At a pre-meeting press conference, ASCO gave reporters a peek at some of the important presentations at the upcoming ASCO20 Virtual Scientific Program. The topics covered include smoking and lung cancer, maintenance therapy for ovarian cancer, the value of geriatric assessment, changes wrought by the Affordable Care Act, and videoconferencing for caregivers.
Smoking and Lung Cancer
A large pooled analysis of 17 studies with a total of almost 35,000 patients enrolled in the International Lung Cancer Consortium (ILLCCO) showed that quitting smoking at any time prior to diagnosis improved lung cancer-specific survival and overall survival [Abstract 1512].
The risk of overall death was reduced by 12% for people who quit less than 2 years before their diagnosis, 17% if the interval was 2-5 years, and 20% if it had been more than 5 years since stopping smoking (all comparisons were with current smokers). However for lung cancer-specific survival, the benefit was significant only for those who quit more than 5 years prior to diagnosis compared with current smokers at the time of diagnosis.
“This research shows that if you are a current smoker and you quit, no matter when you quit you will be more likely to survive after being diagnosed with lung cancer compared to someone who continues smoking,” said lead author Aline Fusco Fares, MD, clinical research fellow at Princess Margaret Cancer center in Toronto. “The study’s message is simple: quit smoking now.”
“The improvements in survival seen even with quitting a short time before lung cancer diagnosis show that it’s never too late to stop smoking,” said ASCO President Howard A. Burris, III, MD.
Maintenance Olaparib in Ovarian Cancer
The final overall survival analysis of the double-blind, randomized, multicenter SOLO2 trial showed that maintenance therapy with olaparib provided an unprecedented improvement of 12.9 months of median overall survival versus placebo in patients with platinum-sensitive recurrent ovarian cancer and a BRCA mutation [Abstract 6002].
At 5 years, 28.3% of patients in the olaparib arm were alive and did not need subsequent treatment versus 12.8% of patients in the placebo arm. At 5 years, 42.1% of olaparib patients were alive versus 33.2% of placebo patients.
Patients who received olaparib in the time between response and disease progression had a 26% reduced risk of death. In addition, 38.4% of the placebo arm crossed over to treatment with olaparib.
“This is the first study with olaparib tablets … to provide long-term follow-up and final overall survival data in patients with platinum-sensitive relapsed ovarian cancer,” said lead author Andreas Poveda, MD, Initia Oncology Hospital Quironsalud, Valencia, Spain.
“A median overall survival improvement of nearly 13 months is impressive in ovarian cancer and brings a substantial benefit to our patients. With the addition of overall survival data, this study helps usher in a new era of personalized medicine for women with this difficult-to-treat cancer,” Dr.Poveda added.
Geriatric Assessment and Management
Integrating geriatric assessment (GA) and geriatrician-led collaborative care for patients over age 70 slated for chemotherapy, targeted therapy, or immunotherapy improved outcomes for both patients and the healthcare system [Abstract 12011].
The INTEGERATE prospective randomized study of 154 patients showed that comprehensive GA and geriatrician-led management of issues identified in the GA improved patients’ quality of life, reduced emergency room visits, reduced in-hospital stays, and enabled more patients to stay on treatment compared with usual care.
“The comprehensive GA is a powerful tool, because it helps optimize care for older cancer patients. Older people receiving systemic anti-cancer therapy should receive comprehensive GA management to optimize their clinical care and health outcomes. This is one of the first randomized trials to show benefits to both the patient and the healthcare system,” said lead author Wee-Kheng Soo, MD, geriatrician and medical oncologist at Eastern Health, Melbourne, Australia.
ACA and Expansion of Medicaid
The first study to directly measure cancer survival after implementation of expansion of Medicaid under the Affordable Care Act (ACA) found greater decreases in cancer mortality rates in states that adopted Medicaid expansion than in states that did not: 29% from 1999-2017 versus 25%, respectively [Abstract 2003].
The additional mortality benefit for states that adopted Medicaid expansion amounted to an estimated 785 fewer cancer deaths in 2017 alone.
Looking at subpopulations, it was somewhat surprising to find that although African Americans patients had large mortality gains during the study period, no additional reduction in mortality was observed for them in states with Medicaid expansion, while Hispanic patients had a greater magnitude of improvement in mortality in states that adopted Medicaid expansion. The authors said that it is not clear why African Americans failed to experience the same magnitude of benefit in these states and that further study is needed.
“This is the first study to show the benefit of Medicaid expansion on cancer death rates on a national scale. We now have evidence that Medicaid expansion has saved the lives of many people with cancer across the US,” said lead author Anna Lee, MD, radiation oncology fellow at Memorial Sloan-Kettering Cancer Center, New York City.
“Better access to quality cancer care, in this case through state expansion of Medicaid, leads to fewer deaths,” said ASCO Chief Medical Officer and Executive Vice President Richard L. Schilsky, MD.
Videoconference Intervention and Coaching
A study that has particular relevance in the COVID-19 era found that a videoconference coaching intervention helped to reduce anxiety and distress for caregivers who live more than one hour away from the cancer patient they were caring for [Abstract 12123].
The randomized controlled trial was conducted at a large urban comprehensive cancer center, and patients undergoing treatment for any type of cancer were included.
Distance caregivers were randomized to Arm 1 (4 monthly videoconferences with a nurse practitioner or social worker focused on information and support, participation in a patient’s appointment with the oncologist, and access to a specially-designed website for distant caregivers); Arm 2 (no coaching sessions but the other 2 components); and Arm 3 (access to the website only).
At the completion of the study of 441-patient-caregiver dyads, only Arm 1 showed a significant 21% improvement in anxiety over time, and a significant improvement in distress over time (54.3%).
The majority of the caregivers (71%) were female, 65% were Caucasian, and 65% were the child of the patient.
“Distance caregivers experience a tremendous amount of anxiety and distress – often greater than people with cancer themselves. With COVID-19, the challenges distance caregivers face are now the same challenges facing many local caregivers who can’t attend their loved ones’ appointments [with the oncologist].
“Our videoconference intervention shows that it’s possible to meaningfully reduce anxiety and distress for distance caregivers through fairly simple technology,” said lead author Sara L. Douglas, PhD, RN, professor in oncology nursing and assistant dean for research at the Case Western Reserve University School of Nursing, Cleveland, OH.
By John McCleery
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