Colleen Moretti

Patients with ovarian cancer who were treated at programs who often used neoadjuvant chemotherapy had greater improvements in short-term mortality and similar gains in median overall survival compared with programs who infrequently utilized this chemotherapy approach, according to recent study results.

In particular, neoadjuvant chemotherapy is given to patients to shrink a tumor before undergoing the main cancer treatment, which is often surgery

Dr. Alexander Melamed, lead author of this study and assistant professor of obstetrics and gynecology at Columbia University Medical Center, told CURE® that this study assures patients and providers that neoadjuvant therapy is safe and effective for treatment of advanced ovarian cancer — despite past skepticism.

“The importance of this study is that it may help to resolve sort of a long-standing controversy that has existed in gynecologic oncology,” he said. “Despite the fact that there have been multiple randomized trials that have demonstrated that giving (patients) neoadjuvant chemotherapy before you do their surgery for advanced ovarian cancer is a reasonable approach that probably reduces surgical harm, there have been people who have continued to doubt that conclusion despite their being trials.”

, evaluated overall survival in two groups — 19,562 patients (mean age, 64 years) treated in cancer programs with increased adjuvant chemotherapy use and 19,737 patients treated at programs with marginal use of the strategy. Of note, increases in the use of neoadjuvant chemotherapy at the first group of cancer programs were observed between the years 2004 to 2009 and 2010 to 2015 (21.7% to 42.2%). For cancer programs with infrequent use, utilization of neoadjuvant chemotherapy only marginally increased from 20.1% to 22.5%.

Median overall survival time improved similarly in programs with high and low use of neoadjuvant chemotherapy after 2010. Specifically, standard survival time improved from 31.4 months during the years 2004 to 2009 to 36.8 months during 2010 to 2015 for programs that had a low use. In those same years programs that had a high use improved survival time from 31.6 months to 37.9 months.

Melamed mentioned that although this study does not go directly into details on why the use neoadjuvant therapy resulted in these improvements, he has thoughts on why it might be. Many patients with advanced ovarian cancer often go through surgery which can be harmful, and they may not recover enough to receive chemotherapy, which is “the most important treatment for advanced ovarian cancer,” he explained. However, there was no decrease in long-term survival demonstrated in centers that administered neoadjuvant chemotherapy.

“I think when (providers) use neoadjuvant chemotherapy more, you help patients that are going to get potentially very hurt by primary cytoreductive surgery, and you don’t harm the patients that would have done well with it anyway,” he said.

Additionally, there were reductions in early mortality in programs with high use of neoadjuvant chemotherapy. For programs with high use of the strategy, standard six-month mortality rate declined from 16.4% to 12%. In low-use programs, this declined from 16.1% to 14.4%. Researchers found a similar trend found in one-year morality rate, which declined from 25.6% to 19.3% in high-use programs, and from 24.9% to 21.8% in low-use programs.

“I think the significance of this study is that despite the concerns of some skeptics, this study can really reassure both patients and providers that neoadjuvant chemotherapy is an appropriate upfront treatment strategy for patients with advanced ovarian cancer,” Melamed concluded.

 article was originally published on Cure®. 

Articles

Treatment programs that often use neoadjuvant chemotherapy as a strategy may help prolong survival in patients with advanced ovarian cancer compared with those that infrequently used the tactic, which may reassure patients and providers.

Frequent use of neoadjuvant chemotherapy may further benefit patients with advanced ovarian cancer

There are many treatment options for patients with breast cancer, and it is important stay informed to understand all of the options and their benefits and side effects, according to an expert.

Dr. Ana Botero, a radiation oncologist at the Miami Cancer Institute at Baptist Hospital, presented on radiation therapy for early-stage breast cancer at CURE®’s Educated Patient® Breast Cancer Summit and emphasizes the importance of staying informed and educated on treatment options.

In an interview with CURE®, she explained that radiation therapy is done using a large machine that emits energy, or what Botero called protons and photons, to locally prevent the tumor from coming back. This may also extend survival for patients.

“It’s not only decreasing (the) potential for a local recurrence by maybe 60%, but (it) translates into survival regardless if it’s an early stage or if it’s advanced stage,” she said.

Botero compared administering radiation therapy to patients with prescribing antibiotics. Prior to treatment, there will be scans and appointments to understand which organs need to be protected from further cancer spread. This also helps the radiologist to target those at-risk spots, she explained.

She added that the process of receiving radiation treatment is very fast, takes about 10 to 15 minutes, whereas the treatment itself takes three or four minutes.

More than 95% of patients who had a lumpectomy will undergo radiation therapy as part of their treatment, Botero said, as well as patients who has three or more positive lymph nodes and positive surgical margins. Only a few patients would not be recommended for radiation therapy, including older patients aged 70 to 75 years, , those with small tumors or patients without very aggressive disease.

However, she said, “That is just a rule of thumb.” Deciding if a patient is eligible for radiation therapy is not as “black and white.” For patients who might not meet the recommended criteria for radiation, it may still provide a benefit, although at an estimated 10% to 15%, Botero said.

“It will be an open discussion (of) benefits versus side effects with the patient, especially in young females that have another 30 years to live,” she added. “Many patients opt to have the radiation therapy again because the radiation technology has made a big difference on these patients having basically minimal or no side effects, so that 10% to 15% is in their benefit.”

Side effects of radiation therapy include fatigue and redness of the skin, which may be alleviated with creams and other skincare products, Botero said. She added that there is also a risk of 

, which is the swelling of the arm on the side surgery was performed, but there are ways to help ease that burden and prevent it from happening.

Botero said patients don’t decide upon a treatment on their own; they often go to their physician, listen to their recommendations and base their decision on that information. Although this is a good process, Botero explained that it is important for patients to stay informed and educated about all treatment options. She said if a patient is more informed on treatment options, they can ask more adequate and proper questions to help make a more informed decision.

“I think that knowledge basically enables (a patient) not only to choose (a treatment) but also not to be afraid of the treatment and the potential side effects,” she said. “I think that is very important for the patient as well as for the physician (because) if the patient has a certain level of knowledge, then (a physician) can discuss a little bit more (of the) details that are important for treatment.”

This article was originally published on Cure®. 

Being informed and educated may help patients with breast cancer make a treatment decision and feel less afraid.

Understanding radiation therapy as a patient with breast cancer

Minority and medically underserved breast cancer survivors experienced significant health benefits after participating in a community-based physical activity program, according to recently published study results.

The data — which were published in the journal 

 — demonstrated that participation in a 12-week program that was tailored to individuals in a community setting improved several mental and physical health outcomes among a diverse group of breast cancer survivors.

The program, known as Active Living After Cancer, consists of 12 weekly group sessions which provides survivors with training in cognitive and behavioral skills for behavior change, brief physical activity, and cancer survivorship-related content.

This particular program was adapted from an evidence-based plan and tailored to individuals who are of minority race or more prone to being medically underserved.

Karen Basen-Engquist, a co-author on this study and a director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center in Houston, explained in an interview with CURE® that not all cancer survivors have the adequate means to access fitness resources, such as a gym or personal trainer. As a result, this program was developed and offered to participants for free. The program was also offered in Spanish as there aren’t many programs that have that benefit, she said.

This study included 127 breast cancer survivors. Participants completed assessments of their physical activity, quality of life and physical functioning (six-minute walk distance and 30-second sit-to-stand test) at the start of the trial and at a 12-week follow-up.

Physical activity significantly improved from 17.8 minutes per week at the start of the trial to 344.6 minutes per week at follow up. Basen-Engquist explained that this was an important improvement not just for the management of symptom, but also because there is additional research that those who are physically active are less likely to die of cancer.

Debbie Mendoza, who was diagnosed with metastatic breast cancer in February 2019, completed her treatment in March 2020 and was left without any energy. She participated in the Active Living After Cancer program and noted that she benefitted from it. Before the program started, she said she could only walk up her street and back — now she is walking a mile and a half or 30 minutes with her dog every day.

“For me, I got lots of confidence, I feel much stronger now,” Mendoza said in an interview.

The study results also demonstrated that distance in the six-minute walk and the sit-to-stand test improved significantly from the start of the trial to follow up.

Of note, cancer survivors often go through an accelerated aging process, Basen-Engquist explained, meaning they tend to physically and mentally age more after a cancer diagnosis. The improvements in six-minute walk and sit-to-stand test are important, according to Basen-Engquist, because that activity can reverse the aging process and allow survivors to return to performing daily tasks.

“If we can help improve people’s performance on tests like these, this indicates that maybe we’re starting to arrest that accelerated aging and reverse it,” she said.

There were also statistically significant improvements in physical and 

 from the start of the trial to follow up. Mendoza said she physically feels “so much better now.” And mentally, her quality of life improved as well.

Mendoza was just finishing her treatment when the COVID-19 pandemic was beginning. Because she was immune compromised, she could not see many people. However, she noted that the program gave her a sense of community. She said it was good to talk to people online who were going through the same journey.

“We were really happy to see that when it’s done in kind of a real-world setting, that we still see that the program is effective,” Basen-Engquist added.

Basen-Engquist also highlighted that physical activity may be beneficial for all breast cancer survivors, regardless of race, because it has been shown to reduce the risk of a chronic disease associated with a cancer diagnosis. She explained that breast cancer survivors, diagnosed with stage 1 to 3 disease, are more likely to 

, rather than their cancer, and physical activity may help reduce this risk. Additionally, those survivors who are physically active might be less likely to have a cancer recurrence, she said.

“In addition to potentially affecting the cancer-related outcomes, we’re also having a positive influence on other chronic diseases,” Basen-Engquist noted.

Recommendations for Breast Cancer Survivors

After the 12-week program ended, 83% of participants implemented two or more behavioral changes they had learned during the program into their life. Almost all the participants (98%) were satisfied with the program and would recommend it to another cancer survivor. Moreover, most participants reported that the program helped them become more physically active (97%) and feel better physically (92%) and emotionally (83%).

Mendoza is one of the many participants who implemented these changes after the study ended, and physical activity is now a part of her daily routine. Before the program started, she didn’t believe that exercising would give her more energy, because she didn’t have energy to exercise in the first place. When the study had finished, she said she was doing a form of physical activity about four times a week, which has now increased to every day.

Basen-Engquist recommended that breast cancer survivors who want to become more active to talk to their oncologist and see what resources are available to them. A great place to start, she noted, is to walk, and then incorporate longer walks or brisk walks for 10 minutes at a moderate pace.

Medically underserved and minority breast cancer survivors experienced improved outcomes and quality of life after participating in community-based physical activity programs, according to recent study results.

Colleen Moretti

Articles

Frequent use of neoadjuvant chemotherapy may further benefit patients with advanced ovarian cancer

Understanding radiation therapy as a patient with breast cancer

Community-based activity programs benefit underserved breast cancer survivors