January 2015 Edition Vol.11, Issue 1

Top Cancer Stories of 2014

Top Cancer Stories of 2014 (continued)

6) A New Option in Colorectal Cancer Screening

Although not as accurate as the more traditional colonoscopy, U.S. regulators approved Exact Sciences’ Cologuard® on Aug. 11, 2014 as the first and only FDA approved, noninvasive stool-based DNA screening test for colorectal cancer. In March, an FDA advisory panel unanimously backed the self-administered test for premarket approval as safe and effective and said that its benefits outweighed its risks. In a clinical trial that enrolled more than 10,000 patients, the test found 92% of colorectal cancers in average risk patients, with 87% specificity. In August, the Mayo Clinic became the first healthcare system to offer it to patients. In November, the American Cancer Society updated its national guidelines to include the at-home test among its recommended list of screening options for colorectal cancer. Physicians praised Cologuard as an alternative for people who refused or were unable to tolerate the more invasive colonoscopy. Any screening method to detect colorectal cancer was better than none, most doctors agreed. In another coup for Exact, CMS agreed to reimburse the test and issued a final payment decision set at $502.00. 

7) CMS Likely to Cover Lung Cancer Screening

In November, the Centers for Medicare and Medicaid Services (CMS) made a preliminary decision to cover lung cancer screening with low-dose computed tomography (LDCT) for eligible patients. In April, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) voted against recommending national Medicare coverage for annual screening for lung cancer with low-dose CT in high-risk individuals. The MEDCAC ruling, which isn’t binding, had screening supporters up in arms. Forty-plus medical societies and members of the US House and Senate have urged CMS to reimburse for screening in older adults. CMS is expected to issue a final decision in February 2015. As of Jan. 1, 2015, the Affordable Care Act requires private insurers to cover lung cancer screening without cost-sharing.

8) E-Cigarettes, Regulation and Kids

In April, the FDA proposed for the first time a rule to regulate the growing market for electronic cigarettes (e-cigarettes) as well as cigars, pipe tobacco, and hookahs. But the agency stopped short of broader restrictions for marketing practices saying that rigorous scientific research was first needed to prove that such products posed a significant public health risk, especially to young people. The fierce debate over risks versus benefits of e-cigarettes raged as tobacco-control advocates argued that the use of the battery-operated devices was a gateway to smoking tobacco and especially appealing to youth, while supporters said that e-cigarettes might help smokers quit the more deadly habit as a tobacco cessation tool. The confusion only intensified in August when the Centers for Disease Control and Prevention (CDC) released a new study showing that adolescents who “vaped” said they were much more likely to take up smoking conventional cigarettes. In August, ASCO and the American Association for Cancer Research (AACR) in a joint letter urged the FDA to extend its regulatory authority over all tobacco products including e-cigarettes and called on the agency to do more, especially in the area of aggressive youth-oriented advertising and marketing.

Update: On January 12, 2015, ASCO and AACR issued a joint policy statement calling for further research and tighter state and federal regulations regarding the use and sale of e-cigarettes and other electronic nicotine delivery systems (ENDS). 

9) An Increased Emphasis on Palliative Care

An inaugural Palliative Care in Oncology symposium in October was the first major meeting to bring together cancer care specialists and health care professionals who focus on the relief of symptoms in cancer patients. The conference reflected an increased awareness of the critical role that palliative care plays in ensuring quality cancer care for patients, many of whom are coping with their disease as a chronic illness rather than a death sentence. Topics covered at the meeting included the value of Patient Reported Outcomes (PRO’s), allowing physicians to gauge the side effects of medications on patients and alleviate suffering if possible, the importance of advance care planning, and the use of ‘smart’ technology to monitor symptom management. One positive shift in the oncology treatment landscape noted by attendees is the fact that oncologists and palliative care specialists are now consulting together earlier than ever before during the treatment continuum to improve the well-being and quality of life of both patients and caregivers.      

10) Obesity: A Major Cancer Risk

In October, ASCO released its first-ever policy statement on cancer and obesity, identifying it as a leading cause of cancer and a complication in caring for cancer patients, and calling for increased education, research, and advocacy to reduce its toll.  Obesity, the organization said, is projected to outpace tobacco as the leading preventable cause of cancer in the US and for those already living with cancer, being overweight increases the chances of cancer recurrence and lower survival.  An interesting study in 2014 found that obese cancer patients often suffer from malnutrition.     

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