patients with solid tumors, 59% had stage IV disease.

What does this mean? Additional support, including videoconferencing, can better support caregivers who cannot be near their loved one during cancer treatments, resulting in less anxiety and distress.

“Distance caregivers experience a tremendous amount of anxiety and distress—often greater than people with cancer themselves. With COVID-19, the challenges that distance caregivers face are now the same challenges facing many local caregivers who can’t attend their loved ones’ appointments. Our video conferencing intervention shows that it’s possible to meaningfully reduce anxiety and distress for distance caregivers through fairly simple technology.”

—   lead study author Sara L. Douglas, PhD, RN
Case Western Reserve University School of Nursing
Cleveland, Ohio

The abstract number for this study is 12123. View this study abstract and the authors’ full disclosures on the ASCO website.

Stay Informed

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