Cancer

Abnormalities in the H‐cadherin gene have been reported in several human malignancies, including nonsmall cell lung carcinoma (NSCLC). Aberrant methylation of the H‐cadherin promoter also has been reported in NSCLC, but its clinical significance remains to be elucidated.

The authors studied H‐cadherin methylation in 305 patients with NSCLC to gain a further understanding of the clinicopathologic and prognostic significance of H‐cadherin methylation in patients with NSCLC. The methylation status of the H‐cadherin gene was investigated by using methylation‐specific polymerase chain reaction analysis in paraffin blocks from 305 patients with NSCLC. Ki‐67 expression was assessed by immunohistochemical staining. All statistical analyses were 2‐sided with a 5% Type I error rate.

H‐cadherin methylation was observed in 130 of 305 tumor samples (43%). The prevalence of H‐cadherin methylation was associated significantly with pathologic stage and was observed in 44% of patients with Stage I disease, in 23% of patients with Stage II disease, in 59% of patients with Stage III, and in 88% of patients with Stage IV disease (P = 0.001). H‐cadherin methylation occurred with a 2.71 times greater prevalence (95% confidence interval [95% CI], 1.21–6.09; P = 0.01) T2 tumors than in T1 tumors and with a 3.78‐fold greater prevalence (95% CI, 1.05–13.59; P = 0.04) in T3 tumors than in T1 tumors. However, lymph node metastasis was related inversely with H‐cadherin methylation (odds ratio = 0.51; 95% CI, 0.28–0.95; P = 0.03), and H‐cadherin methylation was not associated with the Ki‐67 labeling index (P = 0.53) or with tumor size (P = 0.89). No relation was found between H‐cadherin methylation and survival in patients with Stage I NSCLC (P = 0.51) or in patients with Stage II NSCLC (P = 0.46).

The current findings suggested an association between H‐cadherin methylation and tumor progression in NSCLC but had no prognostic significance in patients with early‐stage NSCLC. In addition, H‐cadherin methylation may be a valuable candidate molecular marker for the early detection of NSCLC. Cancer 2005. © 2005 American Cancer Society.

Methadone is an effective and inexpensive opioid for cancer pain treatment. It has been reported as difficult to use in the outpatient setting because of its variable relative potency and long half‐life. The purpose of this study was to determine the outcome of methadone initiation or rotation for cancer pain treatment in outpatient settings.

Chart review was done of 189 consecutive patients who underwent methadone initiation or rotation at the authors' palliative care outpatient center. Data were collected regarding demographic and clinical characteristics, symptoms, and opioid side effects at baseline and for 2 follow‐up visits (F1, F2). Failure was defined as methadone discontinuation by the palliative care physician or patient's hospitalization for uncontrolled pain or methadone‐related side effects at F1.

One hundred (53%) initiations and 89 (47%) rotations were conducted. Success rates for methadone initiation and rotation were 82 of 89 (92%) and 85 of 100 (84%), respectively. Mean (standard deviation) age was 60 (11) years. One hundred (53%) patients were women, 138 (73%) were white, and 182 (96%) had solid cancers. The main reason for rotation was pain (65 of 89 patients, 47%). Median (interquartile range, IQR) pain scores (Edmonton Symptom Assessment Scale/0‐10) were 6 (5‐8), 4 (3‐6), and 3 (2‐5) at baseline, F1, and F2, respectively (P < .0001). Median (IQR) daily methadone dose for initiation and rotation was 10 (5‐15) mg and 15 (10‐30) mg at F1 (P < .0001) and 10 (8‐15) mg and 18 (10‐30) mg at F2 (P < .0001), respectively. Constipation and nausea improved (P < .005) after initiation/rotation to methadone. Frequency of sedation, hallucinations, myoclonus, and delirium did not increase after initiation/rotation to methadone.

Outpatient methadone initiation and rotation for cancer pain treatment were safe, with high success rates and low side effect profiles. Cancer 2010. © 2010 American Cancer Society.

Individuals from disadvantaged communities are among the millions of uninsured Americans gaining insurance under the Affordable Care Act. The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown.

This study linked the Surveillance, Epidemiology, and End Results registries to US Census data to study patients diagnosed with the 4 leading causes of cancer deaths between 2007 and 2011. A county‐level social determinant score was developed with 5 measures of wealth, education, and employment. Patients were stratified into quintiles, with the lowest quintile representing the most disadvantaged communities. Logistic regression and Cox proportional hazards models were used to estimate associations and cancer‐specific survival.

A total of 364,507 patients aged 18 to 64 years were identified (134,105 with breast cancer, 106,914 with prostate cancer, 62,606 with lung cancer, and 60,882 with colorectal cancer). Overall, patients from the most disadvantaged communities (median household income, $42,885; patients below the poverty level, 22%; patients completing college, 17%) were more likely to present with distant disease (odds ratio, 1.6; P < .001) and were less likely to receive cancer‐directed surgery (odds ratio, 0.8; P < .001) than the least disadvantaged communities (median income, $78,249; patients below the poverty level, 9%; patients completing college, 42%). The differences persisted across quintiles regardless of the insurance status. The effect of having insurance on cancer‐specific survival was more pronounced in disadvantaged communities (relative benefit at 3 years, 40% vs 31%). However, it did not fully mitigate the effect of social determinants on mortality (hazard ratio, 0.75 vs 0.68; P < .001).

Cancer patients from disadvantaged communities benefit most from health insurance, and there is a reduction in disparities in outcome. However, the gap produced by social determinants of health cannot be bridged by insurance alone. Cancer 2017;123:1219–1227. © 2016 American Cancer Society.

Recent research has supported the use of colorectal cancer (CRC) tests to reduce disease incidence, morbidity, and mortality. A new health survey has provided an opportunity to examine the use of these tests in California's ethnically diverse population. The authors used the 2001 California Health Interview Survey (CHIS 2001) to evaluate 1) rates of CRC test use, 2) predictors of the receipt of tests, and 3) reasons for nonuse of CRC tests.

The CHIS 2001 is a random‐digit dial telephone survey that was conducted in California. Responses were analyzed from 22,343 adults age ≥ 50 years. CRC test use was defined as receipt of a fecal occult blood test in the past year and/or receipt of an endoscopic examination in the past 5 years.

Nearly 54% of California adults reported receipt of a recent CRC test. Insurance coverage and having a usual source of care were the most important predictors of CRC testing. Latinos age < 65 years were less likely to be tested than whites (relative risk [RR], 0.84; 95% confidence interval [95% CI], 0.77–0.92). Men were more likely to be tested than women, an effect that was greater among individuals age 50–64 years (RR, 1.28; 95% CI, 1.23–1.32) than among individuals age ≥ 65 years (RR, 1.19; 95% CI, 1.15–1.23). Women were more likely than men to say that their physician did not inform them the test was needed and that CRC tests were painful or embarrassing.

Results of the current study indicate a need for physicians to recommend CRC testing to their patients. Assuring that all individuals have both health insurance and a usual source of care would help address gaps in the receipt of CRC tests. Cancer 2004. © 2004 American Cancer Society.

Scant evidence exists on the long‐term course of cancer‐related post‐traumatic stress disorder (PTSD). This is among the few studies worldwide, and the first in the South‐East Asian region, to prospectively evaluate PTSD in patients with cancer using gold‐standard clinical interviews. The objective of the study was to assess the course and predictors of PTSD in adult patients with cancer in a South‐East Asian population.

A prospective, longitudinal study was conducted in a cohort of 469 consecutively recruited patients (aged ≥18 years) with various cancer types within 1 month of diagnosis at a single oncology referral center. Only patients who had significant psychological distress (Hospital Anxiety and Depression Scale total cutoff score ≥16) underwent the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (SCID) at at 6‐months follow‐up. All patients completed the SCID at the 4‐year follow‐up assessment regardless of their initial Hospital Anxiety and Depression Scale score.

In an analysis combining patients who had both full and subsyndromal PTSD, there was a 21.7% incidence of PTSD at the 6‐month follow‐up assessment (n = 44 of 203 SCID‐interviewed patients), with rates dropping to 6.1% at the 4‐year follow‐up assessment (n = 15 of 245 SCID‐interviewed patients). Patients with breast cancer (compared with those who had other types of cancer) were 3.68 times less likely to develop PTSD at 6‐months, but not at 4‐years follow‐up.

The overall rates of PTSD decreased with time, but one‐third of patients (34.1%) who were initially diagnosed had persistent or worsening PTSD 4 years later. There is a need for early identification of this subset of patients who have cancer with PTSD to design risk‐targeted interventions. Cancer 2018;124:406‐16. © 2017 American Cancer Society.

The incidence of pelvic fractures and associated risk factors was determined in women treated with curative‒intent radiotherapy for cervical cancer.

The records of 516 women treated with curative‒intent radiotherapy for cervical cancer between 2001 and 2006 at the University of Texas M. D. Anderson Cancer Center were reviewed. Among these, 300 patients had at least 1 post‐treatment computed tomography scan or magnetic resonance imaging study available for review, and they comprised our study population. All imaging studies were re‐reviewed by a single radiologist to evaluate for fractures.

Pelvic fractures were noted in 29 of 300 patients (9.7%). Fracture sites included sacrum (n = 24; 83%), sacrum and pubis (n = 3; 10%), iliac crest (n = 1; 3%), and sacrum and acetabulum (n = 1; 3%). Thirteen patients (45%) were symptomatic, with pain being the most common presenting symptom. The median time from the completion of radiotherapy to the detection of fractures on imaging studies was 14.1 months (range, 2.1‐63.1 months), with 38% of patients diagnosed within 1 year and 83% diagnosed within 2 years of completing therapy. The median age of the patients at diagnosis was higher in the women who developed a fracture compared with the women who did not (56.5 years vs 46.7 years; P = .04). A higher number of women with a fracture were postmenopausal (62% vs 37%; P = .03). The median body mass index was lower in the women who had a fracture (26.0 kg/m² vs 28.0 kg/m²; P = .03).

Pelvic fractures were detected in a substantial proportion of women after radiotherapy for cervical cancer. Bone mineral density screening and pharmacologic intervention should be considered in these women. Cancer 2010. © 2010 American Cancer Society.

Các phác đồ hóa trị liệu hiện đại đã cải thiện tiên lượng cho bệnh nhân mắc bệnh bạch cầu lympho cấp ở người lớn (ALL). Với các phác đồ này, tỷ lệ phản ứng hoàn toàn hiện nay được báo cáo là > 80%, và tỷ lệ sống sót lâu dài dao động từ 30% đến 45%. Phân tích hiện tại cập nhật kết quả lâu dài của chương trình cyclophosphamide hyperfractionated, vincristine, doxorubicin và dexamethasone (Hyper‐CVAD) ban đầu, với thời gian theo dõi trung bình là 63 tháng.

Giữa năm 1992 và 2000, 288 bệnh nhân đã được điều trị bằng Hyper‐CVAD. Độ tuổi trung bình của bệnh nhân là 40 tuổi, và 59 bệnh nhân (20%) từ ≥ 60 tuổi trở lên. Tỷ lệ bạch cầu lympho cấp dương tính với nhiễm sắc thể Philadelphia (Ph) là 17%, và tỷ lệ bạch cầu lympho cấp tế bào T là 13%.

Một phản ứng hoàn toàn (CR) đã đạt được ở 92% bệnh nhân. Tỷ lệ tử vong trong quá trình khởi động điều trị là 5% (2% nếu độ tuổi bệnh nhân < 60 tuổi, và 15% nếu độ tuổi bệnh nhân ≥ 60 tuổi). Với thời gian theo dõi trung bình là 63 tháng, tỷ lệ sống sót 5 năm là 38% và tỷ lệ thời gian CR 5 năm là 38%. Phân tích đa biến của các yếu tố tiên lượng cho thời gian CR đã xác định các yếu tố bất lợi sau: tuổi ≥ 45 tuổi, bạch cầu ≥ 50 × 10⁹/L, trạng thái chức năng kém (điểm của Nhóm Hợp tác Ung thư Đông (ECOG) 3–4), bệnh dương tính với Ph, hình thái L2 theo tiêu chuẩn Pháp–Mỹ–Anh, > 1 đợt để đạt CR, và tỷ lệ bạch cầu trong tủy xương vào Ngày 14 > 5%. Bệnh nhân được chia thành các nhóm nguy cơ thấp (điểm nguy cơ 0–1; 37%), nguy cơ trung bình (điểm nguy cơ 2–3; 36%), và nhóm nguy cơ xấu (điểm nguy cơ ≥ 4; 27%) với tỷ lệ thời gian CR 5 năm tương ứng là 52%, 37% và 10%.

Hepatocellular carcinoma (HCC) is increasing in incidence due to hepatitis C. Stereotactic body radiotherapy (SBRT) is a noninvasive, effective therapy in the management of liver malignancies. The authors evaluated radiological response in 26 patients with HCC treated with SBRT at Indiana University.

Between March 2005 and June 2008, 26 patients with HCC who were not surgical candidates were enrolled in a phase 1 to 2 trial. Eligibility criteria included solitary tumors ≤ 6 cm or up to 3 lesions with sum diameters ≤ 6 cm, and well‐compensated cirrhosis. All patients had imaging before, at 1 to 3 months, and every 3 to 6 months after SBRT.

Patients received 3 to 5 fractions of SBRT. Median SBRT dose was 42 Gray (Gy) (range: 24‐48 Gy). Median follow‐up was 13 months. Per Response Evaluation Criteria in Solid Tumors (RECIST), 4 patients had a complete response (CR), 15 had a partial response (PR), and 7 achieved stable disease (SD) at 12 months. One patient with SD experienced progression marginal to the treated area. The overall best response rate (CR + PR) was 73%. In comparison, by European Association for the Study of the Liver (EASL) criteria, 18 of 26 patients had ≥ 50% nonenhancement at 12 months. Thirteen of 18 demonstrated 100% nonenhancement, being > 50% in 5 patients. Kaplan‐Meier 1‐ and 2‐year survival estimates were 77% and 60%, respectively.

SBRT is effective therapy for patients with HCC with an overall best response rate (CR + PR) of 73%. Nonenhancement on imaging, a surrogate for ablation, may be a more useful indicator than size reduction in evaluating HCC response to SBRT in the first 6 to 12 months, supporting EASL criteria. Cancer 2012;118: 3191–98. © 2011 American Cancer Society.

There still is debate as to whether breast carcinoma patients with isolated supraclavicular recurrence should be considered to be patients with disseminated disease or patients for whom aggressive treatment with curative intent is justified.

In the period 1984–1994, 4669 patients with invasive breast carcinoma underwent axillary dissection in 1 of 8 community hospitals in the southeastern part of the Netherlands. During follow‐up, 42 patients with isolated supraclavicular recurrence, without other sites of distant disease, were identified.

The median interval between treatment of the primary tumor and diagnosis of the supraclavicular recurrence was 2.5 years (range, 0.2–11.5 years). Radiotherapy was administered to 25 patients (60%), 5 of whom also underwent surgery and 16 of whom also received chemotherapy or hormonal therapy. Eleven patients received hormonal therapy only, and four received chemotherapy only. One patient received surgical treatment only, and one patient remained untreated. Complete remission was achieved in 35 patients (83%), but a second supraclavicular recurrence occurred in 12 (34% of patients who achieved complete remission). Overall, 6 patients (14%) were alive without evidence of disease after a follow‐up period of 4.4–8.3 years. The 5‐year actuarial overall survival and distant disease–free survival rates, based on the date of diagnosis of supraclavicular recurrence, were 38% (95% confidence interval [CI], 23–53%) and 22% (95% CI, 8–35%), respectively. The distant disease–free survival rate was somewhat better for the 25 patients who underwent radiotherapy as part of the treatment for supraclavicular recurrence than it was for the 17 patients who did not receive radiotherapy (P = 0.06); the difference became more pronounced after the exclusion of 8 patients who had received axillary and supraclavicular radiotherapy as part of treatment for the primary tumor (P = 0.002).

Although complete remission can be obtained in most patients with isolated supraclavicular recurrence, the prognosis for these patients is poor. Involved field radiotherapy appears to play an important role in the treatment of supraclavicular recurrence and may improve the distant recurrence–free survival rate. Cancer 2003;98:11–7. © 2003 American Cancer Society.

DOI 10.1002/cncr.11469