Understanding What An End-Of-Life Cancer Prognosis Means

All cancer patients, for better or worse, are confronted with a prognosis from their doctors. A prognosis serves as a prediction of how the illness is expected to progress over time. It may also include how different treatment methods may affect survival. For those that are confronted with a fatal type of cancer, an end-of-life prognosis also estimates how long a patient can expect to survive.

However, just because a doctor suggests a survival time of 6 months, 1 year or whatever, that does not mean patients necessarily need to start counting down the days. Though an end-of-life prognosis can provide a good estimate of survival time, it is important to understand the data and downfalls associated with where these numbers come from.

A prognosis is based on how a patient’s particular type of cancer has advanced in past patients. Since 1973, the National Cancer Registry has painstakingly tracked survival statistics and treatment effectiveness for all types of cancers. From this vast mountain of data, means and averages for survival can be culled.

While data collection and number crunching are both extensive, the process is not without its flaws. For example, many prognoses are based purely on a single variable, most likely the stage of cancer progression. However, there are multiple variables that can affect survival time, including histology of the tumor, how early the cancer was detected, attempted treatments and age/general health of the patient. These facts are sometimes not taken into account when collecting data.

With this in mind, cancer patients are encouraged to ask doctors what factors were considered when determining their prognoses. Even when patients are further broken down into smaller subgroups, patients need to be aware of what exactly a prognosis means.

Most doctors hand down a prognosis that aligns with the median survival time of past cases of the patient’s particular cancer. Therefore, if a median survival time for a type of cancer is 1 year, that means half of all patients survived less than 1 year. In contrast, half of all patients also survived longer than 1 year. In some cases, patients survive significantly longer than the median average.

Another issue at hand is a doctor’s general inclination to not want to be overly optimistic about survival. This may lead him or her to offer conservative estimates in relation to an end-of-life prognosis. To counter this, patients may wish to talk to their oncologists about the probabilities of survival over different ranges of times.



Direct Chemo Delivery Shows Signs of Prolonging Patient Survival

Malignant gliomas are an especially difficult type of cancer to treat. Manifesting in the brain or spine, patients diagnosed with this deadly form of cancer have only a 3 percent likelihood of surviving five years or more. Now, a new method for delivering chemotherapy drugs is showing early signs of prolonging survival times among patients with malignant glioma.This new delivery process, called convection enhanced delivery, uses two catheters that are stereotactically placed in the tumor tissue to directly deliver Topotecan to the cancerous area.

Of the 16 patients who received the Phase 1 trial treatment, the median survival was 59 weeks. Furthermore, the median time to tumor progression was recorded at 20 weeks, and more than three-fourths of all patients survived for at least 6 months. These figures were statistically much better than those found in present treatment processes.

The direct chemotherapy process was formulated to overcome a poor penetration rate of intravenous and oral cancer drugs related to brain tumors. Due to a blood-brain barrier, the majority of drugs in the bloodstream never enter the brain. Additionally, surgery is not typically an effective treatment method because gliomas tend to grow tentacles that make them very difficult to remove completely.

Topotecan, a chemo drug currently used for lung cancer and sold by GlaxoSmithKline, was chosen for the trial because it has been shown to be effective in killing malignant glioma cells. However, the amount of Topotecan required in standard treatment procedures to adequately penetrate the brain was deemed too toxic for normal cells.

Though the new treatment has achieved early success, additional studies are required. Phase 2 clinical trials will begin in the coming months. Side effects presently linked to the new treatment include weakness in the upper extremities and neurological issues that occur due to brain damage.




Opioid Pain Reliever Approved for Breakthrough Pain in Cancer Patients

 Pain is an infamously difficult cancer symptom to treat. Even when potent pain relievers are used, waves of pain often flare up and break through the effects of the medication. This type of pain is known as breakthrough pain.

Now, doctors and patients have a new tool to help combat breakthrough pain. Recently, the U.S. Food and Drug Administration (FDA) approved a drug specifically designed to minimize breakthrough pain. This new drug, called Onsolis, is a potent medication that is part of a class of drugs known as opioid fentanyls. Onsolis is meant to be used in conjunction with other opioid medicines.

Onsolis is not a traditional prescription pill. Rather, it is administered through an absorbable film that is placed inside the mouth. Onsolis sticks to the side of the cheek, and the opioids transfer into the bloodstream from there.

Because of the high potency of Onsolis, the drug is only intended for cancer patients who are “opioid tolerant.” This typically means that tolerance to opioid drugs is reduced due to round the clock use of pain relievers.

The potential for misuse and abuse places additional caveats on Onsolis prescription approval. For example, the patient’s age must be 18 years or older. Additionally, Onsolis was only allowed approval with the inclusion of a Risk Evaluation and Mitigation Strategy (REMS). An REMS requires a drug to have heightened plan of action that reduces risks associated with the drug.

In the case of Onsolis, the REMS calls for restricted distribution through the FOCUS program. This means that only patients, pharmacies and prescribers who are registered with the program will be granted access to the drug.

The heightened measures of approval are intended to reduce the potential for drug abuse. The Onsolis box also includes a warning that states the drug should not be used for the management of traditional pain, or by patients that use opioids intermittently. For those that are not opioid tolerant, Onsolis has the potential to lead to overdose and death.

Esophageal Stents As a Palliative Care Measure for Mesothelioma

Mesothelioma, a cancer that invades the wall lining of the lungs and other internal organs, is a particularly difficult type of cancer to treat. Almost universally related to the inhalation of asbestos particles, treatment of advanced stages of the disease is largely palliative. Palliative health care refers to the focus of relieving symptoms and pain as opposed to taking steps to eliminate the illness.

In many advanced cases of mesothelioma, patients experience a difficulty swallowing. The medical term for such a symptom is dysphagia. As the mesothelioma tumor spreads from the lungs to the esophagus, the tumor can reduce the diameter of the air pathway. In some cases, this reduced ability to breath and swallow is the direct cause of death.

In an effort to assuage dysphagia, prolong survival and reduce discomfort, a recent study performed at the Department of Cardiothoracic Surgery in Derriford Hospital points to esophageal stents as a potential treatment.

A case report published in the January 25, 2008 Journal of Cardiothoracic Surgery details the success of self-expanding esophageal stents on patience with mesothelioma. In the three patient cases discussed in the report, all three patients achieved immediate satisfactory reduction in dysphagia. However, progressive dysphagia resurfaced 1 to 6 months later. In such cases further stenting is required to open up a larger portion of the esophagus.

As dysphagia is usually an end-case symptom, patients are not expected to survive a considerable length of time as a result of the stents. However, the primary goal of the procedure is to relieve pain and improve quality of life for the patient.



New Cancer Initiative Set for Launch

Stand Up to Cancer, a charity that will provide funding for cancer research is set to launch this summer through a collaboration with major television networks, entertainers and prominent cancer researchers.

The initiative will support cancer research by providing money for cancer studies including high-risk high-impact research proposals often not supported by conventional funding sources. Research projects will be proposed to the American Association for Cancer Research which will review and administer funding for studies with the guidance of the Scientific Advisory Committee. In addition the charity will form an advisory council composed of leaders from 25 cancer related organizations.

On average cancer claims one life every minute in the United States and cancer killed more than 7.5 million people in 2005. However, continued progress in cancer treatments and therapies have saved or extended countless lives with 10 million cancer survivors currently in the United States.

The charity will air a special 1-hour fundraiser on ABC, CBS and NBC on September 5, 2008 at 8pm EDT and PDT. For more information visit their website Stand Up to Cancer

Exercise beneficial for cancer patients, study concludes

British researchers conducted a literature review and meta-analysis of medical studies and found that physical exercise can help improve quality of life during treatment and afterwards. One big complaint of most cancer patients is fatigue. The researchers found “statistically significant improvements in fatigue were identified following an exercise programme.” Story here.

Study: Disappointing Results for Mesothelioma and Chemotherapy

A study in the newest issue of The Lancet concluded that adding chemotherapy to other treatments given to mesothelioma patients does not appear to affect survival or quality of life.

Patients suffering from malignant pleural mesothelioma were separated into three groups. The first was given a weekly injection of vinorelbine while the second was a given four cycles of mitomycin, vinblastine and cisplatin every three weeks. The treatments were administered in addition to active symptom control treatments which include steroids, painkillers and palliative treatments. The final group only received symptom treatment with no chemotherapy.

The study found that there was a slight but insignificant difference between 1-year survival rates. Patients receiving chemotherapy had a 32 percent rate compared to 29 percent for those only receiving symptom treatment.

Patients in the group that received vinorelbine had a 37 percent 1-year survival rate and researchers concluded it deserves further investigation. However the survival difference was not statistically significant and the authors concluded that the addition of chemotherapy to treatment regimens offered no major benefits.

In addition, quality of life scores among the three groups did not show any major differences.

Video on cancer development

Jaqueline Lees, a cancer researcher, is in an online video on cancer. It’s quite good, and she is better than most scientists when it comes to talking to the public about technical issues. She explains the development of tumors through several stages, which can potentially take years. This makes sense to anyone who follows mesothelioma and knows of its long latency period.

Cancer is essentially a genetic disease, she says, and she talks about the two types of geners that can allow cancers to form: ongogenes and tumor suppressor genes.

Dietary Supplements

The University of Pennsylvania’s Oncolink website had an article by Carolyn Vachan on dietary supplements, which is often a sore spot with doctors and medical researchers even as they are very popular with the general public. Supplements (vitamins, minerals, etc.) make up a $23 billion industry in the United States, and they are largely unregulated. The FDA recently introduced new regulations which will be phased in to mid 2010. Vachan recommends patients tell their healthcare teams about supplements they use, if only because some supplements could interfere with cancer treatment. More on nutrition for cancer patients.