ASCO Annual Meeting 2018: Geriatric Assessment Improves Communication, Racial and Gender Differences in Cancer Treatment, and a Comparison of Cancer Treatment Costs

2018 ASCO Annual Meeting; #ASCO18
June 1, 2018
Greg Guthrie, ASCO staff

The theme of the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting is Delivering Discoveries: Expanding the Reach of Precision Medicine. Precision medicine has led to many advances in cancer care, but there is still much to learn in this growing field of research. Even more, as ASCO President Bruce E. Johnson, MD, FASCO, writes in this year’s Clinical Cancer Advances report, the promise of precision medicine “is only as good as our ability to make these treatments available to all patients.” While much of the cancer research at this year’s meeting will focus on precision medicine, there is also an ongoing effort to increase access to these treatments for all patients.

More than 32,000 oncology professionals from around the world are at the ASCO Annual Meeting, presenting and discussing the latest research in cancer treatment and patient care. Learn about the research released today:

  • Geriatric assessment improves communication between oncologists and older patients

  • Treatments for advanced prostate cancer may work better in black men

  • Women with head and neck cancer may be undertreated

  • Treatment for colorectal cancer costs twice as much for U.S. patients than Canadian neighbors

Watch a patient education video with Dr. Johnson explaining how the ASCO Annual Meeting changes patients’ lives.

Geriatric assessment improves communication between oncologists and older patients

Results from a federally funded clinical trial found that using a geriatric assessment in the care of older adults with advanced cancer improves doctor-patient communication and patient satisfaction. About 70% of people with cancer are 65 or older, and this is expected to increase over the next 20 years.

A geriatric assessment is an evaluation of many concerns that are specific to older adults and that are not normally covered during a routine clinical visit. Topics covered include different aspects of physical and mental health, nutrition, and social support. This assessment can help find individuals who might have health problems that are not related to cancer and who may have a higher risk of cancer treatment-related side effects. ASCO recommends that people with cancer who are 65 or older and who are receiving chemotherapy should receive a geriatric assessment to identify any additional problems these people may have. Previous research has shown that geriatric assessments are most widely used in major cancer centers with geriatric oncology programs, but not as often in other types of clinics.

In this study, 31 community oncology practices were randomly assigned to 1 of 2 groups, either a geriatric assessment group or to a usual care group. These practices provided information on 542 people, all of whom were 70 or older, had incurable advanced tumors or lymphoma, and had at least 1 impairment identified during the geriatric assessment.

The geriatric assessment in this study evaluated:

  • Function, which is the ability to participate in the activities of daily life

  • Physical performance, such as balance, history of falls, and overall physical health

  • Comorbidity, which is when someone has more than 1 disease or disorder at the same time as the cancer diagnosis

  • Nutrition

  • Social support

  • Depression

  • Cognition, such as memory problems

Physical and cognitive abilities of the patients were tested by trained coordinators in the clinic, and the other factors were reported by the patients through a questionnaire. Altogether, this took less than 1 hour of the person’s time.

All of the patients received a geriatric assessment in this study, but only the oncologists at the practices in the geriatric assessment arm received a summary of the results of the assessment as well as recommendations for how to treat potential problems. In the usual care group, oncologists only received information if the geriatric assessment found that the older adult had serious cognition problems or depression. During clinic visits within 4 weeks after the geriatric assessment, the researchers recorded and transcribed the communication during 1 clinic visit for each person in the study.

The researchers defined quality doctor-patient communication as conversations in which the doctor gathered more information about age-related concerns and the doctor thoroughly addressed the older adult’s concerns. Patient satisfaction with the quality of the doctor-patient communication was evaluated by using a phone questionnaire with each patient after the clinic visit.

In the geriatric assessment group, there was an average of 3.5 more discussions about age-related concerns than in the usual care group. There was an average of 2 more high-quality doctor-patient conversations in the geriatric assessment group than in the usual care group. And, older adults and doctors had an average of 2 more conversations that led to medical care, called interventions, in the geriatric assessment group than in the usual care group. Examples of these interventions included physical therapy for those with a history of falls, removing or reducing high-risk medications for those taking more than 5 prescriptions, and assessing decision-making ability in those with cognition problems. The people in the geriatric assessment arm also had more discussions about nearly all of their age-related concerns that were measured by the geriatric assessment and were happier with the quality of their communication with the doctor.

What is Geriatric Assessment? In this illustrations, a patient completes the assessment, and the doctor reviews the results, leading to better patient-doctor communication. ASCO ®

What does this mean? Geriatric assessment helps older adults and their health care team with communicating about and acting on the patient’s concerns and health problems.share on twitter Talk with your doctor about a geriatric assessment if you feel it could be helpful to your care.

“As oncologists, we need to step away from focusing solely on the cancer, especially in our older patients. While living longer is important, there are many non-cancer related health issues that are as, if not more important. Both patients and their caregivers clearly want the oncologist to discuss age-related concerns. Our study shows that geriatric assessment can help oncologists meet these needs for their older patients.”

—   lead study author Supriya Gupta Mohile, MD
Previous recipient of Conquer Cancer YIA
University of Rochester
Rochester, New York

Treatments for advanced prostate cancer may work better in black men

In the United States, prostate cancer is the most common cancer diagnosis for men, and black men have a 60% higher rate of prostate cancer than white men. Black men are more likely to be diagnosed at a younger age, with an advanced stage, and with a higher grade. They are also twice as likely to die from prostate cancer than white men. Yet research from 2 new studies shows that certain treatments for metastatic castration-resistant prostate cancer (mCRPC) may work better in black men than in white men.share on twitter mCRPC is when the cancer has spread to other parts of the body and is no longer stopped by hormone therapy, also called androgen-deprivation therapy or ADT. This type of advanced prostate cancer can be difficult to treat successfully.

Read a text transcript.

Black men treated with chemotherapy have survival rates equal to or higher than those of white men

In this first study, researchers analyzed data from 9 different phase III clinical trials, which in total covered more than 8,820 men of different races with mCRPC who were treated with chemotherapy. The researchers had to bring together this data from different clinical trials because not enough black men were included in each of the studies individually to scientifically compare whether the chemotherapy regimen worked as well as in white men. Among the patients’ data that was analyzed for this study, 7,528 (85%) were white men and 500 (6%) were black men. Data for only white men and black men were analyzed because the intention of this study was to test whether black men with mCRPC really have a worse prognosis, which is the chance of recovery.

The treatment plans used in all of the clinical trials in this study were docetaxel (Docefrez, Taxotere) plus prednisone (multiple brand names) or docetaxel plus prednisone plus other treatments. The researchers also compared the data for black men and white men using similar factors that affect a person’s prognosis, such as age, site of metastasis, prostate-specific antigen (PSA) levels and performance status, which is a measure of a person’s general well-being and ability to perform the activities of daily living.

The analysis shows that black men have at least the same chances of survival as white men. The median survival for black men and white men was the same (21 months). The median is the midpoint, which means that half of the people were on each side of the median. Further analysis shows that when men with similar prognostic factors are compared, black men have a 19% lower risk of death than white men. It is important to remember that this analysis is based on data for just 500 black men compared with more than 7,000 white men, so more research is needed to learn more about the different ways in which prostate cancer works in black men and in white men.

“By pooling data across clinical trials, this study provided a unique opportunity to evaluate how race might affect prostate cancer response to treatment. This study underscores the importance of increasing the participation of racial minorities in clinical trials. Every patient who participates in a clinical trial contributes to improving care, and all patients should have the opportunity to receive needed therapies.”

—   lead study author Susan Halabi, PhD
Duke University
Durham, North Carolina

Abiraterone appears to be more effective at treating prostate cancer in black men

In the second, separate study, the Abi Race clinical trial included 100 men with mCRPC: 50 black men and 50 white men. During the clinical trial, all the men were treated with a hormone therapy called abiraterone acetate (Zytiga), along with prednisone (Deltasone), until the cancer worsened or side effects forced them to stop. The researchers measured the time it took for the cancer to worsen, called progression-free survival (PFS), by using imaging scans and the PSA blood test.

The study’s results showed abiraterone was effective at stopping or slowing advanced prostate cancer in both black men and white men. When that effectiveness was measured by imaging scans, both groups had a median PFS of nearly 17 months. This means that the cancer had visually stopped growing and spreading on scan images during that time span.

But when PFS was evaluated using the PSA blood test, there was a notable difference between black men and white men. The blood’s PSA level is 1 factor that can help indicate whether prostate cancer treatment is working. If the PSA level goes down after treatment, men may live longer and have a better quality of life than if there is no decline in the PSA level. The median PFS when measured by PSA test results was nearly 17 months in black men and 11.5 months in white men.

In addition, treatment with abiraterone led to greater declines in PSA in black men than in white men. Nearly half (48%) of the black men had a 90% or better decline in PSA levels, compared with 38% of white men. Three out of every 4 black men had a 50% or better decline in PSA levels, compared with 2 out of every 3 white men. Most of the men in the study had a 30% or better decline in PSA levels (86% of black men and 76% of white men). Abiraterone did not lower PSA levels in 4 black men and 8 white men.

Side effects were similar across the 2 groups. Fatigue was more common in white men. Low potassium level is a side effect caused by abiraterone, and it was twice as common among black men than white men. If not treated, a low potassium level can be very dangerous.

“Black men are more than twice as likely to die of prostate cancer than white men and are generally thought to have worse prostate cancer outcomes. Our study suggests that when black men and white men with advanced prostate cancer are given the same hormone treatment, this is not the case. Our research underscores the importance of specifically studying genetically diverse populations and raising awareness to these results so that everyone who can benefit from abiraterone is offered this treatment.”

—   lead study author Daniel George, MD
Duke University
Durham, North Carolina

The researchers of both studies think that there are biological differences in what drives prostate cancer in black men and white men. Other research has shown that the way hormones work in black men is different from how they work in white men, and this may help explain the different treatment effects. For both studies, the next step is to conduct a genomic analysis of blood and tumor samples to try to learn more about what is driving these differences.

These 2 studies also highlight how important it is to include black men and other underrepresented groups in prostate cancer clinical trials. The percentage of minority participants, including black people, in cancer clinical trials is often much lower than the percentage of the same people in the general population. This makes it hard to judge the effectiveness and safety of cancer treatments by race. This difference in representation in clinical trials also means that fewer people in minority groups receive new cancer treatments.

What does this mean? Black men have a better chance of living longer when they receive chemotherapy or abiraterone to treat mCRPC.share on twitter

Women with head and neck cancer may be undertreated

Researchers analyzing cancer registry data found that women with head and neck cancer were less likely than men to receive intensive chemotherapy and radiation therapy and had a higher risk of dying from the disease.

In the United States this year, nearly 65,000 people will be diagnosed with head and neck cancers, which are more than twice as common in men than in women.

Developing a treatment plan for head and neck cancer depends on many factors, such as the overall well-being of the patient and whether the cancer is caused by the human papillomavirus (HPV). People who are in better general health can often receive more intensive treatments for the cancer, such as platinum-based chemotherapy combined with radiation therapy. HPV-related head and neck cancers respond better to treatment, so people with these cancers have a better chance of recovery. A previous study by the same authors found that HPV-related head and neck cancers are more common in men (77.4%) than in women (22.6%).

In this new study, the researchers studied health data from a Northern California hospital system for 223 women and 661 men, all of whom had stage II to stage IVB head and neck cancer. The researchers used a statistical method to estimate the chances someone would receive intensive cancer treatment. They also used a mathematical tool to compare the risk of dying from cancer to the risk of dying from other causes.

Overall, the study found several differences between women and men with head and neck cancer:

  • Treatment: The chances of receiving intensive chemotherapy were 35% for women compared with 46% for men. The chances of receiving radiation therapy were 60% for women and 70% for men.

  • Risk of death: At a median follow-up of nearly 3 years, 271 people died of cancer and 93 from other causes. The median is the midpoint, which means that half of the people were on each side of the median. Both men and women were more likely to die of cancer than of other causes, but the ratio of cancer deaths versus non-cancer deaths was 1.92 times higher for women than for men.

  • HPV-related cancers: More men than women had oropharyngeal cancers (55% men vs. 38% women), and HPV-related cancers occur more frequently in the oropharynx. The researchers suspect that because people with HPV-related head and neck cancers have a better chance of recovery and because more men than women have HPV-related cancer, this may help explain why women have a higher risk of dying of head and neck cancer than men.

What does this mean? It is unclear exactly why women receive less-intensive treatment for head and neck cancer and have a higher risk of dying from the disease, but there is a disparity in treatment that needs more research.share on twitter

“We weren’t looking for gender differences, so the results were really surprising. Besides undertreatment, there are a number of factors that could contribute to the differences in outcomes between women and men with head and neck cancer, and it’s clear we need further investigation. With this mathematical model, we have a tool that can help us identify patients likely to benefit from more intensive treatment, as well as those more likely to die from other non-cancer-related causes. The hope is that by integrating this model into our care, we can improve the care of all patients with head and neck cancer.”

—   lead study author Jed A. Katzel, MD
Kaiser Permanente
Santa Clara, California

Treatment for colorectal cancer costs twice as much for U.S. patients than Canadian neighbors

An analysis of health claims data from 2 regions on either side of the U.S. and Canada border shows that common treatment for advanced colorectal cancer costs twice as much on the U.S. side. Despite the higher cost, the U.S. patients are not living longer than those in Canada.

The study team was made up of both U.S. and Canadian researchers interested in learning more about differences between single-payer insurance health care in Canada and the United States’ private insurance and government-run insurance system. They reviewed data from Canada’s British Columbia and from western Washington state, both of which have a mostly white population, a large Asian minority population, and similar levels of income and education. This study included data from 1,622 people with metastatic colorectal cancer from British Columbia and 575 from western Washington. The Canadian patients were older than those in Washington (median age 66 years vs. 60 years), probably because data on U.S. patients with Medicare were not available for this study. The median is the midpoint, which means that half of the people were on each side of the median.

Both regions also used initial systemic treatments for advanced colorectal cancer that provide the same benefit to people with cancer. People in Canada were most often treated with a chemotherapy combination called FOLFIRI plus a targeted therapy, bevacizumab (Avastin). In the United States, people were most often treated with a chemotherapy combination called FOLFOX.

The researchers found that more U.S. patients received initial systemic treatment (79%) than those in Canada (68%), but this difference may be due to the fact that the U.S. patients were younger. They also found that average treatment costs were higher in western Washington ($12,345) than in British Columbia ($6,195).

However, there were no significant differences in how long people lived between the 2 regions. For those who received systemic treatment, the median survival was 21.4 months in Washington state and 22.1 months in British Columbia. Among those who did not receive systemic treatment, median survival was 5.4 months in western Washington and 6.3 months in British Columbia. More research is needed to find out if there are differences in the patient’s quality of life between the regions.

What does this mean? Even though treatment regimens in western Washington and British Columbia are about equally effective for advanced colorectal cancer, people in the United States pay more for the treatment.share on twitter

“To our knowledge, this is the first study to directly compare treatment cost and use, along with health outcomes in two similar populations treated in different health care models. Understanding these differences may help us improve care and potentially lower health care costs.”

—   lead study author Todd Yezefski, MD
Fred Hutchinson Cancer Research Center
University of Washington School of Medicine
Seattle, Washington

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