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|Year : 2020 | Volume
| Issue : 2 | Page : 224-227
News from the world of oncology
|Date of Submission||24-Apr-2020|
|Date of Decision||24-Apr-2020|
|Date of Acceptance||25-Apr-2020|
|Date of Web Publication||17-May-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. News from the world of oncology. Indian J Cancer 2020;57:224-7
| » Swiss Smart Bra: a New Cancer Screening Modality|| |
Breast cancer is the most frequent cause of cancer death in women worldwide. Although majority of the breast cancers in US are detected by screening, even then, it remains the second most common cause of cancer death there. The situation is much worse in India where majority of the breast cancers come to the notice only when symptomatic. To cut the long story short, screening, which is the cancer detection method/procedure, in asymptomatic women results in the detection of cancer at the earliest possible stage to achieve better treatment outcomes. Presently available methods for screening are sonomammography, X-ray mammography, tomosynthesis, and MR mammography. All modalities have their absolute and relative indications and certain contraindications. Of course, the one with minimum side effects is sonomammography. Efforts to improve the accuracy and accessibility of sonomammography will be the most user-friendly step. One such smart move is attempted by students from the Swiss university. According to a news published in “healthcare-in-europe.com ” on Apr 7, 2020, this smart-clothing technology is fitted with multiple small piezoelectric crystals along with a plastic material which will act as a lubricant, designed to detect cancer at the earliest stages. It uses a noninvasive, painless method based on frequent ultrasound monitoring. Researchers of this award-winning innovation claim that the bra will be out in the market in 2021. The first target population will be the already diagnosed patients undergoing systemic treatment, where they can monitor the tumor size on a daily basis. Thereafter, the product will be opened to the high-risk ladies with a strong genetic predisposition and finally, it will be accessible to anyone who is interested. Technically, it will be a miniature ultrasound, which will continuously monitor the breast tissue. The user will get alerted in case a suspicious mass is perceived by the sensor.
Right now, the field of screening mammography is looking forward to the revolutionary advancements through artificial intelligence, which is going to impact the healthcare sector in a big way. Smart bra technology, being devoid of radiation exposure can totally transform this further. Researchers also claim that apart from early detection, this technology may have some therapeutic role in the form of inducing apoptosis in the cancerous cells; however, there is no scientific evidence to support such a claim. In the opinion of a medical oncologist from Udaipur, Dr. Manoj Mahajan “If proven clinically successful in the needy patients, this technique will not only alleviate procedure-related pain associated with current screening methods but also reduce or avoid the cumulative radiation exposure for screening by X-ray mammography. ” Of course, this sounds interesting and promising, but bringing anything from bench to bedside in medicine requires well planned randomized clinical trials. Hence, whether and when such a modality gets its way through up to an oncologist's prescription pad is a question the time will have to answer.
HS Darling, Gurugram
| » Childhood Cancers Need Additional Investment to Prevent 6 Million Deaths Worldwide by 2050|| |
A multi-centric study titled “Sustainable care for children with cancer ” by Rifat Atun, Nickhill Bhakta and others published in Lancet Oncology (2020, Vol 21, No 4, e185-e224) on 30th March 2020 has emphasized on the need for additional investment in pediatric cancer management. The study included centers from North America, Europe, Asia, South America, Africa, and Australia. From India, Tata Memorial Hospital and Max Superspecialty hospitals participated in the study.
The study estimates that around 11 million children (84% of these from low and lower-middle income group countries) who are less than 14 years of age will die in next 30 years if additional investment and focus is not made toward this age group. Although it is believed that the cost of cancer treatment for pediatric age group is high along with it being unattainable and inappropriate as there are other medical priorities that need to be taken care of, Prof Rifat Atun, Harvard T.H. Chan School of Public Health, USA, Co-chair of the Commission rejects the assumption as a misconception. Despite improvement in diagnosis, treatment, supportive care, and improved cure rates of many pediatric cancers, there is a wide gap in the investments made and access to care worldwide. The children of high-income countries have >80% survival rates as compare to <30% 5-year survival rates in low-income countries and around 8% 5-year survival rates in Africa.
The study further reveals that the treatment of children with cancer is not only feasible but also a highly cost-effective investment. Appropriate investment at this time can prevent 6 million deaths of children leading to US$2 trillion economic benefits over the next 30 years. The return on investment would be three times the funds that need to be invested. The actions will be required to be implemented not only by governments and international organizations but at various levels like civil society, professional associations, philanthropic organizations, and private sector.
The recommended actions are as follows:
- Incorporating childhood cancers into essential benefits package when expanding universal health coverage
- Developing national cancer control programs and providing predictable financing to ensure the development of sustainable cancer care for children
- Elimination of out-of-pocket expenses for children with cancer to curb catastrophic expenses and abandonment of treatment
- Expansion of access to effective services for childhood cancers by establishing cancer networks
- Investments in the development of cancer registries that incorporate pediatric cancers
- Investment in research, development, and innovation.
The significance of the study as per Dr C.P. Raghuram, consultant pediatric oncologist, Bangalore is that “the paper has quantified the possible number of children with cancer, made projections for future, and possible solution for the current problems. ” But he cautions that the study is very aspirational and “to achieve the objectives, it will need more allocation of resources and funding. ” On being asked about what is being done in India on this front, he added that, “Treatment of cancer in children is covered under the national insurance schemes which is of great help. Programs have been initiated to reduce the abandonment of treatment. ” He adds that, “There is a need to increase the accessibility of pediatric oncology services to improve the overall survival for childhood cancer. ”
Neha Chauhan, Bangalore
| » Gender-Neutral Vaccination Strategy for Eradication of Human Papilloma Virus-Induced Cancers|| |
Human Papilloma Virus (HPV) vaccines of high vaccine efficacy were introduced more than 10 years ago. However, due to poor implementation of vaccination programs against HPV in girls varying from 25%–90% in different countries, a gender-neutral vaccination is being thought of in some countries to protect boys from HPV-related diseases, including cancer. The concept is based on the principle of herd immunity, where a certain level of the population-level immunity confers protection to other individuals who are at risk of developing the disease in question.
A brief report on this was submitted by Vänskä S, Luostarinen T, Baussano I, Apter D, Eriksson T, Natunen K, et al. in an article titled “Vaccination with moderate coverage eradicates oncogenic human papillomaviruses if a gender-neutral strategy is applied, ” published on the 12th of March 2020 in the Journal of Infectious Diseases (2020, DOI-10.1093/infdis/jiaa099, pages 1-9). This article has explored the potential herd effect of the HPV gender-neutral vaccine in Finland. This study was conducted in 33 communities that compared the effectiveness of HPV vaccination of girls only versus both boys and girls.
A three-pronged approach of 11 communities each from the Finnish Population Registry was used to compare the potential herd effects of HPV vaccine in the communities. The first arm consisted of 11 communities with gender-neutral HPV vaccination, where more 90% of the boys and girls received HPV 16/18 (AS04 adjuvanted-Cervarix vaccine) along with 10% vaccination with Hepatitis B virus (Engerix) Vaccine. The second arm consisted of 11 communities where 90% of girls were vaccinated with the HPV vaccine and Hepatitis B vaccine was given to all boys and 10% of the girls. The third arm consisted of 11 communities where all boys and girls received only HBV Vaccine. This comparison was made for birth cohorts of 1992 to 1995 and 1995 in these 33 communities using mathematical modelling for the derivation of potential herd immunity and protective effects.
The herd immunity and protective effects were significantly higher among gender-neutral arm to the tune of 150% and 40%, respectively, among the 1995 birth cohort for HPV 18/31/33. Since HPV 18/31/33 are faster clearing viruses with a vaccine, 95% vaccine efficacy, the gender-neutral strategy reaps more benefits in terms of herd immunity. However, for the eradication of HPV 16, 95% coverage of girls would be required to achieve herd effects. The same herd effects would require only 75% coverage forecasted the elimination of HPV 16 if only the gender-neutral strategy were to be implemented.
Ankeeta Menona Jacob, Mangalore
ORCID ID: 0000-0002-9839-3556
| » Covid-19 and Clinical Trials in Oncology|| |
COVID-19, a pneumonia-causing illness is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was initially identified in Wuhan, a city in China, in the end of year 2019 and later spread all over the world. It was declared as pandemic by WHO on 12 Mar 2020. While the whole world is struggling to control the direct brunt of this disease at present, there are many long-term social, economical, cultural, and developmental consequences which the mankind will be dealing with in the future.
Oncology is one of the fastest developing and most challenging branches of medicine. As on April 2020 alone, the ClinicalTrials.gov, the largest clinical trials database in the world, has 335,815 registered studies from 210 countries. Out of these, 83308 are in oncology only. There are many such databases from different countries which are also conducting thousands of oncology studies. The frequency and timing of visits, samplings, interventions, data recording, timely drug administrations, and follow-ups in the patients under clinical trials are of paramount importance. In the current COVID scenario, there are lockdowns in most part of the world with only essential services running to the bare minimum extent. The restricted number of patient healthcare interactions and limited transportation will definitely jeopardize the strict trial protocols, which may ultimately affect the trial results significantly. The delays and/or alterations in the treatment of cancer patients may affect their quality of life and survival. Moreover, most of the cancer patients being immunocompromised are also potentially vulnerable to contract the coronavirus disease.
Keeping this in view, the USFDA issued “A Message to Patients with Cancer and Health Care Providers about COVID-19 ” on 23 Mar 2020, assuring the oncology community of continuing to expedite oncology product development. However, it has reckoned that modifications may be required in clinical trials. The National Cancer Institute (NCI) has also issued interim guidelines for participating practitioners to amend protocols and practices in their new drug trials. The NCI website has asked the Institutional Review Boards that oversee each protocol to ensure the safety of patients to work with investigators quickly to make changes that will provide flexibility while maintaining patient safety. At the same time, precautionary instructions for cancer patients have also been issued considering the current unprecedented hazard. In a telecommunication with Dr. Amit Dhiman, Director Medical and Hemato-oncology, DEEP Hospital, Ludhiana (Punjab), he shared “What I feel the major challenge in treating cancer patient in a clinical trial is many screening visits and compliance in visits as required in the trials. Another issue which we are facing is the procurement of the study drug and transportation of the same. As we are trying to limit the exposure of the patient to hospital so clinical trials are little on backfoot in our mind. Treatment of metastatic disease is what we can postpone or keep patients on oral treatment or symptomatic treatment. But for curable young patients, I am trying to give the best possible treatment. ”
HS Darling, Gurugram
| » Transmission of Sars-Cov-2 in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China|| |
A research letter published online titled “SARS-CoV-2 Transmission in Patients with Cancer at a Tertiary Care Hospital in Wuhan, China ” on March 25, 2020 by JAMA Oncology (2020 Mar 25: e200980; DOI: 10.1001/jamaoncol. 2020.0980) has implicated hospital admission and recurrent hospital visits as potential risk factors for severe adult respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in cancer patients based on which the authors Jing Yu, Wen Ouyang, Melvin L. K. Chua, and Conghua Xie have proposed that aggressive measures should be undertaken to reduce frequent hospital visits and admissions of patients with cancer during this viral pandemic and for patients undergoing active treatment, proper isolation protocols must be in place to mitigate the risk of SARS-CoV-2 infection.
This retrospective study was conducted during the treatment course of 1524 cancer patients who were admitted to the Department of Radiation and Medical Oncology of a Tertiary Care Hospital of Wuhan between December 30, 2019 to February 17th, 2020 (around a month and half). An outbreak of 2019 novel coronavirus disease (COVID-19) occurred in Wuhan, Hubei, which has been linked to the SARS-CoV-2 with rapid human-to-human transmission from droplet contamination. The rate of infection of SARS-CoV-2 in patients with cancer from this institution at less than one percent (12 of 1524) was more than double the cumulative incidence of all diagnosed COVID-19 cases that was reported in the city of Wuhan over the same time period. Patients with cancer may be susceptible to infection during a viral epidemic owing to their immune-compromised status.
The median age of infected patients was 66 years (range: 48–78 years) with 8 of the 12 patients (66.7%) older than 60 years, implying older patients (>60 years) may be at a greater risk of COVID-19. Seven of the 12 (58.3%) infected had nonsmall cell lung carcinoma (NSCLC) further suggesting that patients with NSCLC were more vulnerable. Five (41.7%) of them were being treated with either chemotherapy with or without immunotherapy or radiotherapy. Meaning to say less than half of those infected were actually undergoing active treatment for their cancers. Hospital visits for the rest could easily be avoided. Three of these patients (25.0%) developed SARS and 1 among them required intensive-level care. Nearing the end of the study, 6 (50.0%) had been discharged, whereas 3 deaths (25.0%) were recorded.
Tom McNalley, Clinical Fellow in Hospice and Palliative Medicine, University of California, San Francisco says “The work of caring for patients goes on, even and especially in the times of COVID-19. This research helps reinforce that procedures and protocols need to be put in place to protect patients with cancer during the pandemic, and raises the question—if it might be better in some cases to postpone active chemotherapy. ” Way forward, he further suggested, “As communities relax quarantines but consider keeping higher-risk patients in 'shelter-in-place,' persons with a history of cancer as well as those undergoing active treatment must be counted among those who need to be isolated. ”
Some of the findings of this study may not be in line with larger general population study, namely, age not being associated with susceptibility to infection for the resolution of which, larger sample size needs to be deployed.