A Different Chemotherapy Approach for Ovarian Cancer

OVARIAN CANCER that spreads to the lining of the abdominal cavity, called the peritoneum, is difficult to treat. Patients with this advanced cancer typically undergo debulking, also called cytoreductive surgery, a lengthy procedure in which surgeons aim to remove all cancer from the abdominal cavity and affected organs, including the ovaries and fallopian tubes as well as the bladder, colon and other parts of the gastrointestinal tract. In recent years, researchers have looked at the efficacy of using hyperthermic intraperitoneal chemotherapy (HIPEC), which is heated chemotherapy delivered directly to the peritoneum, to destroy remaining cancer cells immediately after debulking surgery.

Scientists in Belgium and the Netherlands published long-term data from OVHIPEC-1, a randomized phase III trial to evaluate adding HIPEC to interval cytoreductive surgery for ovarian cancer, in the October 2023 Lancet Oncology. (In interval surgery, chemotherapy is given to shrink the cancer prior to surgery.) The study enrolled 245 women with stage III epithelial ovarian cancer whose cancer showed no signs of progression after upfront chemotherapy. Researchers randomly assigned women to have debulking surgery alone, or surgery plus HIPEC using the chemotherapy drug cisplatin. After 10 years, median overall survival for the surgery-plus-HIPEC group was 44.9 months versus 33.3 months for the surgery group. Median progression-free survival was 14.3 months and 10.7 months, respectively. The rates of adverse events were similar—25% with surgery alone versus 27% with surgery plus HIPEC—and the most common events were abdominal pain, infection and slowed bowel function.

These results are in line with the researchers’ five-year analysis, published in the New England Journal of Medicine in 2018. In that analysis, 6.6% of patients in the surgery group had survived without progression at five years, compared with 12.3% in the surgery-plus-HIPEC group. At 10 years, 6.6% of the people who received surgery were alive with no progression versus 10.1% in the surgery-plus-HIPEC group. While surgery plus HIPEC did not result in better cure rates, the authors note that it significantly prolonged the time cancer was controlled. “The most important finding is that the benefit for patients with stage III ovarian carcinoma when interval cytoreductive surgery is combined with HIPEC remains present after a 10-year follow up,” says Willemien van Driel, lead author and a gynecologic oncologist at the Netherlands Cancer Institute in Amsterdam, who notes that patients in both arms of the study received similar treatment after subsequent recurrences.

Van Driel says that there is still variation in the use of HIPEC along with cytoreductive surgery. European guidelines published in October 2023 note that HIPEC with cytoreductive surgery should not be considered a standard of care. In the U.S., National Comprehensive Cancer Network guidelines state that HIPEC can be considered for patients with stage III epithelial ovarian cancer.

Van Driel and her colleagues are now enrolling patients in the OVHIPEC-2 trial, which will study the effect of adding HIPEC in women with stage III ovarian cancer undergoing primary surgery, which is surgery done upfront prior to chemotherapy. Other trials are evaluating HIPEC use for recurrent ovarian cancer. She notes there are several unanswered questions, including optimal dosing and temperature for HIPEC and the impact of including other drugs, such as PARP inhibitors, with this approach, since many of these drugs were not standard of care at the time of the trial.

HIPEC may be a valid choice for patients who are generally healthy and open to a longer procedure and hospital stay. Although the length of surgery plus HIPEC varies, HIPEC generally adds 90 minutes or more to debulking surgery, which itself takes several hours. Also, patients typically require a longer hospital stay for recovery, possibly with intravenous or tube feedings while the digestive system recovers. 

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A Different Chemotherapy Approach for Ovarian Cancer

Stem Cell Therapy: A New Horizon in Breast Cancer Treatment

Breast cancer is one of the most common cancers affecting women worldwide, with millions of new cases diagnosed each year. Despite advances in treatment, it remains a leading cause of cancer-related deaths among women. Traditional treatments such as surgery, chemotherapy, and radiation have improved survival rates, but they often come with significant side effects and may not be effective in all cases, particularly in advanced or metastatic stages of the disease. As the medical community continues to seek more effective and less invasive treatments, stem cell therapy is emerging as a promising frontier in the fight against breast cancer.

Understanding Breast Cancer: A Global Challenge

Breast cancer occurs when cells in the breast tissue grow uncontrollably, forming a tumor that can invade surrounding tissues and spread to other parts of the body. The causes of breast cancer are multifactorial, involving genetic, environmental, and lifestyle factors. Early detection through screening programs like mammography has significantly improved outcomes, but the need for more effective treatments remains critical, especially for patients with aggressive or resistant forms of the disease.

Traditional treatments, while often life-saving, can have significant drawbacks. Surgery can be disfiguring and may not completely eliminate the risk of recurrence. Chemotherapy and radiation, although effective at killing cancer cells, also damage healthy cells, leading to side effects like fatigue, hair loss, and compromised immune function. Moreover, some breast cancers do not respond well to these treatments, particularly triple-negative breast cancer, which lacks the hormone receptors targeted by many therapies.

This is where stem cell therapy comes into play—a novel approach that has the potential to revolutionize breast cancer treatment.

Stem Cell Therapy: A New Horizon in Breast Cancer Treatment

Stem cell therapy has garnered significant attention in recent years as a potential game-changer in cancer treatment. Unlike traditional therapies that target the symptoms or manifestations of the disease, stem cell therapy aims to address the underlying causes by regenerating damaged tissues, boosting the immune system, and even targeting cancer stem cells that are believed to drive tumor growth and recurrence.

1. Understanding Stem Cells:

  • Stem cells are unique in their ability to develop into different types of cells in the body. They have the potential to repair or replace damaged tissues and can be used to regenerate healthy tissue in areas affected by cancer.
  • There are two primary types of stem cells relevant to cancer therapy: embryonic stem cells, which can differentiate into any cell type, and adult stem cells, which are more limited but still hold significant therapeutic potential. In breast cancer, researchers are particularly interested in the role of cancer stem cells— a small subset of cells within tumors that are resistant to conventional treatments and are thought to be responsible for relapse and metastasis.

2. The Role of Stem Cells in Breast Cancer:

  • One of the most promising aspects of stem cell therapy in breast cancer is its potential to target cancer stem cells. These cells are thought to be the root cause of tumor growth and metastasis, and they often evade traditional therapies, leading to recurrence. By specifically targeting and eliminating these cells, stem cell therapy could significantly reduce the risk of relapse and improve long-term outcomes.
  • Additionally, stem cell therapy can be used to regenerate healthy tissue damaged by surgery, chemotherapy, or radiation. For example, adipose-derived stem cells (from fat tissue) are being explored for their ability to repair tissue damage after a mastectomy or lumpectomy, improving cosmetic outcomes and reducing the need for additional surgeries.

3. Current Research and Clinical Trials:

  • While stem cell therapy for breast cancer is still in its early stages, there have been promising developments in both preclinical and clinical research. Clinical trials are currently underway to evaluate the safety and efficacy of various stem cell-based therapies for breast cancer.
  • One area of focus is the use of mesenchymal stem cells (MSCs), which have shown potential in targeting breast cancer cells and enhancing the effects of chemotherapy. These stem cells can be engineered to deliver anti-cancer drugs directly to tumors, increasing the precision and effectiveness of treatment while minimizing side effects.
  • Another exciting avenue is the use of stem cells in combination with immunotherapy. By enhancing the body’s immune response to cancer, stem cells could help to overcome the immune evasion tactics used by tumors, making immunotherapy more effective.

4. Challenges and Future Directions:

  • Despite the promise of stem cell therapy, there are still significant challenges to overcome. Ensuring the safety of these therapies is paramount, as there is a risk that stem cells could promote tumor growth if not properly controlled. Moreover, the complex nature of cancer stem cells means that therapies must be precisely targeted to avoid unintended consequences.
  • The future of stem cell therapy in breast cancer will likely involve a combination of approaches, integrating stem cells with existing treatments such as chemotherapy, radiation, and immunotherapy. As our understanding of cancer biology continues to grow, so too will the potential of stem cell therapy to provide more effective and less toxic treatment options for breast cancer patients.

    Conclusion: A Promising Future Ahead

    The fight against breast cancer is far from over, but the advent of stem cell therapy offers a new ray of hope. As research continues to advance, this innovative approach could become a cornerstone of breast cancer treatment, offering patients more effective, personalized, and less invasive options. While challenges remain, the potential of stem cell therapy to transform breast cancer care is undeniable, and the ongoing research in this field is something that the medical community and patients alike should watch closely.

    As we move forward, it is essential to continue supporting research and clinical trials that explore the full potential of stem cell therapy in breast cancer. With continued innovation and collaboration, we may one day see a world where breast cancer is not only treatable but curable—thanks in part to the incredible power of stem cells.

    Find more : https://www.linkedin.com/company/medipocketusa/posts/?feedView=all

How to Find the Right Oncologist for You

After a cancer diagnosis, it’s one of the most important decisions you’ll make.

After a career as a golf professional in southeastern New Mexico, Doug Lyle, 76, decided he had somewhere better to be than on the course: spending time with his new grandchild. Then this summer, just as he was settling into retirement, he learned he had prostate cancer.

“When you’re first diagnosed, you immediately go to the internet, and you can be overwhelmed in short order,” he said. “The more you read about it, the more complicated it gets.”

One of the first and most important choices he had to make was who his oncologist would be. Many of the two million patients diagnosed with cancer in the United States each year get the news from a primary care doctor. Those patients might accept a referral to an oncologist without question. But research suggests that it’s worth considering the choice closely: It can shape the care you receive, your satisfaction with the treatment and your chances of survival.

Not everyone has a choice of oncologists. There are fewer providers in rural areas, and patients must travel farther to reach them. Insurers may only cover certain clinicians and hospitals. And patients from certain populations have less access to oncologists for a range of reasons, which may affect the care they receive. For example, research suggests that Black and Hispanic women with breast cancer are more likely than white women to experience delays in starting radiotherapy. And Black men with prostate cancer are less likely than white men to receive treatment that’s intended to cure their condition, even when they’re at similar stages of disease.

No matter your circumstances, you should feel empowered to have a say in who treats your cancer.

Ideally, experts said, you’d be able to easily compare doctors’ levels of experience and the outcomes of patients they’ve treated with your same diagnosis. But such apples-to-apples comparisons are not always easy to make. But “right now, there are no publicly available data to help a patient with cancer say, ‘Oh, this is where I want to go,’” said Dr. Nancy Keating, a physician and professor of health care policy and medicine at Harvard Medical School. (And even if there were, apples-to-apples comparisons are not always easy to make, since patient populations vary from one doctor to the next).

Still, there are some accreditations to look for. The National Cancer Institute has given a special designation to 72 cancer centers, which must show they treat patients in accordance with the latest evidence and also conduct research into new therapies. The American College of Surgeons Commission on Cancer has accredited over 1,500 programs that meet certain standards. And the American Society of Clinical Oncology has several certification programs, including a list of 300 practices recognized for their quality and safety.

There are resources to help you search for oncologists, too, including a U.S. News & World Report directory that lets you sort by location, patient reviews and accepted forms of insurance. The consumer research firm Castle Connolly also has a database of doctors who are nominated by their peers and then evaluated for their qualifications, interpersonal skills and more.

Look for an oncologist who frequently treats patients with diagnoses similar to yours. Research has long shown that when doctors perform certain procedures more often, their patients have better outcomes. One study found that patients of surgeons who removed more than 25 lung cancers a year spent less time in the hospital, had a lower risk of infection and were more likely to survive three years without recurrence of disease.

Dr. Timothy Pawlik, the chair of the surgery department at Ohio State University Wexner Medical Center, said he only treats a handful of cancers. “You want someone with depth, not breadth,” Dr. Pawlik said. That way, he explained, “the patient may have a rare cancer, but it’s not rare to that doctor.”

Additionally, everyone else on the care team including the anesthesiologists and nurses, will also be familiar with your particular cancer and treatment.

Your primary care provider may be able to find someone specializing in your diagnosis. Some physicians’ websites will identify sub-specialties, and you can also ask for guidance from patient advocacy groups focused on your type of cancer. When you reach out to a doctor, don’t be shy about asking how many patients with similar cancers they treat per year.

Mr. Lyle hesitated to get a second opinion for fear of offending the first doctor he’d seen. But he ultimately chose to do so, a step many experts recommend. “Medicine is an art, and there are sometimes differences of opinion,” said Karen Knudsen, the chief executive of the American Cancer Society. Weighing those differences can help you make a more informed choice.

If a second physician agrees with your original treatment plan, it can give you more confidence in the approach. Research suggests a second opinion can also lead to clinically meaningful changes in treatment. One 2023 study of 120 cancer patients found that a for a third of patients, a second opinion led to treatment changes that yielded better outcomes. Many had received evidence-based care from their first doctor but decided after a second opinion to scale back treatments that might have been unnecessary and had harmful side effects.

Mr. Lyle said that during his first conversation with a physician, he didn’t know enough to ask the right questions about his diagnosis and newer treatment options. “The fine points, you’re not aware of yet. So you almost need a rehearsal,” he said. (For help with what to ask during an appointment, the National Comprehensive Cancer Network has detailed information about care for many cancers.)

When it is clinically appropriate, some cancer centers now offer second opinions through telehealth. You can call to see if it’s possible to submit your medical records and get a remote consultation.

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CANCER MAY CONTROL YOUR BODY FOR A WHILE, BUT ΝΟΤ YOUR SOUL…

We dreamed it, we organized it and we finally accomplished it!

Kapa3, always thinking and implementing actions whose main priority and beneficiaries are the patients with cancer, overcoming barriers, social, economic, and social and cultural characteristics! Cancer has no gender, no country, no color, no religion!!!

The team of Kapa3 could not ignore the challenges and needs of people who are forced to leave their countries of origin and, having the problems of their disease out of their priorities, put themselves in danger, crossing the borders of our country, hoping for a better and safer future.

Thus, studying the needs of these people, the group of professionals of KAPA3, being active and present in the wider region of Macedonia and Thrace, submitted a proposal for the implementation of actions in these areas, targeting the refugees and migrants of the region.

With great pleasure, we received the response of the King Baudouin Foundation, which recognized in this proposal our vision and approved funding to support and develop the Cancer Patient Guidance Centre-Kapa3, to provide immediate assistance to refugees and migrants crossing the borders of our country.

Together we can achieve the impossible! Looking cancer in the eye and fighting every day together, is a small but important battle for life, against cancer!

More specifically: The development of the existing network, the addition of mental health professionals, and the development of actions and activities in new places, with new partners, will allow us to help much more in the process of better and more complete treatment of the incidents and difficulties we face.

With funding from the King Baudouin Foundation, over the next 6 months, we will strengthen our network of psychologists, sociologists, and social workers, with a focus on the 15-24 age group, to continue providing primary care and support throughout their treatment. Part of the funding will be used to translate the Kapa3 online portal into at least two languages, in addition to English, with Ukrainian being the first, so that our citizen’s accessibility to any portal of the Public Health System is immediate and seamless.

The Organization has a website and an app where it provides general support and information as well as personalized support to each beneficiary. The staffing of the network with permanent personnel will become the basis for the successful targeting, which is, No One Feels Alone! The activation of psychological support for patients, the categorization of patients by age and the activation of actions to solve additional problems related to each of these age groups are some of the actions that we are ready to take to support these vulnerable groups!

We are well aware that the Greek health system and the support of medical care for cancer patients provided mainly in the country’s public hospitals, given high care costs and economic conditions, are not chosen by a significant number of patients, mainly immigrants, and refugees. The fact that Kapa3 operates in the structures and departments of hospitals that exclusively support cancer patients allows us to be able to record cases and extract qualitative and quantitative data and results to improve and create new actions in this direction.

Our vision has inspired and found support beyond borders! Cancer can control the body of patients for a while, but the soul, which strengthens the power in the battle with cancer, cannot be controlled!!!

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Cancer is on the rise in under-50s – a key task is to work out why

Nine in 10 of all cancers affect people over 50 but research shows a worrying rise in early onset cases

There are many upsides to growing old, but one of the downsides, unfortunately, is a higher risk of developing cancer. Increasing age is a key risk factor. And with more of us living longer worldwide, millions of older people will have to contend with the disease

Now a new study adds weight to previous work warning of a grim trend in global health: cancer in people under the age of 50 is becoming more common.

In the study, researchers led by the University of Edinburgh in Scotland and Zhejiang University School of Medicine in Hangzhou, China, found that the number of under-50s being diagnosed with cancer worldwide rose by 79% between 1990 and 2019, from 1.82 million to 3.26 million. Cancer deaths in the same age group grew by 27%, and more than 1 million under-50s a year are now dying of cancer, the research published in BMJ Oncology reveals

The study is not the first to show the trend. A review in 2022 of cancer registry records from 44 countries found that the incidence of early onset cancer was rising rapidly for 14 types of cancers, and this increase was happening across many middle- and high-income nations.

The new research adds meat to the bone. Examining data from 204 countries, it found a striking increase in the global incidence of early onset cancers. It also showed the highest incidence rates of cancer in the under-50s was in North America, Oceania and western Europe.

Researchers worldwide are only just starting their next task: working out why.

The authors of the 2022 review, led by Harvard University, said any uptick in testing or checks could not account for the rise in diagnoses. They suggested the rise was most likely due to an unhealthy mix of risk factors that could be working together, some which are known and others of which need to be investigated.

Many of these risks had established links to cancer such as obesity, inactivity, diabetes, alcohol, smoking, environmental pollution and western diets high in red meat and added sugars, not to mention shift work and lack of sleep. Experts have speculated that ultra-processed food may also be partly to blame

The researchers behind the new study echoed those observations. Genetic factors are likely to have a role, they say. But diets high in red meat and salt and low in fruit and milk, as well as alcohol consumption and tobacco use, are the main risk factors underlying the most common cancers among under-50s, with physical inactivity, excess weight and high blood sugar other contributory factors.

As worrying as the increase in early onset cancers is, caution is required. Cancer in people under 50 is still uncommon. With breast cancer, the most common type in under-50s, there were 13.7 cases per 100,000 people in 2019. Nine in 10 of all cancers affect people over 50.

Until experts unlock definitive answers, there remains plenty that people young and old can do to reduce their risk of cancer. Not smoking, maintaining a balanced diet and a healthy weight, getting plenty of exercise and staying safe in the sun are among them.

 

Andrew GregoryHealth editor

https://www.theguardian.com/science/2023/sep/05/cancer-is-on-the-rise-in-under-50s-a-key-task-is-to-work-out-why?utm_source=salesforce-marketing-cloud&utm_medium=email&utm_campaign=September+12+2023+Cancer+Today+E-newsletter&utm_term=Read+More+in+the+Guardian

September has been established as Childhood Cancer Awareness Month.

Childhood Cancer Awareness Month.

It is a rare disease, according to the Hellenic Society of Pediatric Hematology – Oncology (EEPAO), but with serious consequences for both patients and their families. A disease that can be defeated but often with painful and long-term efforts and serious immediate and delayed complications.

The numbers are indicative: 300-350 new diagnoses every year in Greece, 35000 throughout Europe with 6000 children dying due to cancer. The Pediatric Oncologists-Hematologists, Elena Solomou and Antonis Kattamis (Professor NKUA) report that in early 2020, the COVID-19 pandemic resulted in the research community turning to a new path of research approach.

In Lancet Oncology, the work of Sheena Mukkada and partners has shown that the scientific community is united for the common good at this difficult time.  This prospective study analyzed data from children and adolescents (<19 years) with cancer and COVID-19 around the world.  Typically, data from approximately 1500 patients from 131 hospitals in 45 countries, including patients from Greece, were used. 259 (19.9%) of the patients had a severe or critical infection, while 50 (3.8%) patients died.  Comparing the data with adults, mortality in adults with cancer is 28%, much higher than in children.

Childhood cancer must be a priority for any strategic planning of each country’s health system. These diseases in childhood are treatable, with overall survival at 80% in high-income countries. But when the right resources are lacking, such as in low-income and middle-income countries (where about three-quarters of the global number of childhood cancer is recorded),  only 20-30% of individuals have long-term survival. Delays in early detection, poor access to diagnostic services in the absence of full access to required cancer medicines, higher rates of comorbidity (e.g. malnutrition, infections and poverty) as well as refusal or abandonment of treatment are common, resulting in increased morbidity and mortality. All these factors result in lower survival rates and higher morbidity rates than in high-income countries.

The COVID-19 pandemic has exacerbated inequalities in access to each country’s health system despite efforts to tackle childhood cancer. With the mandate given by governments in the 2018 cancer resolution, the WHO, together with major international childhood cancer hospitals, set a goal of treating at least 60% of all children with cancer worldwide and reducing pain for all children.

The data from this study enable us to understand that during the pandemic there is a unique opportunity to develop and implement strategies tailored to specific health systems and to reduce inequalities in diagnosis and access to medication in children with cancer globally.

The scientific community makes concerted efforts to achieve high cure rates, with the best possible quality of life and the minimum possible long-term complications. Genetic and molecular biology are now the necessary element of diagnosis and treatment in a large part of neoplasms of children and adolescents. Personalized treatment, which will further increase the chances of cure for young patients, reducing immediate and ultimate toxicity, is a goal that may become a reality in the near future.

In this context, HSPHO has taken initiatives to strengthen cooperation between the oncology departments of the Territory and the recognition of our country as an equal member of European scientific organizations. It participates in international collaborative treatment protocols, thus ensuring access to innovative medicines and therapies under proper and organized supervision. Of course, the process of Greece’s full, equal access to each of these protocols comes at a high cost. Fortunately, however, in the long, arduous struggle of the children and their families, over the years, valuable helpers and supporters, associations and volunteers have stood by.

The understaffing of the Pediatric Hematology / Oncology Departments in medical, nursing and paramedical staff, the lack of public structures for targeted molecular tests, the lack of financial coverage of specialized tests and the difficulty of access to innovative medicines are problems for which we have repeatedly informed the competent bodies.

Each of us can help to the best of our ability! You can become a volunteer blood donor, or volunteer bone marrow donor, or help associations and organizations supporting children and their families, either through sponsorships or by donating some of his time.

Any effort to improve the care of children with cancer is welcome and important!

Learn more:

https://www.iatronet.gr/article/104037/paidiatrikos-karkinos-kai-pandhmia-covid19

https://www.iatronet.gr/eidiseis-nea/epistimi-zwi/news/52168/septemvrios-minas-efaisthitopoiisis-gia-ton-karkino-tis-paidikis-ilikias.html

Cancer Effects on Caregivers and Work

A CANCER DIAGNOSIS RESULTS IN A LOT OF CHANGES for both the patient and the caregiver.

For the caregiver, those changes can include adjusting work schedules, which, in turn, can affect their finances.

The unexpected expense of cancer treatments coupled with the lack of paid leave can be a one-two punch to caregivers’ financial resources. “For many caregivers, keeping debt low or nonexistent may not be possible,” says Cathy J. Bradley, a health economics researcher and co-author of a study titled “Working, Low Income, and Cancer Caregiving: Financial and Mental Health Impacts,” published online April 12 in the Journal of Clinical Oncology. “The Federal Reserve reports that many households would have difficulty absorbing $400 in unexpected costs. Cancer treatments are among the most expensive treatments in the United States.”

In many instances, caregivers can take paid leave to care for their loved one, which can mitigate financial hardship, but that’s not always the case. Often, caregivers are faced with taking unpaid leave or having to stop working altogether—both of which negatively impact their finances.

According to Bradley’s study, 35% of cancer caregivers stopped working and 30% saw their household debt increase. Those in households earning less than the median household income were more likely to experience decreased income and stop work than peers in similar financial situations who were caring for people with conditions other than cancer.

“Data on reasons for stopping work was not part of this study, but we speculate that caregiving demands are greater for cancer patients,” says Bradley, an associate dean of the Colorado School of Public Health and deputy director of the University of Colorado Cancer Center. “We also speculate that lower-income households cannot pay for additional help so that the caregiver can continue working.”

A key element forcing caregivers to stop work is no paid leave at their workplace. According to the American Cancer Society Cancer Action Network (ACS CAN), studies show that cancer patients with paid leave have higher rates of job retention and lower rates of financial burden. However, 48% of caregivers report experiencing problems related to financial pressure caused by not being able to work or having to reduce work hours to care for their loved one.

“Cancer treatment is so all-consuming for the patient but also for the family and anyone who is caregiving for the patient,” says Jennifer Hoque, associate policy principal on access to care for ACS CAN. “And that includes all-consuming with finances and time. Time is money. The more time you have to spend caregiving for the cancer patient, the more potential for lost wages and other money you’re spending. And it’s not just time caring for the patient. It’s also transportation, taking the patient to and from their treatments. Sometimes it’s lodging because sometimes you have to stay overnight.”

To help cancer caregivers, ACS CAN supports legislation providing for paid leave in the workplace so everyone has access to it and can help their family members. The Family and Medical Insurance Leave (FAMILY) Act was introduced in Congress on May 17. If passed, it would provide workers with a maximum of 12 weeks of financial support during a family or medical leave from work. In addition, 11 states and Washington, D.C., have enacted paid leave laws.

Finding assistance is crucial for cancer caregivers. “Caregivers provide a tremendous service to their families and society at large with very few supports,” Bradley says. “As a result, they suffer not only physical and mental consequences, but they also suffer financial consequences that last for years. Lower-income households take on the greatest financial burden and may never recover.”

If you’re caring for a cancer patient, it’s important to find out what type of leave is available. For instance, the Family and Medical Leave Act currently in effect provides 12 weeks of unpaid leave during a one-year period. Although leave is unpaid, the law protects your job while you’re away from work. Also, find out how flexible your employer is in allowing remote work or changing your work hours for doctor appointments and treatments.

Other assistance may be available through local, state and national programs such as the CancerCare Co-Payment Assistance Foundation, HealthWell Foundation, and the Leukemia & Lymphoma Society. Patient navigators at your loved one’s hospital or cancer treatment center can also be a valuable resource in advising you about financial assistance.

Cancer Effects on Caregivers and Work

Essential cancer screening and diagnosis services must be included in UHC schemes to reduce mortality

The earlier a cancer is detected, the easier it is to treat successfully, often with fewer side effects, and at a lower cost. In many high-income regions, such as Europe and the United States, survival rates for cancer have risen in past decades, in part thanks to routine screening that detects cancers at an early stage. It’s especially true for common cancers like cervical, breast, colorectal, and prostate, where routine screening offers a clear test and methodology for early detection.

Investing in routine screening programmes for asymptomatic cancers as well as the early detection of symptomatic cancers and diagnostic and referral services is, therefore, a cost-efficient approach to mitigate the public health costs of cancer. These are estimated to reach USD 458 billion globally by 2030, and cut the projected global economic cost of cancers, estimated at USD 25.2 trillion for the period 2020-2050.

Such investments in services must be accompanied by clear communication about the necessity and benefits of such measures. It is also critical that the general public have access to reliable information on possible early signs of certain cancers (notably, breast, cervical, lung, prostate, ovarian and testicular) and primary healthcare staff must be equipped to spot signs of cancer – with rapid referral options for screening and then treatment.

Unfortunately, many people around the world still lack access to these essential services. In low- and middle-income countries in particular, cancer prevention, diagnosis and care remain a luxury that is out of reach for many.

A significant number of people, particularly those from low-income communities, face barriers that prevent them from accessing necessary health services, such as the distance to healthcare facilities and costs of healthcare – with the risk of financial toxicity if they must be paid for out of pocket.

A weak health system and an absence of knowledgeable healthcare providers can also stand in the way of timely cancer detection and diagnosis.

To close these gaps, routine screening, cancer diagnosis and referral services must be included in health insurance benefits packages.

UHC cannot be achieved unless everyone has access to affordable cancer care. At the same time, without the benefits offered by UHC, access to potentially life-saving screenings remains limited. This means someone may die of a cancer that could have been detected and treated at an earlier stage, but either an early detection programme was not available or that person could not access it, for financial or other reasons. A cost-efficient national cancer control plan with essential services – including routine screening and diagnosis – covered by national health insurance schemes available to everyone – can break down these barriers to accessibility, availability and affordability.

Indeed, often cancer treatment by national health insurance schemes but not screening. Issues of stigma that surround many cancer tests (for instance, those that concern sexual organs) therefore compound concerns about cost or fears of a diagnosis (e.g. cancer may be considered a death sentence, so why get tested?) to prevent high numbers of people getting a timely diagnosis, resulting in many patients presenting with late-stage cancers.

At the second High-level Meeting on Universal Health Coverage taking place on 21 September 2023, Governments are expected to adopt a set of new commitments to accelerate UHC implementation. This meeting will provide an opportunity for UICC to advocate for including comprehensive cancer prevention and control measures in UHC benefits packages.

In preparation for this pivotal meeting, UICC reached out to its members to learn about their concerns and inform its advocacy strategy in the lead-up to the UN HLM on UHC.

UICC is also organising a series of Virtual Dialogues intended to facilitate discussions around UHC and its impact on cancer control. The first dialogue organised in early May looked at UHC and prevention. A second Virtual Dialogue on UHC and early detection will take place on 20 July, and look at examples of successful advocacy to include screening and early detection in UHC benefit packages (for instance, mammography reimbursement in Algeria) and the use of legislation to support screening and early detection programmes and referral to treatment.

Read more :

https://www.linkedin.com/pulse/essential-cancer-screening-diagnosis-services-must-included-uhc-schemes%3FtrackingId=yU3y0j6Af4hHzyucBwUSyw%253D%253D/?trackingId=yU3y0j6Af4hHzyucBwUSyw%3D%3D

 

A post-emergency COVID-19 vaccine strategy: WHO’s end of emergency declaration spells out hope but challenges remain

The declaration of the end to COVID-19 as a public emergency is a symbolic signpost, but COVID-19 remains a threat and vaccination can play a key role in addressing it.

The declaration of the end to COVID-19 as a public health emergency is a symbolic signpost of the transition from an emergency to a more sustainable mode of preparedness and reaction. COVID-19 remains a threat though, and vaccination can play a key role in addressing it.

Thirty-eight months into the pandemic, and COVID-19 claims a life every three minutes globally. This leaves no room for complacency.

Instead, we need, to remain vigilant, have a coherent approach on vaccination and continue reducing COVID-19 hospitalisations, severe disease, as well as protecting our healthcare systems.

In this regard, Member States should strive for a better coordination among their national vaccination strategies in order to avoid major differences, with the EU having a stronger role through further harmonisation of some aspects of the vaccine administration in the Member States.

At the same time, while predictable pattern of COVID-19 seasonality has yet to be established, the impact of the disease has been much higher during the period corresponding to the traditional influenza season. Therefore, where possible, COVID-19 and influenza vaccination campaigns need to be combined.

Second, we need to reflect on the use of joint procurement as part of the EU’s vaccine strategy.

The strategy has been one of the milestones of the EU’s response to the pandemic. It demonstrated the unity of the EU as a whole, facilitated access to a broad and diversified portfolio of safe and affordable vaccines, and saved the lives of more than a million Europeans since the end of 2020.

Capitalising on this success, we need to go one-step further and, seriously, consider extending it to treatments of very rare types of cancer, especially paediatrics, as well as some rare diseases.

Nevertheless, increasing public confidence in vaccination is a key prerequisite to reach these strategies’ objectives.

As EPP Coordinator at the COVI Committee, I find the major disparities in vaccination coverage between and within Member States as well as the resurgence of vaccine-preventable diseases, such as measles, quite concerning. In order to address these, we have to continue tackling misinformation and disinformation, and reduce vaccination hesitancy through science-based communication on the benefits of vaccination.

Last, we should not forget that these challenges are essentially global. The EU played a decisive role in the global response to the COVID-19, by donating hundreds of millions of doses, and billions of aid to assist developing countries.

Building on that, the EU has to continue playing its role in providing support, improving access to vaccines for LMICs, as well as, boost global health research to develop the technologies and countermeasures, which are necessary to improve health.

By Stelios Kympouropoulos

Stelios Kympouropoulos (EL, EPP) is a member of Parliament’s EMPL and PETI Committees, the SANT Subcommittee and the COVI Special Commmittee.

Quality Questions:When you are diagnosed with cancer, how can you be sure you’re getting appropriate care?

IN APRIL 2020, truck driver John Lex was waiting to load up his tractor trailer at a Walmart distribution center in LaGrange, Georgia, when he felt a severe, sharp pain in his lower abdomen. The self-proclaimed “stubborn guy” figured if he went home to lie down, he would feel better. However, by the time he arrived home in Monroe, Georgia, the pain had amped up to “an eight out of 10.” He asked his wife to drive him to the local hospital’s emergency room.

Doctors there thought his pain might be appendicitis, but a CT scan revealed something unexpected: a mass in his colon. “The doctor told me that they believed it was cancerous, but he wouldn’t know for sure until they got in there,” says Lex, now 56, who had immediate surgery to remove the mass and have his colon resected. He would need to wait for results from the biopsy to get confirmation, but “[the doctor] was pretty confident that it was cancer,” Lex says

Three days after surgery, on April 25, 2020, these suspicions were confirmed. Lex’s tumor was malignant—with 19 positive lymph nodes. He had stage IIIC colon cancer. He was referred to a medical oncologist at Piedmont Walton Hospital in Monroe—the same hospital where he had his surgery. He completed a six-month course of chemotherapy with FOLFOX (folinic acid, fluorouracil and oxaliplatin), but in January 2021, the scans showed that the tumors were back in his colon, as well as the lining of his abdominal cavity.

At that time, his oncologist suggested another chemotherapy combination and referred Lex to a colleague at Atlanta-based Winship Cancer Institute at Emory University, which is less than 30 miles away from Lex’s home, for a second opinion. Winship Cancer Institute has earned the National Cancer Institute’s highest honor—a comprehensive cancer center designation—which signifies significant research infrastructure along with the capacity to provide high-quality treatments to patients. The oncologist at Winship confirmed the treatment plan. Lex continued to be treated by his original oncologist, satisfied that he was receiving appropriate care.

Treatment Close to Home

Like an estimated 80% to 85% of people with cancer in the U.S., Lex sought treatment at a community cancer center. Community cancer centers typically provide care through oncology practices or networks, offering treatment at local hospitals instead of specialty cancer centers. They are not usually a part of large academic teaching hospitals and don’t have NCI designations.

“Community hospitals are those institutions that are designed to take care of patients. They’re not necessarily teaching and they’re not necessarily doing research. That’s not to say that they never do,” says Thomas Tucker, the senior director for cancer surveillance and associate director of the Kentucky Cancer Registry at the Markey Cancer Center Prevention and Control Program at the University of Kentucky in Lexington. Tucker has published research on Markey Cancer Center’s efforts to form an alliance with community cancer hospitals to help provide more standardized cancer care throughout Kentucky.

The decision to receive care in a community cancer center is often influenced by geography, given that many people in the U.S. do not live near large academic teaching hospitals or one of the 71 NCI-designated cancer centers spread across 36 states and the District of Columbia. “The number one criterion that’s going to affect where a cancer patient gets treated is going to be their location,” says Rose Gerber, a breast cancer survivor who is the director of patient advocacy and education at the Community Oncology Alliance, a nonprofit organization based in Washington, D.C., that advocates for the preservation of oncology private practices that offer patients high-quality, affordable cancer care close to home. Gerber notes referrals often come from a patient’s primary care doctor who is familiar with local oncologists. In addition, a patient’s and doctor’s familiarity with the local health system and the convenience of not traveling far for what are usually multiple treatments often provide reassurance to patients, Gerber says

Experience Matters

Other variables, including a person’s cancer type, stage, the pathology and genetic makeup of the tumor, and any previous treatments, can all factor into people’s decisions about where they go for their care. When analyzing choices, oncologist Diane Reidy-Lagunes suggests that patients start by asking questions to gain an understanding of the doctor’s experience with the patient’s stage and type of cancer.

“There are definitely some questions that you want to ask the oncologist when you’re meeting them … particularly for instances of rare diseases,” says Reidy-Lagunes, who is the associate deputy physician-in-chief of the Regional Care Network at Memorial Sloan Kettering Cancer Center in New York City. She suggests asking, “Is this a disease that you’re often taking care of? Have you only seen one in your lifetime or do you see five in clinic daily?”

Patients can also look up a physician’s specialties online before the office visit, says Nancy Keating, a primary care physician at Brigham and Women’s Hospital and a researcher in the Department of Health Care Policy at Harvard Medical School in Boston, who studies factors that influence the delivery of high-quality care for people with cancer. “The more specialized training someone has, the better, especially when complex care is needed,” she says, using the example of a surgeon who specializes in a certain kind of cancer. “If you are a colorectal surgeon, you’ve done a fellowship, and you only do colorectal surgery. In addition, you are continually getting exposed to new cases daily and that’s all you do.”

With more experience comes greater proficiency. Research indicates that people with cancer who undergo complex procedures at high-volume surgical centers have better outcomes compared to low-volume centers, including for lung, esophageal and pancreatic cancer. For example, one study published in the April 2017 Annals of Surgery suggests patients with esophageal cancer who traveled to high-volume surgical centers had significantly better five-year survival rates, with 39.8% of patients living five years or longer compared to 20.6% who sought treatment at low-volume surgical centers. Another study published Nov. 1, 2021, in Cancer, compared outcomes at high-volume and low-volume radiation centers for a number of cancers and found patients receiving adjuvant radiation had significantly improved survival at very high-volume facilities when compared to low-volume facilities. Patients who received radiation alone for prostate, non-small cell lung, pancreatic, and head and neck cancer without surgery or other treatments also had increased survival, according to the study.

Lindsay Longo, an IT services director who lives in Tampa, Florida, was diagnosed with stage II Hodgkin lymphoma in November 2020 after going to an emergency room with escalating symptoms from COVID-19. While she was there, doctors performed a CT scan and discovered a large mass in her left lung, a rare presentation of Hodgkin lymphoma. She had a lung biopsy on Nov. 25, 2020, and five days later was diagnosed with cancer.

Longo ultimately decided to get her treatment at Moffitt Cancer Center, an NCI-designated cancer center in Tampa. The 39-year-old was impressed with the depth of experience that Moffitt provided, including swift coordination of care. “I didn’t feel like [the hospital where I was diagnosed] was moving fast enough for me, so I decided on Moffitt for its credibility and the top ranking. For me, it was a no-brainer,” she says.

On Dec. 31, 2020, Longo began treatment, receiving eight rounds of ABVD (Adriamycin, bleomycin, vinblastine, and dacarbazine) administered every two weeks. At the end of treatment, a scan revealed one spot on a lymph node. At that point, a tumor board, consisting of a multidisciplinary team of physicians at Moffitt, reviewed her case and suggested she have four more rounds of chemotherapy. On July 27, 2020, her scans were clear.

Access to Clinical Trials

While the standard-of-care treatments offered in cancer centers and community hospitals already have proven efficacy, some patients may also be interested in experimental treatments and clinical trials, says Gerber, who was diagnosed with stage II HER2-positive breast cancer in 2003.

Gerber had a lumpectomy followed by eight rounds of chemotherapy and radiation at Eastern Connecticut Hematology and Oncology, an oncology practice affiliated with Backus Hospital in Norwich, Connecticut. Her physicians also offered her an opportunity to participate in a clinical trial that tested the use of a targeted medication called Herceptin (trastuzumab) to reduce the chance of her cancer returning.

“[HER2-positive breast cancer] at the time was one of the deadliest diagnoses with a very poor prognosis,” she says. Gerber realizes now how fortunate she was to take part in a ground-breaking clinical trial. Today, she credits her survival and good health to being a part of the Herceptin clinical trial, and the drug is now the standard of care for patients with HER2-positive breast cancer. Gerber notes that many community cancer centers offer clinical trials—and the idea that this type of research is only offered at larger research or academic hospitals is a misconception.

Having access to a range of treatment options—both the standard of care and experimental drugs—is especially important for patients who have advanced cancer, says Heidi Nelson, medical director of the American College of Surgeons, Cancer Programs, which is responsible for the Commission on Cancer (CoC) accreditation program for hospitals. The accreditation means facilities have demonstrated that they provide a range of services, either on-site or through referrals to other facilities, including diagnostic imaging, radiation oncology, systemic therapy, psychosocial support, rehabilitation, nutrition and access to clinical research.

Collaboration between medical oncologists, surgeons, radiation oncologists, nurses and social workers provides a good measure for quality care, Nelson says. “With an appropriate team of specialists, each professional sees a different part of the patients’ needs and the cancer details. The full picture comes together when all the professionals come together around each patient to make sure nothing is left out of the care plan,” she says.

That type of collaboration can also extend across hospital systems—including between NCI-designated cancer centers and community hospitals. One example of this type of collaboration is with the NCI-designated University of Kentucky Markey Cancer Center, in Lexington, which started an affiliate program in 2006 that now includes 21 community hospitals. One of the requirements for facilities taking part in the alliance is achieving and maintaining CoC accreditation, as a means to increase quality of care in cancer hospitals across the state. A study of 13 hospitals in the network published in the February 2021 Annals of Surgical Oncology showed this collaboration increased the hospitals’ ability to meet quality measures three years after they joined the network compared to three years prior. In addition, the number of hospitals that received CoC accreditation increased from three to 12.

“This is an opportunity for the medium- and small-sized hospitals to have access to resources for facing issues or problems they may not have seen before,” says Tucker, who notes that academic and research hospitals don’t have the capacity to treat every cancer patient. “The smart thing [to do] is to help community hospitals develop that capacity. Many of them are quite good at it [already],” he says.

For patients like Lex, having the ability to tap into expertise at both his local cancer center and a larger cancer center provided extra reassurance. This collaboration included having a multidisciplinary team review his case at the hospital to determine the best course of care. “Knowing that it’s not just [my oncologist] that’s looking at my records, that it’s all the doctors that she works with really eased my mind,” he says.

In May 2021, Lex went back to Winship for another second opinion after a PET scan showed one of his three tumors was growing. Genetic testing in early 2021 showed his tumors tested positive for BRAF mutations, which made Lex eligible for a combination of targeted therapies, Erbitux (cetuximab) and Braftovi (encorafenib). Since starting treatment, his tumors have appeared to be less active in the PET scans, which could be an indication that treatment is working. In addition, one tumor has gotten smaller in size. He hopes the targeted therapy will keep his tumors at bay. “We’re hoping that maybe the treatment will knock it out completely,” says Lex. “I am so happy I got the second opinion. It just eases your mind because I have two great doctors looking over me.”

Quality Questions