ASCO Annual Meeting 2017: Improving Survivorship Care

2017 ASCO Annual Meeting. #ASCO17
June 2, 2017
Monika Sharda, ASCO staff

“Although we span many disciplines and professions,” says ASCO President Daniel F. Hayes, MD, FACP, FASCO, “we are a single community with a singular focus: to provide better care for patients at risk for or with cancer.” That is why the theme of this year’s American Society of Clinical Oncology (ASCO) Annual Meeting is Making a Difference in Cancer Care WITH YOU. Watch a patient education video with Dr. Hayes explaining why the ASCO Annual Meeting is so significant.  

More than 38,000 oncology professionals from around the world are at the ASCO Annual Meeting, presenting and discussing the latest research in treatment and patient care. Learn about the research released today:

  • Low testosterone common, linked to chronic health problems in testicular cancer survivors

  • Online therapy program for patients lowers distress

  • New face-to-face therapy program lowers fear of recurrence for cancer survivors

  • Talk therapy lowers distress for people with advanced cancer

  • Severe health problems in childhood cancer survivors steadily decreasing

  • Single radiation treatment relieves symptoms of spinal cord compression

Low testosterone common, linked to chronic health problems in testicular cancer survivorsshare on twitter

A study of 491 testicular cancer survivors showed that 38% of them had a low testosterone level, known as hypogonadism. In addition, these survivors were more likely to have chronic health problems, including high cholesterol, high blood pressure, erectile dysfunction, diabetes, and anxiety or depression, compared with survivors with a normal testosterone level. Some men may have a low testosterone level when they are diagnosed with testicular cancer. Other men may develop a low testosterone level as a side effect of surgery or chemotherapy.

This study analyzed data from a larger, ongoing study called the Platinum Study on the lifelong health of men who received cisplatin (Platinol) as chemotherapy for testicular cancer before the age 55. Researchers collect health information through questionnaires and basic medical tests. Factors that were associated with a higher chance of having low testosterone included being older and being overweight or obese.

2 in 5 testicular cancer survivors have low testosterone. Low T is linked to: high cholesterol, high blood pressure, erectile dysfunction, diabetes, anxiety/depression. 2017 ASCO Annual Meeting.Compared with survivors who have a normal testosterone level, testicular cancer survivors with hypogonadism were more likely to take medicine for:

  • High cholesterol (20% vs. 6%)

  • High blood pressure (19% vs. 11%)

  • Erectile dysfunction (20% vs. 12%)

  • Diabetes (6% vs. 3%)

  • Anxiety or depression (15% vs. 10%)

What does this mean? This study highlights the connection between low testosterone and other health problems in testicular cancer survivors.

“Because testicular cancer occurs at a young age and is highly curable, many survivors may live upwards of 5 decades. Our findings underscore the need for clinicians to assess testicular cancer survivors for physical signs or symptoms of hypogonadism and to measure testosterone levels in those who do.”

— lead study author Mohammad Issam Abu Zaid, MBBS
Indiana University School of Medicine
Indianapolis, Indiana

Online therapy program for patients lowers distressshare on twitter

Researchers found that an 8-week web-based stress management program lowers distress and improves quality of life for people newly diagnosed with cancer. This program, called STREAM, was developed by oncologists and psychologists. It is a newer approach to therapy known as “therapist-guided online intervention” that appears to be as effective as traditional face-to-face therapy.

The STREAM program covers 8 topics (1 per week), including the body’s reaction to stress, cognitive stress reduction, feelings, and social interactions. For each topic, patients received written and audio information and completed practical exercises and questionnaires at a time and place of their choosing. Psychologists went into the system weekly to review their progress and give them written guidance and support.

The 129 people who participated in this study were divided into 2 groups, getting either support through STREAM or no psychological support. Most participants were women with early-stage breast cancer. There were also people with lung cancer, ovarian cancer, lymphoma, melanoma, and gastrointestinal cancers. The patients joined the study within 12 weeks after having their first cancer treatment.

Before and after the study, researchers measured quality of life, distress, and anxiety and depression. They found that the patients’ quality of life improved and distress decreased. Distress was measured on a scale of 0 to 10. A score of 0 to 4 is considered “low distress.” A score of 5 to 10 is considered “high distress.” At the end of the study, the median distress score of patients who participated in STREAM decreased by 2 points, from 6 to 4. The median distress score for patients not participating in STREAM stayed the same at 6. The median is the midpoint, which means that half of all patients had a higher score and half had a lower score. The measures for anxiety and depression were similar for both groups of patients.

After 2 months, the patients who did not initially receive STREAM started using it. Researchers will report on how introducing STREAM later compares to starting it earlier during the ASCO Annual Meeting.

What does this mean? Online tools such as STREAM provide new ways for patients and their health care team to communicate effectively without being face to face. This approach can offer more patients access to psychological support, an important part of high-quality cancer care.

“I think online psychological support will be much more important in the years to come, as the digital generation reaches the age when they are at higher risk of cancer. For them, it will be natural to use such online tools and communicate without face-to-face interaction, and so now is the time to standardize and validate the tools.”

— lead study author Viviane Hess, MD
University Hospital of Basel
Basel, Switzerland

New face-to-face therapy program lowers fear of recurrence for cancer survivorsshare on twitter

A recent study showed that a new face-to-face psychological therapy program lowered cancer survivors’ fear of having the cancer come back, called a recurrence.

Fear of recurrence is common among people who have completed cancer treatment. Severe fear can negatively affect survivors’ follow-up medical care, mood, relationships, work, goal setting, and quality of life.

This new program, called Conquer Fear, was developed by the study’s researchers. It is made up of 5 in-person, individual therapy sessions over 10 weeks. Each session is 60 to 90 minutes long. The program focuses on:

  • Accepting the uncertainty of whether cancer would come back

  • Teaching strategies to control worry

  • Giving survivors more control over where they place their attention

  • Helping survivors focus on what they want to get out of life

  • Choosing a sensible level of cancer screening and sticking to it

In this study, half of the 222 survivors participated in Conquer Fear while the other half received relaxation training. The relaxation training sessions were held for 60 minutes for the same number of days as Conquer Fear. Most of the participants in the study were young women diagnosed with breast cancer. There were also people diagnosed with colorectal cancer and melanoma. All participants had been treated for stage I to stage III cancer before the study and had no signs of cancer during the study.

To measure fear of recurrence, researchers asked participants to fill out a questionnaire when they joined the study, immediately after participating in the Conquer Fear program or relaxation sessions, and then again 3 and 6 months later. The questionnaire, called Fear of Cancer Recurrence Inventory, provides a score from 0 to 168. Higher scores indicate a worse fear of recurrence.

Researchers found that participating in Conquer Fear had a greater positive effect than the relaxation training on reducing the fear of recurrence. Fear lessened by an average of 18 points in the Conquer Fear group and by an average of about 8 points in the relaxation group in the scores taken right after participating. After 6 months, fear lessened by an average of about 27 points in the Conquer Fear group and by an average of about 18 points in the relaxation group.

What does this mean? Counseling that addresses the fear of recurrence could play an important role in enhancing people’s psychological and emotional well-being following cancer treatment. This could expand opportunities for survivors to receive quality post-treatment care.

“In this study, the interventions were delivered by experienced psycho-oncologists. It is possible that community psychologists or other professionals who have basic training in cognitive therapy could deliver the interventions, given appropriate training and supervision.”

— lead study author Jane Beith, MD, PhD
University of Sydney
Sydney, Australia

Talk therapy lowers distress for people with advanced cancershare on twitter

New research has found that people with advanced cancer who received specific in-person counseling sessions had fewer symptoms of depression and improved psychological well-being than those who received the usual care. Usual care consisted of screening for distress and basic psychosocial care.

Advanced cancer triggers enormous distress and brings challenges that can seem overwhelming.  Due to this burden, there is an ongoing need for supportive care approaches that help patients manage the practical and emotional toll of advanced cancer.

In this study, 305 patients received either the usual psychosocial care or took part in the Managing Cancer And Living Meaningfully (CALM) program. CALM was developed by the research team specifically for people with advanced cancer and is made up of 3 to 6 sessions of 45 to 60 minutes led by a health care professional. The sessions focused on 4 main areas:

  • Symptom control, medical decision-making, and relationships with health care providers

  • Changes in self-concept and personal relationships

  • Spiritual well-being and the sense of meaning and purpose in life

  • Future-oriented concerns, hope, and mortality    

As part of the study, patients filled out questionnaires when they joined the study and then again 3 and 6 months later.

Researchers found that those receiving CALM were 19% more likely to show a reduction in severity of symptoms than those receiving usual care after 3 months. After 6 months, those receiving CALM were 29% more likely to show a reduction of severity of symptoms. CALM participants were also less likely to develop symptoms of depression. Over time, patients receiving CALM felt more prepared to understand their cancer experience, were better able to deal with changes in relationships, and found new ways to communicate with their health care team.

What does this mean? Methods like CALM could help many cancer centers improve their psychological health services and, in turn, improve the quality of life for more people with advanced cancer.

“This brief talking therapy helps patients facing advanced cancer, and their loved ones, sustain what is meaningful in their life despite its limitations and face the future. It provides time and space for reflection on the threats and challenges associated with advanced cancer, the experience of a secure base in the therapeutic relationship, and support for the regulation and modulation of emotions.”

— lead study author Gary Rodin, MD
Princess Margaret Cancer Centre
Toronto, Canada

Severe health problems in childhood cancer survivors steadily decreasingshare on twitter

An analysis of data from 23,600 childhood cancer survivors shows that the occurrence of severe health conditions has declined over the past few decades. The rate decreased from about 13% among survivors diagnosed in the 1970s to about 10% among those diagnosed in the 1980s and nearly 9% among those diagnosed in the 1990s.

Researchers took data from the Childhood Cancer Survivor Study (CCSS), which is funded by the National Institutes of Health. The analysis focused on severe, disabling, life-threatening, or fatal health problems occurring within 15 years of a diagnosis of cancer during childhood.

The decreases were largest for survivors of Wilms tumor and Hodgkin lymphoma, but there were also decreases for survivors of astrocytoma, non-Hodgkin lymphoma, and acute lymphoblastic leukemia. No decrease was seen in some types of childhood cancers, such as neuroblastoma, acute myeloid leukemia, soft-tissue sarcoma, and osteosarcoma.

Endocrine conditions and new cancers decreased the most. Gastrointestinal conditions and nervous system-related problems also decreased. The rates of heart problems or lung conditions did not change.

What does this mean? This data suggests that advances in cancer treatment and supportive care have helped improve the long-term health of childhood cancer survivors. However, regular follow-up care remains important due to survivors’ increased risk of long-term effects overall.

“From our findings, it is clear that survivors diagnosed and treated in more modern treatment eras are doing better. Not only are more children being cured, but they also have lower risk for developing serious health problems due to cancer treatment later in life.”

— lead study author Todd M. Gibson, PhD
St. Jude Children’s Research Hospital
Memphis, Tennessee

Single radiation treatment relieves symptoms of spinal cord compressionshare on twitter

A study of 688 patients with metastatic cancer found that a single dose of radiation therapy is as effective as 5 doses of radiation therapy for metastatic spinal cord compression. Spinal cord compression is when cancer is in the spine and presses on the spinal cord, causing pain, numbness, and difficulty walking. It is common in people with metastatic cancer, which is cancer that has spread from the location where it began to other parts of the body. Radiation therapy and/or surgery are commonly used to relieve pain and other symptoms of spinal cord compression. Currently, there is no standard approach to giving radiation therapy for this condition.

Most of the people in the study were men with metastatic prostate cancer, but there were also people with metastatic lung, breast, and gastrointestinal cancers. Researchers measured the effectiveness of the treatments by how well the patients were able to walk.

After 8 weeks, about 70% of patients who received 1 dose of radiation therapy and 73% of patients who received 5 doses were able to walk normally or walk with a cane or walker. In addition, researchers found that the median overall survival of the 2 groups was similar—about 12 weeks for those who received 1 dose and about 14 weeks for those who received 5 doses. The occurrence of severe side effects were almost the same in both groups, but mild side effects were less common for those who received 1 dose of radiation therapy.

What does this mean? A single dose of radiation therapy instead of several doses for spinal cord compression is an option for patients with a shorter life expectancy. More research is needed to find out if more doses of radiation therapy work better for patients who expect to live a longer time.

“Our findings establish single-dose radiotherapy as the standard of care for metastatic spinal canal compression, at least for patients with a short life expectancy. For patients, this means fewer hospital visits and more time with family.”

— lead study author Peter Hoskin, MD, FCRP, FRCR
Mount Vernon Cancer Centre
Middlesex, United Kingdom

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