The tenth Annual Meeting of the National Cancer Research Institute (NCRI) conference took place in Liverpool, UK. Just under 2000 delegates were estimated to have attended the conference, predominantly from the UK and Europe.
It was a multidisciplinary gathering aimed at cancer professionals at every level. The conference included primers on basic science and public communication as well as workshops on more advanced topics.The conference was grouped into six main themes, which this report will address in greater detail.
end-of-life care; cancer communication; cancer statistics; circulating biomarkers; cancer evolution
We report here a case of a 69-year-old woman with a relapsing metastatic angiosarcoma treated with a combination of metronomic chemotherapy and propranolol. The beta blockers were added since the tumour was positive for betaadrenergic receptor. A complete response was quickly obtained and lasted for 20 months.
With this case, the combination of metronomic chemotherapy and propranolol in angiosarcoma warrants additional studies and illustrates the potential of metronomics to generate innovative yet inexpensive targeted therapies for both high-income and low-/middle-income countries.
angiosarcoma; metronomic chemotherapy; drug repositioning; palliative treatment; beta-blockers; propranolol; celecoxib; etoposide; cyclophosphamide
Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about ‘progress’ and ‘value’ in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes ’value’ to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values.
The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value.
We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores.
The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to accelerate and maximise progress against cancer.
cancer; innovation; value; indicators; progress
It is widely recognised that colorectal cancer has become a complex disease and involves many medical disciplines. The mission of the European Multidisciplinary Colorectal Cancer Congress (EMCCC), which is an initiative of the Dutch Colorectal Cancer Group (DCCG), is to facilitate the interaction between relevant disciplines on current issues of research. The three-day meeting in Amsterdam in November 2014 assembled approximately 450 participants with nine different disciplines from 38 countries worldwide. On day one, workshops on imaging, surgery, medical oncology/pathology, radiotherapy, and genetics were followed by the keynote lecture of the congress. On day two and three, a total of 35 established international opinion leaders presented lectures in plenary sessions on prevention and screening of early colorectal cancer, genetics, translational research, biomarkers, organ-saving treatment in rectal cancer, current controversies, and multidisciplinary management. Posters from submitted abstracts were displayed, with selected abstracts being orally presented.
Dutch Colorectal Cancer Group; DCCG; European Multidisciplinary Colorectal Cancer Congress; EMCCC; colorectal cancer
The 2014 OECI Oncology Days was held at the ‘Prof. Dr. Ion Chiricuta’ Oncology Institute in Cluj, Romania, from 12 to 13 June. The focus of this year’s gathering was on developments in personalised medicine and other treatment advances which have made the cost of cancer care too high for many regions throughout Europe.
comprehensive cancer centres; accreditation; designation; personalized medicine; organisation
Tómatelo a Pecho, Funsalud, the Harvard Global Equity Initiative, and the Mexican Ministry of Health led a group of institutions in organising the Sixth Annual International Symposium marking breast cancer awareness month in Mexico on 20–21 October 2014. This year’s event, with the theme ‘Young Women and Breast Cancer: Challenges and Answers’, took place at the National Institute of Perinatology in Mexico City.
This was the first time the symposium focused almost entirely on young women. The reasons for this emphasis were reported on by many national and global experts, who also presented evidence to show that breast cancer has become a leading cause of death among younger women in Mexico, and conveyed the benefits of early breast cancer detection and the need to create innovative solutions for care and survivorship support for this age group.
Over the course of one-and-a-half days, the symposium covered a wide range of topics and perspectives, including the epidemiology, biology, and genetics of breast cancer; challenges; and innovative answers to early detection and the myriad of short- and long-term challenges faced by patients with breast cancer, such as some cutting-edge techniques used to preserve fertility in women undergoing chemotherapy.
How the presence of local and global stakeholders will ensure the accountability of the multiple participants already immersed in the various areas of research and activities related to breast cancer. The voices of the Ministry of Health and of other institutions central to the Mexican health system show that there is a political will for work in this area, and there are the means to make a change happen.
breast cancer; young women; early detection; survivorship
Although thymomas are the most frequent primary tumours of the anterior mediastinum, thymic carcinoma is very infrequent and more aggressive. Combination chemotherapy is the first-line treatment for the advanced stages, but because of the lack of evidence from randomised trials, the management of the successive lines is a challenging field. We report a partial radiological response in the seventh line of a thymic carcinoma stage IV with an oral regimen.
metronomics; recurrent thymic carcinoma; treatment
We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said ‘in the middle of difficulty lies opportunity’ and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.
palliative care; global challenge; pain; education; implementation; Africa; Rwanda
Home-based palliative care is a recognised model of health service provision globally, but is just emerging in Nigeria. The aim of this study isto review the spectrum of adult cancer patients involved in home-based palliative care, the services provided, outcome and benefits.
Records of all adult cancer patients seen on home-based palliative care between March 2009 and January 2013 by the hospice and palliative care unit, University College Hospital (UCH), Ibadan were reviewed. Their biographical data, days on programme, diagnosis, stage of disease, major complaint, pain score, other symptoms, services offered, number of home visits, follow-up, and outcomes were extracted, reviewed, and analysed. The data were analysed using SPSS version 16.0.
Sixty patients were enrolled during the study period: there were 20 (33.3%) males and 40 (66.7%) females out of a total of 787 patients. All of them reside within catchment area of the hospice. Breast and prostate cancer constitute 21.7% each, gastrointestinal 16.7%, liver 11.7%, and cervical cancer 10.0%. Homes were visited 1–23 times per person. Days on programme ranged from 9–1207 days (average: 286 days). Pain was reported by 52 (86.7%) with scores of 7 to10 in 26 (50.0%). Only eight (13.3%) were pain-free. Services offered included pain and other symptom control, counselling and training for carers at home, provision of funds and comfort packs, bereavement services. The cost of services was heavily subsidised by the Centre for Palliative Care, Nigeria (CPCN), a non-governmental organisation and UCH. Although all patients are now deceased, the compassionate care received at a subsidised cost was highly valued, as shown from the appreciative comments of relations and carers.
Home-based palliative care provided at low cost was beneficial to patients and their families. More can be achieved through the training of more health professionals, increased funding, and increased public awareness of the services.
home-based palliative care; services; benefits
The need for palliative care education remains vital to contribute to the quality of life of patients, both adults and children, with cancer in Africa. The number of patients with cancer continues to rise, and with them the burden of palliative care needs. Palliative care has been present in Africa for nearly four decades, and a number of services are developing in response to the HIV/AIDS epidemic. However, the needs of cancer patients remain a challenge. Education and training initiatives have developed throughout this time, using a combination of educational methods, including, more recently, e-learning initiatives.
The role of international and national organisations in supporting education has been pivotal in developing models of education and training that are robust, sustainable, and affordable. Developing a material for education and professional development needs to continue in close collaboration with that already in production in order to optimise available resources. Seeking ways to evaluate programmes in terms of their impact on patient care remains an important part of programme delivery. This article reviews the current situation.
palliative care; education; e-learning; policy; professional development; outcome measurement; Africa
Sudan is facing an increasing number of cancer patients every year, and cancer is now among the top ten killer diseases in the country. The majority of cancer patients are diagnosed with an advanced type of cancer where curative treatment has little, if any, effect. The need for palliative care (PC) is urgent. In spite of this, there is no established programme for comprehensive cancer control in the country. In this article we review the state of PC services available for cancer patients.
A PC service started in 2010 as an outpatient service at the main oncology centre in Sudan. With the help of international bodies, several training activities in PC were held. Currently the service includes an outpatient clinic, a nine-bed ward, and a limited home-care service. PC has started to reach two other hospitals in the country.
Unfortunately, the need is still great; the services provided are not fully supported by the hospital administration. And even now, thousands of patients outside the cities of Khartoum and Medani have no access to oral morphine.
Sudan; cancer; palliative care; palliative care unit; services; training
Paediatric palliative care is an emerging subspecialty that focuses on achieving the best possible quality of life for children with life-limiting conditions and also for their families. It is a response to the suffering and unique needs of such children. Globally there is limited documented data available on the palliative care needs of children with HIV. A retrospective review of data of all the HIV exposed and positive children who were admitted to the ward from January to December 2012 was done to document their palliative care needs.
A total of 243 children were admitted to the ward during the stated period. Of these, 139 (57.2%) were female and 104 (42.8%) were male. Among them 131 (54%) were aged five years and below whereas 112 (46%) were above five years. Some of the identified palliative care needs documented included physical needs: pneumonia 46 (19%), severe acute malnutrition 38 (16%), mild and moderate acute malnutrition 23 (9.6%), and respiratory tract infections 22 (9.3%). Social needs: poor social support 21 (41%), financial instability 16 (31%), and child neglect 4 (8%). Psychological needs: antiretroviral treatment (ART) counselling 127 (36%), HIV counselling and testing for the child and family 63 (18%), adherence support 53 (15%), and others 11 (3%). Spiritual needs: discontinuing ART because of belief in spiritual healing 18 (81%), loss of hope because of severe ill health 1 (5%), and others 3 (14%).
These results emphasise the need for palliative care in children with HIV even in the era of ART. The needs identified are in keeping with studies done elsewhere and are similar to the palliative care needs of children with other life-limiting illnesses such as cancer.
HIV positive and exposed children plus their families have vast palliative care needs and a holistic approach is the key in their management.
paediatric palliative care; HIV infected and exposed children; paediatric palliative care needs
Chemoprevention or the now more preferred ‘cancer prevention’ is the long-term administration of a biological or chemical agent to reduce the risk of cancer. This approach has long been active in individuals at high risk of developing breast or colon cancer. The aim of this expert meeting was to review the current status of the field of cancer prevention and potential, emerging biomarkers specifically focusing on breast, colon, and lung cancer but also with sessions on ovary and prostate.
cancer prevention; biomarkers; eurocanplatform; prevention trials
The aim of this article is to describe cancer education in Lithuania according to the data of 2013.
In Lithuania, there are the following stages of education for physicians: basic education through integrated studies of medicine (six years), postgraduate education through residency studies (four to five years), and continuing professional development.
In recent years, integrated studies of medicine have been the most popular specialty. Oncology is incorporated into the teaching courses in medicine programmes. In each university, an oncology course is mandatory during these studies.
In Lithuania, there are two types of specialists related to oncology: medical oncologists and radiation oncologists. These oncologists complete multidisciplinary residency study programmes in the clinics.
To receive a doctoral degree, specialists may join PhD programmes at any of the accredited universities. In recent years the number of dissertations in oncology has grown. Notably, oncology is chosen not only by students in the field of medicine. It also becomes the choice of those seeking a doctorate in the fields of nursing, public health, biochemistry, and physics.
The professional development of oncologists is a lifelong commitment. In Lithuania, continuing specialist medical training is mandatory. This requirement is ensured with the process of licensing of medical practice.
All Lithuanian study programmes are certificated by an independent public agency and are recognised by a number of other countries as well.
cancer education; Lithuania; oncological educational programmes
To define immunoscore in bladder cancer studying T helper 1 (Th1) immunoreaction. To define a cancer-specific survival model based on Th1 cells infiltration.
A total of 252 patients underwent primary transurethral resection of bladder tumour at our Institution. A retrospective review of a selected cohort with pT1 and muscle-invasive bladder cancer (MIBC) lesions was performed. Pathology blocks were marked with CD3 and CD8 antibodies. Immune cells density in stromal reaction (SR) was measured on five distinct high-power field (HPF) by two dedicated uro-pathologist blinded for patients’ evolution.
Student test or non-parametric Wilcoxon test as appropriate to compare means between two groups. Receiver operating characteristics (ROC) curve to define markers threshold. Cox model to assess survival’s predictors.
Ten pT1 and 20 MIBC consecutive cases were analysed. Median follow-up was 33.4 months. Immunohistological analysis for pT1 lesions featured limited SR. For MIBC, the mean density of lymphocytes in the SR was of 105/HPF (CD3) and 86/HPF (CD8). Survivors harboured higher lymphocytes densities versus non survivors (CD3: p = 0.0319; CD8: p = 0.0279). CD3 (p = 0.034) and CD8 (p = 0.034) lymphocytes densities were independently associated with cancer-specific survival on Cox model analyses. The retrospective design and small size of cohorts are the study limitations.
High CD3 and CD8 lymphocytes SR densities are associated with better cancer-specific survival for MIBC. Th1 reaction against the tumour seems to be protective for bladder cancer. Further evaluation is warranted.
bladder cancer; immune reaction; immunohistochemistry; markers; prognosis; tumor infiltrating lympocytes; immunoscore
Cancer is one of the most important diseases in Chile, with alarming incidence and mortality rates that are among the highest in Latin America. Economic growth in South America has led to demographic change, with an aging population typical of developed countries, but also a growing population with cancer. The incidence and mortality of urological cancers in Chile is significant, and has led to the formulation of health laws and policies promoting the early treatment of urological cancers. It is also well known that there are regions of Chile with extremely high incidence and mortality of bladder cancer caused by arsenic exposure. SLAURO (Simposio Latinoamericano de Urología Oncológica [Latin American Oncological Urology Symposium]) is a new Latin American forum for discussing and promoting knowledge of urological cancers across the region.
Cimetidine, the first H2 receptor antagonist in widespread clinical use, has anti-cancer properties that have been elucidated in a broad range of pre-clinical and clinical studies for a number of different cancer types. These data are summarised and discussed in relation to a number of distinct mechanisms of action. Based on the evidence presented, it is proposed that cimetidine would synergise with a range of other drugs, including existing chemotherapeutics, and that further exploration of the potential of cimetidine as an anti-cancer therapeutic is warranted. Furthermore, there is compelling evidence that cimetidine administration during the peri-operative period may provide a survival benefit in some cancers. A number of possible combinations with other drugs are discussed in the supplementary material accompanying this paper.
drug repurposing; cimetidine; immunostimulant; ReDO project
Elderly patients (65 or older) with cervical cancer often receive suboptimal radio-chemotherapy. Intensity-modulated radiotherapy (IMRT) may improve tolerance to treatment in this setting. This study was designed to compare the treatment-related toxicities and compliance with treatment in patients of cervical cancer treated definitively with RapidArc IMRT in our institute.
Methods and materials
The treatment records of all patients treated with RapidArc IMRT between April 2012 and April 2014 were reviewed, retrospectively. Prospectively collected data regarding treatment toxicity (CTCAE 4.0), treatment outcomes and parameters related to treatment compliance were compared amongst two age groups (< 65 and ≥ 65 years). The results of 66 patients were identified, of whom 23 were found to be ≥ 65 years age. All patients completed planned external beam radiotherapy. However, significantly fewer patients in the elderly group received concurrent chemoradiation (98% versus 65%, p < 0.001). Old age (median 75 years, IQR: 74–78 years) was the commonest cause for non-receipt of chemotherapy. Incidence of grade 3 haematological toxicities (26.7% versus 16.7%) and gastrointestinal toxicity (16.7% versus 13.3%) were not significantly different between the two groups. Other treatment-related toxicities, breaks, treatment duration and early outcomes were also not significantly different between the two age groups.
The use of IMRT did not result in excess toxicities in the elderly population and was associated with equivalent compliance to treatment. Concurrent chemoradiation can be safely combined in elderly patients with perfect organ function and performance status.
uterine cervical neoplasms; aged; chemoradiation; intensity-modulated radiotherapy; toxicity
The ninth conference of the International Institute for Anticancer Research, held in Sithonia, Greece in October 2014, included over 700 abstracts presented in 79 separate sessions and featured a wide range of topics in basic and clinical cancer research. This report describes a small but representative sample of these sessions. It covers some recent developments in research into the basic signal transduction pathways involved in carcinogenesis; a special session on the role of homeobox genes in cancer development; and clinical sessions covering advances in breast cancer, haematological cancers, and chemotherapy.
International Institute for Anticancer Research Conference; clinical chemotherapy; signal transduction; HOX genes; leukaemia; lymphoma; breast cancer
Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step.
drug uptake; European Medicines Agency (EMA); European Union; marketing authorization; pricing and reimbursement; prescription and compliance
Human papilloma virus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) is associated with a favourable prognosis, although approximately 20–25% of patients ultimately develop recurrent cancer. Most disease recurrence events appear within 3 years; however, long-term follow-up of reported studies are limited, and the risk of late recurrence is unknown. We present a case report of a patient who developed distant metastases of HPV-related SCC 11 years after initial diagnosis and treatment of HPV-related OPSCC. Late disease recurrence may occur after initial diagnosis of HPV-related OPSCC. This observation has implications on the appropriate duration of follow-up and surveillance of these patients.
oropharynx; human papilloma virus; p16
The European Oncology Nursing Society (EONS), in partnership with the Oncology Nursing Association of Turkey (TONA), organised the 9th EONS Congress in Istanbul, Turkey, 18–19 September 2014. The Congress venue was in Harbiye Cultural Centre and Istanbul Military Museum and offered two days of unprecedented scientific, educational, and networking opportunities for all stakeholders active in the field of oncology nursing around the world.
EONS is a pan-European organisation dedicated to the support and development of cancer nurses. Through individual members and national societies EONS engages in projects to help nurses develop their skills, network with each other, and raise the profile of cancer nursing across Europe.
This biennial Congress brings together cancer nurses across the globe from many fields of expertise to ‘Celebrate Excellence in Cancer Nursing’ through interactive sessions, lectures, and collegial networking. The format was specifically designed to meet the needs of nurses working in the field of cancer care, education, and research.
9th EONS Congress; conference highlights; oncology nursing
This is the case of a 47-year-old woman diagnosed with chemotherapy and radiation-refractory BRAF V600E mutant, poorly differentiated intrahepatic cholangiocarcinoma (ICC), with multiple metastatic lesions within the liver, lungs, pleura, and bone, stage IV. Discussion of her malignancy’s next-generation sequencing genomic information at a multidisciplinary molecular tumour board took place. The patient was considered a suitable candidate for dual BRAF and MEK inhibition, with the intent to prolong her survival and optimize the quality of life. We report her excellent tolerance and exceptional response to dual therapy with dabrafenib and trametinib, including symptomatic and sustained near-complete radiological improvement. We also briefly review the current knowledge of the genomics of cholangiocarcinoma with a focus on BRAF mutations, and make a point of the importance of the establishment of a molecular tumour board for personalized genomic medicine approaches. To our knowledge, this is the first reported case of the use of personalized genomic information for the successful management of a patient with ICC, and it is also the first description of dual BRAF and MEK targeted therapy in this malignancy, leading to what is considered an exceptional response.
BRAF; cholangiocarcinoma; dabrafenib; exceptional responder; genomic medicine; MEK; molecular tumour board; next-generation sequencing; personalized medicine; trametinib
Major differences exist in the nature of leukaemia and lymphoma in low-income African children compared to those in the high-income countries. These include the absence of the peak incidence of acute lymphoblastic leukaemia (ALL) in under-five-year olds that characterizes the disease in high-income countries. Conversely, chloroma association with acute myelogenous leukaemia (CA-AML/AMML) and Burkitt’s lymphoma (BL) are rare in the high-income countries. This report describes clinical and laboratory as well as epidemiological features of childhood leukaemia and lymphoma reported betwen 1982 and 1984 in the city of Ibadan, Nigeria. The observed pattern of distribution of childhood haematological malignancies in the city is more consistent with the observations of Ludwik Gross’s experiments on environmental influences, such as malnutrition and infections, animal leukaemogenesis, and mirroring the consequences of the primordial pressures that have shaped human genetics and pathophysiology.
childhood leukaemia; lymphoblastic; environmental factors; chloroma; leukaemogenesis; socio-economic; lifestyle
Cystic hypersecretory pattern is a rare and poorly recognised variant of invasive ductal carcinoma of the breast. Cystic hypersecretory lesions of the breast have a spectrum of morphological features ranging from clearly benign cystic hypersecretory hyperplasia (CHH), CHH with atypia, cystic hypersecretory carcinoma (CHC) to invasive CHC. Until now, no case of invasive CHC has been reported in India, to the best of our knowledge. We report a case of a 57-year-old female with a history of a lump in the inferomedial quadrant of the right breast for three years, gradually increasing in size. A mammography showed a well-defined, lobulated radio-opacity. A modified radical mastectomy was done. Gross examination showed multiple cystic spaces filled with thick gelatinous material and solid areas. On histopathology, cystic hypersecretory variant of invasive ductal breast carcinoma with focal papillary pattern was diagnosed. Cystic hypersecretory ductal carcinoma behaves in a low-grade fashion for many years but has a potential for invasiveness and metastasis, so regular follow-up of such cases is crucial.
breast; carcinoma; mastectomy