Cancer patients who are older than 65 years have poorer physical health and, in some cases, mental health when compared with people of the same age group without cancer, according to a study in the June 9 online issue of the Journal of the National Cancer Institute.

Because health-related quality of life (HRQOL) before cancer is not often measured, the impact of cancer on HRQOL is poorly understood.

To quantify the changes before and up to 2 years after cancer diagnosis, Bryce B. Reeve, of the Division of Cancer Control and Population Sciences at the National Cancer Institute in Bethesda, Md., and colleagues looked at changes in HRQOL from 1998 through 2003 in 1,432 patients aged 65 years or older. They compared the patients who were enrolled in Medicare managed care plans with 7,160 matched control subjects, by using data from the Surveillance, Epidemiology, and End Results registry linked with Medicare Health Outcomes Survey (MHOS).

For patients diagnosed with prostate, breast, bladder, colorectal, kidney, or non-small cell lung cancers, or non-Hodgkin lymphoma, the researchers observed a statistically significantly greater decline in physical health of patients compared with control subjects without cancer. They also found that patients with prostate, colorectal, or non-small cell lung cancer experienced statistically significantly decreased mental health relative to matched control subjects without cancer.

“We expect this study to provide a benchmark for capturing the burden of cancer on HRQOL and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects,” the authors write.

In another study, also published in this issue, John L. Gore, of the Robert Wood Johnson Clinical Scholars Program at the University of California, Los Angeles, and colleagues describe HRQOL outcomes among patients 48 months after treatment for localized prostate cancer. This team, which used questionnaires that measure generic physical and mental health, as well as dysfunction specific to prostate cancer treatment, found that urinary incontinence was more common after prostatectomy than after brachytherapy or external beam radiation therapy and that sexual dysfunction “profoundly” affected all treatment groups.

“These results may guide decision making for treatment selection and clinical management of patients with health-related quality-of-life impairments after treatment for localized prostate cancer,” the authors write.

In an accompanying editorial, Pamela J. Goodwin, M.D., and Srikala S. Sridhar, M.D., of the Princess Margaret Hospital and the Samuel Lunenfield Research Institute at Mount Sinai Hospital in Toronto reiterate the importance of the studies, but point out several limitations to both.

They point out that Reeve et al. left out younger age groups, had a short study period, and produced findings not sufficiently linked to specific cancer treatments to assist patients with making decisions about treatment. Gore et al., according to the editorialists, did not address multimodality treatment and the impact of this combined approach–a growing trend for patients with aggressive disease.

“These two reports have added to our knowledge about quality of life in cancer patients,” the editorialists write. “However, further research is needed to better understand the short and longer term impact of cancer diagnosis and treatment on overall quality of life, especially as screening becomes more common, our anticancer treatments improve, and patients live longer after a diagnosis of cancer.”

Citations:

Article 1:
“Impact of Cancer on Health-Related Quality of Life of Older Americans.”
Reeve et al.
J Natl Cancer Inst 2009, 101: 860-868.

Article 2:
“Survivorship Beyond Convalescence: 48-Month Quality-of-Life Outcomes After Treatment for Localized Prostate Cancer.”
Gore et al.
J Natl Cancer Inst 2009, 101: 888-892.

Editorial:
“Health-Related Quality of Life in Cancer Patients - More Answers but Many Questions Remain.”
Goodwin P and Srikala Sridhar.
J Natl Cancer Inst 2009, 101: 838-839.

Source
Journal of the National Cancer Institute

The Sarah Cannon Cancer Center (SCCC) at Centennial Medical Center last week began treating patients with a new non-invasive weapon in the battle against cancer. The Sarah Cannon Cancer Center is the first and only cancer center in Middle Tennessee to offer image-guided robotic stereotactic radiosurgery.

“The Sarah Cannon Cancer Center is proud to continue delivering on its promise to provide the highest quality, most advanced cancer treatment options in our region with the addition of the CyberKnife(R) stereotactic radiosurgery system,” said Rocky Billups, administrator for The Sarah Cannon Cancer Center Network. “With this new image-guided robotic technology, we are giving new hope to those whose tumors were previously thought to be inoperable and untreatable.”

According to Billups, The Sarah Cannon Cancer Center now has the ability to treat tumors anywhere in the body, even the brain, spine, lung, liver, pancreas and prostate, with such accuracy that there is little or no damage to surrounding tissue.

The new robotic radiosurgery technology is so sophisticated that it adjusts with every breath patients take. The robotic system tracks the tumor’s position, detects any movement of the tumor or the patient, and automatically corrects radiation delivery. It then targets the tumor with multiple pin-point beams of high-energy radiation, destroying abnormal tissue.

“If you’ve ever seen a snake charmer keep a cobra focused on his hand, you have an idea of what the robotic arm looks like during treatment,” said James Gray, M.D., a radiation oncologist at The Sarah Cannon Cancer Center trained in the technology. “This remarkable tracking system even detects abrupt chest motion, such as a cough or sneeze, shutting off the beam until the respiratory cycle resumes its normal motion and the tumor can be confidently tracked again. This heightened accuracy and targeting confidence allows for safer, yet more intensive, radiation delivery.”

Therapy can be directed at any part of the body, from any direction, with the help of a robotic arm. Treatment is pain-free and, unlike other forms of radiation therapy, can be completed within one to five days. Treatments are performed on an outpatient basis with no recovery time, allowing patients to return to normal activities immediately.

The total investment for the robotic radiosurgery system and construction of a dedicated CyberKnife(R) suite in The Sarah Cannon Cancer Center was approximately $5.7 million. Last year, Centennial Medical Center announced a $143 million campus expansion project that includes a dedicated cancer center. The cancer center will integrate inpatient nursing units, radiation oncology, operating rooms, a new comprehensive cancer imaging center, outpatient services and laboratory services.

According to Ed Hunt, M.D., who is also trained on the robotic radiosurgery technology, CyberKnife(R) - unlike other radiosurgery options such as Gamma Knife - does not require invasive head or body frames. He also said the newer treatment is ideal for treating both cancerous and benign tumors that are medically inoperable or surgically complex.

According to a recent report published by the Journal of Clinical Oncology, by 2030, Americans age 65 and older will account for 70% of all cancer diagnoses — up from about 61% of current cases. The cancer sites with the highest percentage of increase between 2010 and 2030 are expected to be those that are often more complex to treat: stomach (67%), liver (59%), myeloma (57%), prostate (55%), pancreas (55%), bladder (54%), lung (52%), and colorectum (52%).

The Sarah Cannon Cancer Center in Nashville is one of 10 HCA hospitals to offer the new CyberKnife(R) technology and one of only 107 facilities nationwide.

The Sarah Cannon Cancer Center Network–accredited by The Cancer Commission of the American College of Surgeons with commendations for providing superior cancer care–is second to none in the Southeast for the diagnosis and treatment of cancer. With eight affiliated medical facilities, The Sarah Cannon Cancer Center Network has grown to become the largest community-based, privately-funded diagnostic and treatment center in the country. Through its investment in advanced technologies and a network of hundreds of cancer experts and researchers, more patients are benefiting from life-saving cancer diagnosis, treatment and access to clinical trials.

Source: HCA

A new study suggests that delivering small RNAs, known as microRNAs, to cancer cells could help to stop the disease in its tracks. microRNAs control gene expression and are commonly lost in cancerous tumors. Researchers have shown that replacement of a single microRNA in mice with an extremely aggressive form of liver cancer can be enough to halt their disease, according to a report in the June 12 issue of the journal Cell, a Cell Press publication.

They delivered the microRNA to the mice using a virus that has been applied in other forms of gene therapy. That so-called adeno-associated virus (AAV) is particularly good at targeting new genetic material to the liver.

“Mice given the control virus showed no change in the growth rate of their tumors and within three weeks, the cancer had taken over,” said Joshua Mendell of Johns Hopkins University School of Medicine. “When we gave them the microRNA-carrying virus, some animals showed essentially complete regression of their tumors.” In other cases, he said, the tumors were much smaller and far fewer.

Mendell said his team, which included his father Jerry Mendell at The Research Institute at Nationwide Children’s Hospital, was hopeful the strategy would work based on previous evidence. Nonetheless, he added, “it is always surprising to see results this striking.”

They were also amazed by how specifically the microRNA affected cancer cells, while leaving normal cells unscathed. “We found that the tumor cells are exquisitely sensitive [to microRNA replacement]–they not only stopped proliferating, but they actually died,” he said. Meanwhile, the mice showed no evidence of any damage to their normal liver tissue.

MicroRNAs are important regulators of gene activity, the researchers explained, and a single microRNA can have far-reaching effects. That’s because an individual microRNA can influence hundreds of gene transcripts to coordinate complex programs of gene expression and affect global changes in the physiology of a cell. A growing body of evidence shows that microRNAs are essential for normal development and to keep cells in balance. By the same token, when microRNAs get out of whack, they can lead to disease.

In the last five years, researchers have discovered a particularly important role for microRNAs in cancer. “Virtually all examined tumor types are characterized by globally abnormal microRNA expression patterns,” Mendell said. Some microRNAs lead to cancer when they reach levels that are higher than normal. But in most instances, microRNA levels are found to decline in cancerous tumors compared to normal tissue.

Earlier studies have begun to suggest that methods to replace those lost microRNAs might hold particular promise for therapy. For one thing, reducing the level of microRNAs can actually drive the transformation of normal cells into cancerous ones. And, in the case of lymphoma, Mendell’s group showed that a single microRNA could suppress the growth of cancer cells.

The new study is the first to show that the strategy might work in a living animal.

First, they showed that primary liver cancers, known as hepatocellular carcinomas (HCC), have a dramatic reduction in a specific microRNA designated as miR-26a. miR-26a is found at high levels in many tissues throughout the body. When they introduced the microRNA back into cancer cells, those cells stopped progressing through the cell cycle. Likewise, mice with the liver cancer that were given the virus-delivered microRNA therapy were protected from the disease as their cancer cells stopped proliferating and underwent a programmed cell death.

There is a dire need for new strategies to combat HCC, which the researchers said is the third leading cause of cancer deaths and the fifth most common malignancy worldwide. HCC is often diagnosed at an advanced and incurable stage. Even when it is caught earlier, other characteristics of the disease tend to make it a challenge to treat with currently available drugs.

The promising strategy for HCC is also likely to work in other cancers as well. The researchers chose mice with liver cancer as a test bed in part because the liver is readily targeted by AAV, but they said that they don’t think there is anything special about liver cancer that makes it more sensitive to microRNA replacement therapy.

The barrier to applying this strategy to other tissues will rather be getting the microRNA into cancer cells, Mendell said. However, he noted, there are ways to deliver microRNA to other tissues using AAV and scientists are working on other vehicles for delivery — synthetic nanoparticles, for instance — that may just fit the bill.

The researchers include Janaiah Kota, The Research Institute at Nationwide Children’s Hospital, Columbus, OH; Raghu R. Chivukula, Johns Hopkins University School of Medicine, Baltimore, MD; Kathryn A. O’Donnell, Johns Hopkins University School of Medicine, Baltimore, MD; Erik A. Wentzel, Johns Hopkins University School of Medicine, Baltimore, MD; Chrystal L. Montgomery, The Research Institute at Nationwide Children’s Hospital, Columbus, OH; Hun-Way Hwang, Johns Hopkins University School of Medicine, Baltimore, MD; Tsung-Cheng Chang, Johns Hopkins University School of Medicine, Baltimore, MD; Perumal Vivekanandan, Johns Hopkins University School of Medicine, Baltimore, MD; Michael Torbenson, Johns Hopkins University School of Medicine, Baltimore, MD; K. Reed Clark, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, The Ohio State University, Columbus, OH; Jerry R. Mendell, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, The Ohio State University, Columbus, OH; and Joshua T. Mendell, Johns Hopkins University School of Medicine, Baltimore, MD.

Source:
Cathleen Genova

Cell Press