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Tag: Medical Meetings

  • New Research Highlights Superior Long-Term Survival with Multi-Arterial Coronary Artery Bypass Grafting Over Single Arterial Grafting

    New Research Highlights Superior Long-Term Survival with Multi-Arterial Coronary Artery Bypass Grafting Over Single Arterial Grafting


    Newswise — SAN ANTONIO (January 27, 2024) ─ A new study presented at The Society of Thoracic Surgeons’ 2024 Annual Meeting in San Antonio, Texas, examines the ongoing controversy surrounding the choice between multi-arterial grafting (MAG) and single arterial grafting (SAG) in coronary artery bypass grafting (CABG) for multivessel coronary revascularization.

    The research, spanning from 2008 to 2019 and involving over one million patients undergoing isolated CABG with more than two bypass grafts, found that multi-arterial grafting CABG is associated with superior long-term survival compared to single arterial grafting, establishing it as the preferred surgical strategy for multivessel revascularization. 

    “Multiple small studies have demonstrated a survival benefit of multi-arterial grafting. We wanted to know if this survival benefit of multi-arterial grafting observed in single-center studies would translate to a large national cohort,” said the study’s lead author, Joseph Sabik III, MD, University Hospitals.  “Using the STS Adult Cardiac Surgery Database, we were able to demonstrate that it does.”

     At 10 years, MAG demonstrated improved unadjusted (HR 0.59, 95% CI 0.58-0.61) and adjusted (HR 0.86, 95% CI 0.85-0.88) survival rates compared to SAG. A center volume of 10 or more MAG cases per year was associated with survival benefits. 

    MAG’s survival advantage over SAG was found in various subgroups, including stable coronary disease, acute coronary syndrome, and acute infarction. Notably, MAG showed superior survival for patients with a BMI less than 40, whereas patients with a BMI of 40 or higher had superior survival with SAG. Survival outcomes were equivalent between MAG and SAG for patients aged 80 years or older, and those with severe heart failure, renal failure, peripheral vascular disease, or obesity.

    Patient data was collected from the STS Adult Cardiac Surgery Database and linked to the National Death Index for comprehensive longitudinal survival analysis. Risk-adjustment measures, including inverse probability weighting and multivariable modeling, were implemented to ensure accurate comparisons.

    These findings have significant implications for clinicians and cardiac surgeons when deciding on the most appropriate multivessel revascularization approach.

    “The survival benefit of multi-arterial grafting was observed in nearly all patients, except in those 80 or older and in those with co-morbidities graded as severe, where multi and single-arterial grafting resulted in similar survival. The only patients where single arterial grafting resulted in better survival were severely obese,” said Dr. Sabik. 

     

    This research not only contributes valuable insights to the ongoing debate but also provides evidence-based guidance for healthcare professionals in optimizing patient outcomes during CABG procedures.

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    Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,700 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.





    The Society of Thoracic Surgeons

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  • STS Announces Late-Breaker Research to Be Presented at the 2024 Annual Meeting

    STS Announces Late-Breaker Research to Be Presented at the 2024 Annual Meeting

    Newswise — SAN ANTONIO (January 27, 2024) — The Society of Thoracic Surgeons has released late-breaking research scheduled for presentation at the 2024 Annual Meeting taking place January 27 – 29 in San Antonio. The conference, healthcare’s leading scientific and educational convening specializing in cardiothoracic surgery, has a rich history of showcasing clinical trials with a strong foundation of detailed methodology and trusted data collection governed by ethical clinical principles.

    The event’s late-breaking trial sessions focus on studies anticipated to significantly influence advances in cardiothoracic patient care. In this fast-paced healthcare landscape, surgeons look for the latest evidence to identify new therapies or preventive measures and help inform the most effective treatment decisions.  

    Key late-breaking studies selected for presentation include:

    Longitudinal Follow-up of Elderly Patients After Esophageal Cancer Resection in the Society of Thoracic Surgeons General Thoracic Surgery Database

    The study defines characteristics associated with long-term survival following esophagectomy for cancer in the Medicare population, using the STS General Thoracic Surgery Database linked to Centers for Medicare and Medicaid Services data. The analysis included 4,798 patients from 207 STS sites who underwent esophagectomy between 2012-2019. The researchers found that Medicare patients undergoing esophagectomy for cancer exhibit identifiable predictors for long-term survival and readmission. The absence of pathologic T and N downstaging increases the risk for long-term mortality and readmission.

    These findings suggest opportunities to enhance clinical practice and improve outcomes for Medicare patients undergoing esophagectomy for cancer.

    Cardiac Surgery after Transcatheter Aortic Valve Replacement: Trends and Outcomes

    The researchers set out to document trends and outcomes in cardiac surgery following transcatheter aortic valve replacement (TAVR), a topic gaining importance as reports of subsequent cardiac operations and early TAVR explantations increase. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the study covers adult patients who underwent cardiac surgery after an initial TAVR from January 2012 to March 2023.

    The findings underscore the escalating need for both aortic and non-aortic valve cardiac surgeries following TAVR. They note a substantial increase in the frequency of these surgeries, emphasizing the importance of understanding outcomes. The observed elevated risk in these cases, as indicated by mortality and stroke rates, calls for careful consideration, particularly given the expanding use of TAVR across a broader range of age and risk profiles. The study suggests the need for ongoing assessment and longitudinal evidence to inform decision-making in the evolving landscape of TAVR applications.

    The STS 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation: Key Takeaways and How Do They Differ from the ACC/AHA Atrial Fibrillation Clinical Practice Guidelines?

    The Society of Thoracic Surgeons’ 2023 clinical practice guidelines for the surgical management of atrial fibrillation (AF) incorporates the latest evidence for surgical ablation (SA) and left atrial appendage occlusion (LAAO) across various clinical scenarios. It emphasizes the evolving role of surgical ablation and left atrial appendage occlusion in managing atrial fibrillation.

    Compared to the 2017 clinical practice guidelines, this latest version emphasizes SA in first-time, non-emergent cardiac surgery and its long-term benefits, an extension of the recommendation to perform SA in all patients with AF undergoing first-time, non-emergent cardiac surgery. Further guidance is provided for patients with structural heart disease and AF who are considered for transcatheter valve repair or replacement.

    The recommendations highlight the importance of a multidisciplinary team, comprehensive assessment, and long-term follow-up, with specific attention to diverse clinical scenarios. The Class I recommendation for LAAO and expanded use of SA signify the growing confidence in these interventions based on recent evidence.

    Impact of Surgical Factors on Event-Free Survival in the Randomized, Placebo-Controlled, Phase 3 Trial of Perioperative Pembrolizumab For Early-Stage Non-Small-Cell Lung Cancer

    New findings from the KEYNOTE-671 research study, focused on resectable early-stage non-small-cell lung cancer (NSCLC), have unveiled a significant breakthrough in the treatment landscape.

    The study, titled “Impact of Surgical-Related Data on Event-Free Survival in KEYNOTE-671,” demonstrated that neoadjuvant therapy with pembrolizumab plus chemotherapy did not delay surgery. Neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab provided meaningful improvement in EFS compared with neoadjuvant chemotherapy alone for resectable early-stage NSCLC regardless of clinical nodal status, baseline disease stage, or type of surgery.

    Note to editors: Abstracts are available upon request.

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    Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,700 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

    The Society of Thoracic Surgeons

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  • Landscape for AML Patients Evolving Rapidly as Research Discoveries Advance New Treatments

    Landscape for AML Patients Evolving Rapidly as Research Discoveries Advance New Treatments

    Newswise — MIAMI, FLORIDA (EMBARGOED UNTIL DEC. 10, 2023, AT 7:30 P.M. ET) – The treatment landscape for acute myeloid leukemia (AML) is evolving rapidly, as research discoveries at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and other academic cancer centers advance new, more effective therapies for this aggressive blood cancer. 

    “We’ve seen more progress during the past 10 years than the previous four decades combined,” said Justin M. Watts, M.D., Sylvester hematologist, associate professor of medicine, and Pap Corps Early Career Endowed Professor in Leukemia, “especially when it comes to treating older AML patients.”

    Watts, who serves as chief of the leukemia section at Sylvester, will highlight new drugs, such as Venetoclax plus Azacitidine, and new targeted therapies resulting from research advances when he leads an educational session at ASH 2023, the annual meeting of the American Society of Hematology in San Diego, Dec. 9-12.

    The session is designed to update community-based physicians who treat AML patients on current standards of care for using these new drugs sequentially or in triplet combinations with targeted inhibitors.  

    Background

    Acute myeloid leukemia is a cancer characterized by the rapid growth of abnormal cells that build up in the bone marrow and blood and interfere with normal blood-cell production. It’s one of the most common leukemia types in adults, although it’s fairly rare, accounting for about 1% of all cancers.

    It tends to afflict older adults, with 68 being the median age when first diagnosed, according to the American Cancer Society. Men are slightly more at risk than women.

    Typically, AML patients have been treated with intensive chemotherapy and a bone-marrow or stem-cell transplant. Those therapies are generally more effective in people under age 60. “We can cure about 60% of younger patients now, which is significantly better than just two decades ago,” said Watts. “But older patients, depending on their fitness level, don’t usually tolerate these treatments and historically less than 10 percent were cured, but this is now pushing 30% with the advent of venetoclax plus azacitidine and targeted inhibitors.”

    Until recently, next steps for these patients were limited to supportive care and blood transfusions, he added.

    Targeted Therapies for Mutations

    However, the outlook has improved, especially for older patients, with the emergence of new drugs and targeted inhibitors for the mutations driving AML, Watts says.

    “AML is almost always driven by mutations acquired over time,” he explained. “That’s why the risk of AML increases as we age.”

    Although there are hundreds of mutations that can cause this blood cancer, and most patients have more than one, there are five more common ones that are targetable: IDH1, IDH2, FLT3, NPM1 and MLL, Watts said. All of these now have approved therapies – or ones in development – thanks to ongoing research at Sylvester and other cancer centers.

    The results are encouraging. “We’re seeing very promising results in our studies and trials, combining Venetoclax, Azacitidine and targeted therapies, often as frontline therapy for AML,” he noted.

    Watts said the combination of Venetoclax and Azacitidine is producing good outcomes in about 52% of older patients, and the median survival is more than 2 years in these patients, with some patients living much longer.  

    Additionally, targeted therapies are proving effective, even in relapsed patients, and these treatments are also better tolerated than chemotherapy.

    Now, researchers like Watts and his colleagues must determine the best way to combine venetoclax and targeted therapies to produce the best outcomes. “That includes designing clinical trials to help us identify the optimal combinations for the right patients with specific mutations,” he explained, “and determining when we stop therapy for patients in a long remission.”

    On the Horizon

    Watts said that up to 50% of AML patients have a mutation for which there is no current targeted therapy. “We have to expand our targeted therapies to treat AML patients with harder to target mutations,” he explained, citing TP53 and RAS mutations as two common pathways for treatment resistance. “We currently have few approved therapies that are effective for these patients, especially if they are older.”

    Watts believes the future direction for AML treatment will involve targeted therapy combined with the “best backbone we have, possibly chemotherapy for younger patients or the drugs like venetoclax and azacitidine generating good results for older adults.”

    One of the biggest things that may come into play is immunotherapy, he said. “I can see us getting the immune system more involved in treating these blood cancers, as it has done with solid tumors and lymphoma.”

    Disclosures

    Dr. Watts serves on the consulting/advisory boards of Rigel, Servier, Celgene/BMS, Daiichi Sankyo, Aptose and Ativarre. He receives research funding from Takeda, Immune Systems Key Ltd, and Rigel.

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    ASH Presentation Title:

    “The Future Paradigm of HMA + VEN or Targeted Inhibitor Approaches: Sequencing or Triplet Combinations in AML Therapy”

    Presentation Date/Time:

    Sunday, Dec. 10, 2023, 7:30 to 8:45 pm ET (4:30 to 5:45 pm PT)

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    Sylvester Comprehensive Cancer Center

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  • ASH: Novel combination therapy significantly reduces spleen volume in patients with myelofibrosis

    ASH: Novel combination therapy significantly reduces spleen volume in patients with myelofibrosis

    Newswise — SAN DIEGO ― Combining the JAK inhibitor ruxolitinib with the BCL-xL inhibitor navitoclax was twice as effective in reducing enlarged spleens – a major indicator of clinical improvement – compared with standard-of-care ruxolitinib monotherapy for adult patients with intermediate or high-risk myelofibrosis, a rare bone marrow cancer, according to results of the Phase III TRANSFORM-1 trial reported by researchers from The University of Texas MD Anderson Cancer Center.

    Data from the global, randomized, placebo-controlled clinical trial were presented today at the 2023 American Society of Hematology (ASH) Annual Meeting by Naveen Pemmaraju, M.D.,  professor of Leukemia. At the time of data cut-off, 63.2% of patients who received ruxolitinib and navitoclax achieved a spleen volume reduction of at least 35% within 24 weeks, compared to 31.5% of patients receiving ruxolitinib plus placebo, meeting the study’s primary endpoint.

    “By adding a second drug to an approved therapy, we were able to improve spleen volume reduction compared to the current standard of care. This is an important measurement of the clinical benefits of this novel drug combination because treatments can be less effective when the spleen remains enlarged,” Pemmaraju said. “If we can treat myelofibrosis earlier on in the disease course, we may have an opportunity to impact overall disease modificationimprove patient outcomes and reduce symptom burden.”

    Currently, there are few Food and Drug Administration-approved drugs for the treatment of myelofibrosis. Available options provide patients with spleen and symptom improvement, but a substantial unmet need remains for therapies that provide durable spleen size reduction and other longer-term clinical. Allogenic stem cell transplants are an effective treatment option, but not all patients qualify.

    This international trial enrolled 252 patients with intermediate or high-risk myelofibrosis and measurable spleen enlargement who had not received prior JAK inhibitor treatment. The trial randomized 125 patients to receive the navitoclax and ruxolitinib combination and 127 patients to receive ruxolitinib plus placebo. Most patients were male (57%) and the median age was 69.

    The trial met its primary endpoint of spleen volume reduction at 24 weeks. Spleen volume reduction at any time was achieved by 77% of patients on the combination arm and 42% of patients on the control arm. The median time to first spleen volume reduction response was 12.3 weeks with the combination and 12.4 weeks with monotherapy. At 24 weeks, there were no significant differences between the groups in a myeloproliferative neoplasm symptom assessment, a secondary endpoint of the study.

    Patients treated with the combination therapy, patients experienced side effects that were manageable and consistent with previous trials. The most common treatment-related side effects were thrombocytopenia, anemia, diarrhea and neutropenia. Serious adverse events were experienced by 26% of patients on the combination arm and 32% on the control arm.

    “This study marks a notable achievement in the field of myelofibrosis, as one of the first reported global Phase III frontline randomized combination clinical trials in our field,” Pemmaraju said. “This dataset now opens the door for additional research and investigation into combination therapies to treat myelofibrosis and, importantly, highlights a potential new era of investigating disease modification for patients. Additional data from the TRANSFORM-1 study is being evaluated.”

    The trial was funded by AbbVie. Pemmaraju receives research support from AbbVie. A full list of co-authors and their disclosures may be found here.

    Read this press release in the MD Anderson Newsroom.

    University of Texas MD Anderson Cancer Center

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  • Wearable Ultrasound Monitor Can Aid Rehabilitation from Injury #Acoustics23

    Wearable Ultrasound Monitor Can Aid Rehabilitation from Injury #Acoustics23

    Newswise — SYDNEY, Dec. 5, 2023 – Millions suffer from musculoskeletal injuries every year, and the recovery process can often be long and difficult. Patients typically undergo rehabilitation, slowly rebuilding muscle strength as their injuries heal. Medical professionals routinely evaluate a patient’s progress via a series of tasks and exercises. However, because of the dynamic nature of these exercises, obtaining a clear picture of real-time muscle function is extremely challenging.

    Parag Chitnis of George Mason University led a team that developed a wearable ultrasound system that can produce clinically relevant information about muscle function during dynamic physical activity. He will present his work Dec. 5 at 5:00 p.m. Australian Eastern Daylight Time, as part of Acoustics 2023 running Dec. 4-8 at the International Convention Centre Sydney.

    Many medical technologies can give doctors a window into the inner workings of a patient’s body, but few can be used while that patient is moving. A wearable ultrasound monitor can move with the patient and provide an unprecedented level of insight into body dynamics.

    “For instance, when an individual is performing a specific exercise for rehabilitation, our devices can be used to ensure that the target muscle is actually being activated and used correctly,” said Chitnis. “Other applications include providing athletes with insights into their physical fitness and performance, assessing and guiding recovery of motor function in stroke patients, and assessing balance and stability in elderly populations during routine everyday tasks.”

    Designing a wearable ultrasound device took much more than simply strapping an existing ultrasound monitor to a patient. Chitnis and his team reinvented ultrasound technology nearly from scratch to produce the results they needed.

    “We had to completely change the paradigm of ultrasound imaging,” said Chitnis. “Traditionally, ultrasound systems transmit short-duration pulses, and the echo signals are used to make clinically usefully images. Our systems use a patented approach that relies on transmission of long-duration chirps, which allows us to perform ultrasound sensing using the same components one might find in their car radio.”

    This modified approach allowed the team to design a simpler, cheaper system that could be miniaturized and powered by batteries. This let them design an ultrasound monitor with a small, portable form factor that could be attached to a patient.

    Soon, Chitnis hopes to further improve his device and develop software tools to more quickly interpret and analyze the ultrasound signals.

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    ———————– MORE MEETING INFORMATION ———————–

    The Acoustical Society of America is joining the Australian Acoustical Society to co-host Acoustics 2023 in Sydney. This collaborative event will incorporate the Western Pacific Acoustics Conference and the Pacific Rim Underwater Acoustics Conference.

    Main meeting website: https://acoustics23sydney.org/ 
    Technical program: https://eppro01.ativ.me/src/EventPilot/php/express/web/planner.php?id=ASAFALL23     

    ASA PRESS ROOM

    In the coming weeks, ASA’s Press Room will be updated with newsworthy stories and the press conference schedule at https://acoustics.org/asa-press-room/. 

    LAY LANGUAGE PAPERS

    ASA will also share dozens of lay language papers about topics covered at the conference. Lay language papers are summaries (300-500 words) of presentations written by scientists for a general audience. They will be accompanied by photos, audio, and video. Learn more at https://acoustics.org/lay-language-papers/.

    PRESS REGISTRATION

    ASA will grant free registration to credentialed and professional freelance journalists. If you are a reporter and would like to attend the meeting or virtual press conferences, contact AIP Media Services at [email protected]. For urgent requests, AIP staff can also help with setting up interviews and obtaining images, sound clips, or background information.

    ABOUT THE ACOUSTICAL SOCIETY OF AMERICA

    The Acoustical Society of America (ASA) is the premier international scientific society in acoustics devoted to the science and technology of sound. Its 7,000 members worldwide represent a broad spectrum of the study of acoustics. ASA publications include The Journal of the Acoustical Society of America (the world’s leading journal on acoustics), JASA Express Letters, Proceedings of Meetings on Acoustics, Acoustics Today magazine, books, and standards on acoustics. The society also holds two major scientific meetings each year. See https://acousticalsociety.org/.

    ABOUT THE AUSTRALIAN ACOUSTICAL SOCIETY

    The Australian Acoustical Society (AAS) is the peak technical society for individuals working in acoustics in Australia. The AAS aims to promote and advance the science and practice of acoustics in all its branches to the wider community and provide support to acousticians. Its diverse membership is made up from academia, consultancies, industry, equipment manufacturers and retailers, and all levels of Government. The Society supports research and provides regular forums for those who practice or study acoustics across a wide range of fields The principal activities of the Society are technical meetings held by each State Division, annual conferences which are held by the State Divisions and the ASNZ in rotation, and publication of the journal Acoustics Australia. https://www.acoustics.org.au/ 

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    Acoustical Society of America (ASA)

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  • New Study Shows Insurance Coverage Disruptions Affect Key Cancer Screenings for U.S. Adults

    New Study Shows Insurance Coverage Disruptions Affect Key Cancer Screenings for U.S. Adults

    ASCO Quality Care Symposium Abstract #116

    Newswise — ATLANTA, October 28, 2023 — A new study by researchers at the American Cancer Society (ACS) shows that adults in the United States with prior insurance coverage disruptions are significantly less likely to receive guideline-concordant and past-year cancer screening, compared to people with continuous coverage. The guideline-concordant screening rates were 63.1% vs. 80.5% for breast cancer, 47.1% vs. 65.4% for colorectal cancer, and 73.1% vs. 80.0% for cervical cancer among people with private health insurance coverage. People without health insurance coverage had the lowest screening levels. The findings will be presented at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, October 27 – 28, 2023.

    In the study, researchers, led by Kewei Sylvia Shi, associate scientist in health services research at the American Cancer Society, identified adults in the U.S. eligible for breast, colorectal, and/or cervical cancer screening from the 2010, 2015, 2018, 2019, and 2021 National Health Interview Surveys. Adults were categorized into five groups based on insurance type at the time of the survey and prior coverage disruptions (defined as any lack of insurance during the prior 12 months). Researchers looked at whether those eligible had screening ever, within the past year, and if the screening was concordant with the U.S. Preventive Services Task Force guidelines available at the time of each survey.

    The research also showed that people with continuous private or public insurance coverage had higher rates of past-year screenings across all three cancer types studied, compared with their counterparts with prior coverage disruptions. Among those eligible for breast cancer screening, for example, past-year screening for individuals with private coverage with and without prior disruptions were 62.2% and 44.1%, respectively. Similarly, among people with public coverage, 51.4% with continuous coverage received breast cancer screening in the previous year, while 36.9% with prior coverage disruptions did.

    Researchers emphasized that these findings underscore the importance of stable health insurance coverage as part of a comprehensive approach to improve cancer screening rates and early detection of cancers when treatment is most effective.

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    About the American Cancer Society The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 100 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, Twitter, and Instagram.

    American Cancer Society (ACS)

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  • New Study Shows Adults Treated for Non-Small Cell Lung Cancer Vulnerable to Hazards of Wildfires

    New Study Shows Adults Treated for Non-Small Cell Lung Cancer Vulnerable to Hazards of Wildfires

    ASCO Quality Care Symposium Oral Abstract #302

    Newswise — ATLANTA, October 27, 2023 — New research by scientists at the American Cancer Society (ACS) and the University of California, San Francisco, shows individuals in the United States undergoing radiotherapy for non-small cell lung cancer (NSCLC) who are exposed to wildfires near the treating facility have worse overall survival than unexposed individuals. The findings will be presented at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, October 27 – 28, 2023.

    In the study led by Dr. Leticia Nogueira, scientific director, health services research at the American Cancer Society and senior author of the paper, scientists identified 228,138 patients who initiated definitive radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2019 from the hospital-based National Cancer Database. Exposure was defined as a wildfire disaster declaration (identified by the Federal Emergency Management Agency) in the county where the patient was being treated. Overall survival was defined as the age when radiation therapy started and the age of death, last contact, or study end.

    Study results showed individuals whose facility had a wildfire disaster declared within 12 weeks of their radiation start date had worse overall survival than unexposed individuals. 

      

    Researchers emphasized individuals undergoing radiotherapy for NSCLC are a vulnerable population to the hazards of wildfires. The unique needs and vulnerabilities of this vulnerable population must be prioritized in emergency preparedness and climate adaptation efforts of oncology institutions.

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    About the American Cancer Society The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 100 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, Twitter, and Instagram.

    American Cancer Society (ACS)

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  • fMRI study finds correlated shifts in brain connectivity associated with overthinking in adolescents

    fMRI study finds correlated shifts in brain connectivity associated with overthinking in adolescents

    Newswise — COLUMBUS, Ohio – A new study from The Ohio State University Wexner Medical Center and College of Medicine, University of Utah and University of Exeter (UK) substantiates previous groundbreaking research that rumination (overthinking) can be reduced through an intervention called Rumination-focused Cognitive Behavioral Therapy (RF-CBT). In addition, the use of fMRI technology allowed researchers to observe correlated shifts in the brain connectivity associated with overthinking.

    Study findings are published online in the journal Biological Psychiatry Global Open Science.

    “We know adolescent development is pivotal. Their brains are maturing, and habits are forming. Interventions like RF-CBT can be game-changers, steering them towards a mentally healthy adulthood. We were particularly excited that the treatment seemed developmentally appropriate and was acceptable and accessible via telehealth during the early pandemic,” said corresponding author Scott Langenecker, PhD, vice chair of research in the Department of Psychiatry and Behavioral Health at Ohio State, who started this project while at the University of Utah.

    RF-CBT is a promising approach pioneered by Ed Watkins, PhD, professor of experimental and applied Clinical Psychology at the University of Exeter. It has been shown to be effective among adults with recurrent depression.

    “We wanted to see if we could adapt it for a younger population to prevent the ongoing burden of depressive relapse,” said Rachel Jacobs, PhD, adjunct assistant professor of psychiatry and behavioral sciences at Northwestern University who conducted the pilot study in 2016.

    “As a clinician, I continued to observe that standard CBT tools such as cognitive restructuring didn’t give young people the tools to break out of the painful mental loops that contribute to experiencing depression again. If we could find a way to do that, maybe we could help young people stay well as they transition to adulthood, which has become even more important since we’ve observed the mental health impact of COVID-19,” Jacobs said.

    In the just published trial, 76 teenagers, ages 14-17, with a history of depression were randomly assigned to 10-14 sessions of RF-CBT, while controls were allowed and encouraged to receive any standard treatment. Teens reported ruminating significantly less if they received RF-CBT. Even more intriguing, fMRI illustrated shifts in brain connectivity, marking a change at the neural level.

    Specifically, there was a reduction in the connection between the left posterior cingulate cortex and two other regions; the right inferior frontal gyrus and right inferior temporal gyrus. These zones, involved in self-referential thinking and emotional stimuli processing, respectively, suggest RF-CBT can enhance the brain’s ability to shift out of the rumination habit. Notably, this work is a pre-registered replication; it demonstrates the same brain and clinical effects in the Utah sample in 2023 that was first reported in the Chicago sample in 2016.

    “For the first time, this paper shows that the version of rumination-focused CBT we have developed at the University of Exeter leads to changes in connectivity in brain regions in adolescents with a history of depression relative to treatment as usual. This is exciting, as it suggests the CBT either helps patients to gain more effortless control over rumination or makes it less habitual. We urgently need new ways to reduce rumination in this group in order to improve the mental health of our young people,” Watkins said.

    Next, the researchers will focus on demonstrating the efficacy of RF-CBT in a larger sample with an active treatment control, including continued work at Ohio State, Nationwide Children’s Hospital, University of Exeter, University of Utah and the Utah Center for Evidence Based Treatment. Future directions include bolstering access to teens in clinical settings and enhancing the ways we can learn about how this treatment helps youth with similar conditions.

    “Our paper suggests a science-backed method to break the rumination cycle and reinforces the idea that it’s never too late or too early to foster healthier mental habits. Our research team thanks the youths and families who participated in this study for their commitment and dedication to reducing the burden of depression through science and treatment, particularly during the challenges of a global pandemic,” Langenecker said.

    This work was supported by the National Institutes of Mental Health and funds from the Huntsman Mental Health Institute and is dedicated to researcher Kortni K. Meyers and others who have lost their lives to depression.

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    Ohio State University Wexner Medical Center

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  • New Study Finds Limited Documentation of Cost Discussions With Patients Newly Diagnosed With Advanced Cancer

    New Study Finds Limited Documentation of Cost Discussions With Patients Newly Diagnosed With Advanced Cancer

    ASCO QCS Abstract #3

    Newswise — ATLANTA, October 27, 2023 — A new study by researchers at the American Cancer Society (ACS) and the National Cancer Institute (NCI), shows only about a quarter of individuals newly diagnosed with advanced cancers had documented physician discussions about costs of care, which may hinder identifying patient needs and tracking outcomes of referrals for assistance. Growing costs of cancer care can result in financial hardship for patients, and many professional organizations recommend patient-physician discussions about expected treatment costs as part of high-quality care. Documentation of these discussions is critical as even privately insured patients may find care unaffordable without additional assistance. The study looked at documented discussions between physicians and individuals newly diagnosed with advanced non-small cell lung cancer (NSCLC) and melanoma, cancers with recent high-cost treatment advances, and found that cost discussions were documented in the medical records of 24.6% of NSCLC and 25.5% of melanoma patients.  “Out-of-pocket costs,” “patient assistance plan,” and “inability to pay” were the most commonly used terms. The findings will be presented at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, October 27 – 28, 2023.

    In the study, researchers, led by Dr. Robin Yabroff, scientific vice president, health services research at the American Cancer Society, used data from patient medical records from the population-based NCI Patterns of Care study conducted in 12 SEER registries, which included individuals newly diagnosed in 2017-2018 with advanced-stage NSCLC and melanoma. The medical records were reviewed for reported cost discussions and analyzed along with information on patient-, treatment- and hospital- factors, including age, sex, race and ethnicity, comorbidities, and health insurance coverage.

    Researchers found that when documented, cost discussions were most often noted in physician and nursing progress notes and assessment plans. Results also showed that people with private insurance were less likely to have documented cost discussions when compared with those with public insurance. Cost conversations were much less common among people who did not receive systemic therapy or any cancer-directed treatment than those who received systemic treatments.

    Researchers emphasized that systemic documentation of cost-of-care discussions as part of high-quality care could help ensure informed decision-making for all patients and that lack of information in the medical record would limit assessment of patient risk of financial hardship and whether any patient unmet financial needs were addressed.

                                                                                   # # #

    About the American Cancer Society The American Cancer Society is a leading cancer-fighting organization with a vision to end cancer as we know it, for everyone. For more than 100 years, we have been improving the lives of people with cancer and their families as the only organization combating cancer through advocacy, research, and patient support. We are committed to ensuring everyone has an opportunity to prevent, detect, treat, and survive cancer. To learn more, visit cancer.org or call our 24/7 helpline at 1-800-227-2345. Connect with us on Facebook, Twitter, and Instagram.

    American Cancer Society (ACS)

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  • Dual-action drug produces positive results in patients with advanced neuroendocrine tumors, trial finds

    Dual-action drug produces positive results in patients with advanced neuroendocrine tumors, trial finds

    Newswise — Boston – A drug that simultaneously strikes cancer cells’ growth circuits and pipeline to the bloodstream produced encouraging results in a clinical trial involving patients with advanced neuroendocrine tumors, according to a study led by Dana-Farber Cancer Institute investigators.

    Jennifer Chan, MD, MPH, director of the Program in Carcinoid and Neuroendocrine Tumors at Dana-Farber, will present the findings of the CABINET trial at the annual European Society for Medical Oncology (ESMO) Congress on October 22, 2023, in Madrid, Spain. Chan is first author on the study. Jeffrey Meyerhardt, MD, MPH, co-director of the Colon and Rectal Cancer Center at Dana-Farber, is senior author.

    Patients treated with the drug, cabozantinib, survived significantly longer with no worsening of their disease than patients who received a placebo. The results suggest cabozantinib, which has been approved by the U.S. Food and Drug Administration for some patients with renal cell carcinoma, hepatocellular carcinoma, or thyroid cancer, can benefit patients with neuroendocrine tumors that continue to grow and spread after previous treatment, researchers say.

    More than 12,000 people in the United States are diagnosed with a neuroendocrine tumor each year. The tumors begin in neuroendocrine cells – which have characteristics of nerve and hormone-producing cells – and can arise in multiple sites in the body, most often in the gastrointestinal tract, lungs, and pancreas. Treatments may include surgery, targeted therapy, peptide receptor radionuclide therapy, chemotherapy, or other local treatment approaches depending on the location and stage of the cancer. For patients whose cancer continues to grow and spread after these treatments, better options are urgently needed.

    “Although advances have been made in recent years, there remains a critical need for new and effective therapies for patients with advanced neuroendocrine tumors, particularly patients whose cancer has progressed on currently available options,” said Chan. “Targeting angiogenesis and other growth factor pathways with cabozantinib represents a novel treatment strategy.”

    Cabozantinib undermines tumor cells in multiple ways. It blocks the receptor for VEGF, a protein used to tap into the body’s blood supply, as well as other receptors including c-MET, AXL, and RET that are key to tumor cell survival and metastasis.

    The study enrolled 197 patients with advanced extra-pancreatic neuroendocrine tumors (which arise outside the pancreas) and 93 patients with pancreatic neuroendocrine tumors. Patients were enrolled at sites within the National Cancer Institute (NCI)-funded National Clinical Trials Network (NCTN). Two-thirds of the participants were randomly assigned take a 60 mg cabozantinib pill daily, and the others were given a placebo, or inert pill.

    Researchers measured progression-free survival (PFS) – how long patients lived before their disease worsened – for all participants. At a median follow-up of 13.9 months, the PFS for patients with extra-pancreatic tumors who took cabozantinib was 8.3 months, compared to 3.2 for those who took a placebo. At a median follow-up of 16.7 months, patients with pancreatic tumors who took cabozantinib had a PFS of 11.4 months, compared to 3.0 months for those who took a placebo.

    Side effects of cabozantinib were similar to those found in other studies of the drug. These include hypertension, fatigue, diarrhea, and skin rash.        

    “The results of the CABINET trial are very encouraging,” said Chan. “Cabozantinib significantly improved outcomes in patients with previously treated extra-pancreatic and pancreatic neuroendocrine tumors and may become a new treatment option for patients.”

    The CABINET trial was sponsored by the NCI, part of the National Institutes of Health (U10CA180821, U10CA180882), and was led and conducted by the NCI-funded Alliance for Clinical Trials in Oncology with participation from the NCTN as part of Exelixis’ collaboration with the NCI’s Cancer Therapy Evaluation Program (NCI-CTEP); https://acknowledgments.alliancefound.org.

    ESMO Session Details

    LBA 53: Alliance A021602: Phase III, Double-Blinded Study of Cabozantinib Versus Placebo for Advanced Neuroendocrine Tumors (NET) After Progression on Prior Therapy (CABINET) on Sunday, October 22, 2023, at 2:40 am ET (8:40 CEST) Jennifer Chan, MD, MPH/First Author

    For all ESMO-related media inquiries, call or email Victoria Warren, 617-939-5531, [email protected]. Follow the meeting live on X (Twitter) using the hashtag #ESMO23 and follow Dana-Farber News on X (Twitter) at @DanaFarberNews.

    About Dana-Farber Cancer Institute 

    Dana-Farber Cancer Institute is one of the world’s leading centers of cancer research and treatment. Dana-Farber’s mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. Dana-Farber is a federally designated Comprehensive Cancer Center and a teaching affiliate of Harvard Medical School.

    We provide the latest treatments in cancer for adults through Dana-Farber Brigham Cancer Center and for children through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Dana-Farber is the only hospital nationwide with a top 5 U.S. News & World Report Best Cancer Hospital ranking in both adult and pediatric care.

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    Dana-Farber Cancer Institute

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  • Kidney cancer study shows improved outcomes for patients with advanced disease when treated with belzutifan over everolimus

    Kidney cancer study shows improved outcomes for patients with advanced disease when treated with belzutifan over everolimus

    Newswise — Boston – Belzutifan significantly reduced the risk of progression of clear cell renal cell carcinoma (ccRCC), the most common type of kidney cancer, in patients previously treated with immune checkpoint inhibitors and anti-angiogenic therapies compared with everolimus in a phase 3 clinical trial. The trial, led by Toni K. Choueiri, MD, Director of the Lank Center for Genitourinary Cancer at Dana-Farber Cancer Institute, showed the risk of progression was reduced by 25-26%.

    The results were presented at the annual European Society for Medical Oncology (ESMO) Congress on October 21, 2023, in Madrid, Spain.

    “This is real progress for patients and could lead to approval of this drug for this patient group,” says Choueiri, senior author on the presentation in Madrid.

    Belzutifan, a HIF-2α inhibitor, is currently approved for patients with Von Hippel-Landau (VHL) disease-associated renal cell carcinoma, a form of kidney cancer. The drug was originally investigated and approved for kidney cancer patients with VHL disease because they have inherited a mutation that inactivates the VHL gene, which results in an overabundance of HIF-2α in cells.

    When overabundant in cells, HIF-2α is associated with increased cancer-driving activity, such as cell proliferation, immune evasion, low oxygen levels (called hypoxia), and blood vessel formation (called angiogenesis). Dana-Farber’s William G. Kaelin, Jr., MD, was awarded a Nobel Prize in Physiology or Medicine in 2019 for the discovery of the role HIF-2α in cancer and other diseases.

    “The knowledge we have about hypoxia and angiogenesis in kidney cancer stemmed from this essential pre-clinical research at Dana-Farber,” says Choueiri. “Bringing this knowledge forward to benefit patients is very gratifying.”

    While the mutation that causes VHL disease is inherited, spontaneous mutations that inactivate VHL occur in over 90% of ccRCC tumors, suggesting that a HIF-2α inhibitor might also benefit patients with ccRCC.

    This trial, called LITESPARK-005, enrolled 746 patients with metastatic ccRCC who had progressed after treatment with both an immune checkpoint inhibitor (ICI), such as a PD-1 or PD-L1 inhibitor, and an anti-angiogenic therapy. ICIs and anti-angiogenic medicines have become a standard part of first- and second-line therapies for metastatic ccRCC, though most patients eventually experience disease progression and need additional treatment options.

    Patients were randomized to receive treatment with either belzutifan or everolimus. At the second interim analysis, after a median of 25.7 months, patients taking belzutifan were 26% less likely to have progressed compared with those taking everolimus.

    The overall response rate was also higher with belzutifan, at 22% versus 3.5%, and 13 patients experienced a complete response with belzutifan compared to none with everolimus. Patients taking belzutifan were also less likely to discontinue therapy due to side effects.

    “Importantly, quality of life favored belzutifan,” says Choueiri.

    There was an improvement in overall survival with belzutifan though it was not statistically significant.

    This investigation of monotherapy with belzutifan is part of a broader strategy to learn more about the efficacy and safety of HIF-2α inhibition in RCC. The strategy involves multiple LITESPARK trials examining beluzutifan alone and in combination with other therapies in treatment-naive and pre-treated disease settings. Choueiri also presented updated findings from the phase 2 LITESPARK-003 at the ESMO Congress that showed belzutifan plus cabozantinib showed durable antitumor activity and a safety profile consistent with prior observation previously published in The Lancet Oncology.

    Both trials are sponsored by Merck Sharp & Dohme LLC.

    ESMO Session Details

    LBA 87: Phase 2 LITESPARK-003 Study of belzutifan in combination with cabozantinib for advanced clear cell renal cell carcinoma (ccRCC) will be presented in Proffered Paper Session 2 – Genitourinary tumors, non-prostate on Saturday, October 21, 2023, at 8:45am ET (14:45 CEST) Toni K. Choueiri, MD/First Author

    LBA 88: Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): randomized open-label phase 3 LITESPARK-005 study will be presented in Proffered Paper Session 2- Genitourinary tumors, non-prostate on Saturday, October 21, 2023, at 8:55am ET (14:55 CEST) Toni K. Choueiri, MD/Senior Author

    About Dana-Farber Cancer Institute 

    Dana-Farber Cancer Institute is one of the world’s leading centers of cancer research and treatment. Dana-Farber’s mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. Dana-Farber is a federally designated Comprehensive Cancer Center and a teaching affiliate of Harvard Medical School.

    We provide the latest treatments in cancer for adults through Dana-Farber Brigham Cancer Center and for children through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. Dana-Farber is the only hospital nationwide with a top 5 U.S. News & World Report Best Cancer Hospital ranking in both adult and pediatric care.

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  • Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Opioid use disorder treatment associated with decreased risk of overdose after surgery, suggests first-of-its-kind study of over 4 million surgeries

    Newswise — SAN FRANCISCO — Although people with opioid use disorder (OUD) are significantly more likely to overdose or have a complication after major surgery than those without the disorder, using medications for the treatment of OUD before surgery may eliminate that extra risk, suggests a large, first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients with OUD who didn’t use an OUD medication (such as buprenorphine or methadone) were over four times more likely to overdose after having surgery, yet those who used evidence-based OUD medication before surgery were essentially at no greater risk than those who didn’t have OUD, according to the study. Taken orally, OUD medications reduce withdrawal and cravings and prevent opioids from producing the feeling of euphoria that drives addiction.

    “We know that OUD treatments are very effective in helping to prevent relapse, overdose and death in nonsurgical patients, but our research is the first to show that they also may be remarkably effective in at-risk patients facing surgical stress and recovery pain that often is addressed with opioids,” said Anjali Dixit, M.D., MPH, a pediatric anesthesiologist at Stanford University, California. “This is helping us learn more about how to optimally treat OUD patients so that their surgical and post-surgical pain is well-controlled, while also making sure we are minimizing their risk of relapse and overdose.”

    Researchers analyzed 4,030,032 surgeries performed between 2008 and 2020 from the Merative MarketScan Commercial Database, a nationwide sample of data from patients with both employer-sponsored and Medicare Advantage insurance. The analysis reviewed overdoses and other complications (such as OUD-related hospitalization or infection) that occurred in the three months after surgery for the 25 most common surgeries, including knee and hip replacement, hysterectomy and gallbladder removal.

    Of the over 4 million surgeries, 26,827 were performed on patients who had a history of OUD, 9,699 (36%) of whom used OUD medications in the month before surgery and 17,128 (64%) who did not. OUD patients who did not use OUD medications were 4.2 times more likely to overdose or have an OUD-related infection or hospitalization than those who did not have the disorder, according to the study. OUD patients who used OUD medications did not experience a statistically different risk of opioid-related adverse events compared to those who did not have the disorder.

    As many as 7.6 million people in the U.S. live with OUD, according to research, and that number continues to grow. Only 20% of people with OUD currently use OUD medications, said Dr. Dixit. She noted the number of people in the study who used OUD medications was likely higher, because they had access to commercial insurance and therefore, better access to care. The researchers also want to look at other populations such as those on Medicaid, because they may be sicker and have less access to care.

    “The national efforts to increase access to OUD medications is good news for people with OUD, including those who need surgery,” said Dr. Dixit. “The next step is to determine if a particular medication or regimen is better than another.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

    American Society of Anesthesiologists (ASA)

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  • Black and Hispanic patients much more likely to die after surgery than white patients

    Black and Hispanic patients much more likely to die after surgery than white patients

     

    Newswise — SAN FRANCISCO — About 12,000 Black and Hispanic patients who died after surgery the past two decades may have lived if there were no racial and ethnic disparities among Americans having surgery, suggests a study of more than 1.5 million inpatient procedures presented at the ANESTHESIOLOGY® 2023 annual meeting. This estimate draws attention to the human toll of disparities in surgical outcomes, with Black patients being 42% more likely and Hispanic patients 21% more likely to die after surgery compared to white patients.

    Unless efforts to narrow the racial and ethnic gap in surgical outcomes intensify, preventable deaths will continue among minority patients, the researchers said. The development of equity policies to address disparity gaps can make a difference, with even a 2% reduction in projected excess mortality rates among Black patients averting roughly 3,000 post-surgery deaths in the next decade, they determined.

    “This study represents the first effort to move beyond merely documenting the ongoing disparities in surgical outcomes in the U.S. by quantifying the aggregate human toll of these disparities,” said Christian Mpody, M.D., Ph.D., MBA, lead author of the study and assistant professor of anesthesiology and pediatrics at The Ohio State University College of Medicine, Columbus. “We should not become used to reading statistics about people dying. It’s essential to remember that beyond the statistics, odds ratios and p-values, these are real people — brothers, sisters, mothers and fathers.”

    “The findings bring to light the deaths that may have been preventable if people of various racial and ethnic backgrounds had comparable mortality rates to white patients,” he said. “That’s important for conveying the gravity of the issue to policymakers, health care professionals and the general public.”

    Researchers analyzed the Nationwide Inpatient Sample data of more than a million surgical procedures performed at 7,740 U.S. hospitals between 2000 and 2020. They determined Black patients were 42% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the Northeast (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont). Hispanic patients were 21% more likely than white patients to die within 30 days of surgery, driven by higher mortality in the West (Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming). 

    Although death rates declined for all groups over the 20-year period, the disparity gaps did not narrow over time. The study did not identify causes of death.

    “It’s important to note that disparities in these regions do not necessarily mean that the surgical care is inferior. It may reflect overall population health and socioeconomic conditions,” said Dr. Mpody. “Our team is currently investigating the underlying causes of these regional variations.”

    Dr. Mpody said the study didn’t assess the effectiveness of specific interventions or policies, noting that addressing the problem requires a three-pronged approach involving research, education and service. Suggested interventions by the authors include increasing investment in disparity research and incorporating race and racism lectures in medical and nursing school curricula. Health systems should: provide cultural competency training; focus on diversity in grand rounds; invest in patient education and health literacy; develop personalized medicine approaches that take into account individual patients’ needs and race-sensitive protocols; and increase the number of minority providers. 

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

     

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  • AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery

    AI Pain Recognition System Could Help Detect Patients’ Pain Before, During and After Surgery

    Newswise — SAN FRANCISCO — An automated pain recognition system using artificial intelligence (AI) holds promise as an unbiased method to detect pain in patients before, during and after surgery, according to research presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Currently, subjective methods are used to assess pain, including the Visual Analog Scale (VAS) — where patients rate their own pain — and the Critical-Care Pain Observation Tool (CPOT) — where health care professionals rate the patient’s pain based on facial expression, body movement and muscle tension. The automated pain recognition system uses two forms of AI, computer vision (giving the computer “eyes”) and deep learning so it can interpret the visuals to assess patients’ pain.

    “Traditional pain assessment tools can be influenced by racial and cultural biases, potentially resulting in poor pain management and worse health outcomes,” said Timothy Heintz, B.S., lead author of the study and a fourth-year medical student at the University of California San Diego. “Further, there is a gap in perioperative care due to the absence of continuous observable methods for pain detection. Our proof-of-concept AI model could help improve patient care through real-time, unbiased pain detection.”

    Early recognition and effective treatment of pain have been shown to decrease the length of hospital stays and prevent long-term health conditions such as chronic pain, anxiety and depression.

    Researchers provided the AI model 143,293 facial images from 115 pain episodes and 159 non-pain episodes in 69 patients who had a wide range of elective surgical procedures, from knee and hip replacements to complex heart surgeries. The researchers taught the computer by presenting it with each raw facial image and telling it whether or not it represented pain, and it began to identify patterns. Using heat maps, the researchers discerned that the computer focused on facial expressions and facial muscles in certain areas of the face, particularly the eyebrows, lips and nose. Once it was provided enough examples, it used the learned knowledge to make pain predictions. The AI-automated pain recognition system aligned with CPOT results 88% of the time and with VAS 66% of the time.

    “The VAS is less accurate compared to CPOT because VAS is a subjective measurement that can be more heavily influenced by emotions and behaviors than CPOT might be,” said Heintz. “However, our models were able to predict VAS to some extent, indicating there are very subtle cues that the AI system can identify that humans cannot.”

    If the findings are validated, this technology may be an additional tool physicians could use to improve patient care. For example, cameras could be mounted on the walls and ceilings of the surgical recovery room (post-anesthesia care unit) to assess patients’ pain — even those who are unconscious — by taking 15 images per second. This also would free up nurses and health professionals — who intermittently take time to assess the patient’s pain — to focus on other areas of care. The researchers plan to continue to incorporate other variables such as movement and sound into the model.

    Concerns about privacy would need to be addressed to ensure patient images are kept private, but the system could eventually include other monitoring features, such as brain and muscle activity to assess unconscious patients, he said.

     

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook and follow ASALifeline on Twitter and use the hashtag #ANES23.

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  • More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

    More Patients Go Home Instead of to Long-Term-Care Facility When Sedation for Common Procedures Is Administered or Directed by Anesthesiologist

    Newswise — SAN FRANCISCO — Patients who had common procedures performed outside of the operating room (OR) were more likely to go home instead of to a long-term care facility when they were discharged from the hospital if their sedation was administered or directed by an anesthesiologist, rather than by a physician who is not a trained anesthesiologist, according to a first-of-its-kind study presented at the ANESTHESIOLOGY® 2023 annual meeting.

    Patients who need catheters placed in a vein, angiograms (X-ray of the blood vessels), image-guided biopsies and many other procedures typically are treated in the interventional radiology (IR) suite instead of the OR and given sedation. Sedation is a type of anesthesia that relieves anxiety, controls pain and discomfort, and sometimes makes them fall asleep. One in 10 patients admitted to the hospital requires an IR procedure and many are at increased risk for complications due to health issues or having more complex procedures.

    The study was the first to directly compare the hospital discharge outcomes of patients who received sedation administered by an anesthesiologist, or by a nurse anesthetist under the direction of an anesthesiologist, to the discharge outcomes of patients whose sedation was administered or directed by a physician who was not an anesthesiologist, such as a radiologist or cardiologist. Anesthesiologists are physicians who are experts in ensuring the safety and comfort of patients undergoing surgery and other procedures and are highly trained in critical care to manage medical emergencies if there is a complication. 

    “We focused on patients undergoing IR procedures as they often have health issues such as heart disease or diabetes and some of the procedures are high risk,” said Matthias Eikermann, M.D., Ph.D., senior author of the study and chair of the department of anesthesiology at Montefiore Medical Center, Bronx, New York. “We found anesthesiologists add value to patients undergoing interventional radiology procedures. That’s especially true for complex neurovascular procedures such as angiograms for the treatment of aneurysms or the creation of an arteriovenous (AV) fistula, a connection between an artery and a vein, for people on dialysis and those that typically take longer than an hour.”

    In the study, 9,682 patients had sedation in the IR suite and 1,639 (16.93%) were discharged from the hospital to a long-term care facility (such as a nursing home) because of complications that they may be more likely to experience due to their disease. Anesthesiologists have the training to identify these complications early and address them.

    Of those who were not discharged home, 1,429 (87%) had their sedation administered or directed by a physician who was not an anesthesiologist, often with the assistance of a nurse, and 210 (13%) had their sedation administered or directed by an anesthesiologist.

    “The anesthesiologist is not just providing sedation, but life support for the patient during the entire procedure,” said Dr. Eikermann. “The difference in outcomes is because anesthesiologists are trained to identify early complications and treat them immediately. Physicians who are not anesthesiologists are not trained to do that.”

    Anesthesiologists administered or directed sedation for higher-risk patients, such as those with more health issues or who had more invasive procedures. Despite being at higher risk, the patients who received sedation administered or directed by an anesthesiologist were nearly 70% more likely to be discharged home than those whose sedation was administered or directed by a physician who was not an anesthesiologist.

    “Increasingly, high-risk patients are undergoing procedures outside of the OR,” said Vilma Joseph, M.D., MPH, FASA, co-author of the study and director of procedural sedation at Montefiore Medical Center. “The presence of physician anesthesiologists as part of the anesthesia care team model has been associated with improved outcomes.”

    “Patients should know that they can ask for an anesthesiologist if they are concerned about excessive pain, anxiety or their safety during diagnostic procedures,” said Dr. Eikermann. “Our research suggests rethinking anesthesia assignments to ensure anesthesiologists provide sedation when patients are at higher risk due to their health or are having more complex, longer or more-invasive procedures.”

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

    American Society of Anesthesiologists (ASA)

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  • American Society of Anesthesiologists honors Stanley W. Stead, M.D., MBA, FASA, with its Distinguished Service Award

    American Society of Anesthesiologists honors Stanley W. Stead, M.D., MBA, FASA, with its Distinguished Service Award

    Newswise — SAN FRANCISCO — The American Society of Anesthesiologists (ASA) today presented Stanley W. Stead, M.D., MBA, FASA, with its 2022 Distinguished Service Award in recognition of his enduring contributions to advancing patient-centered, physician-led health care, and his advocacy related to health care economics, including value-based care and equitable physician payment models. The award is the highest honor ASA bestows and is presented annually to a member who has transformed the specialty of anesthesiology.

    A nationally recognized thought leader in health care economics, information technology and quality of care, Dr. Stead served as a professor and senior hospital executive for more than three decades. He recently retired from his positions as vice chair and professor of anesthesiology and perioperative medicine at the University of California, Los Angeles (UCLA), and senior executive director of strategic planning, utilization, perioperative services, capital planning and risk management at the University of California, Davis. He also recently retired from his role as president and founder of Stead Health Group, Inc., in Los Angeles. 

    Dr. Stead served as ASA’s vice president of professional affairs from 2013-18, where he made innumerable contributions, both within the Society and to the specialty more widely. Notably, he led ASA’s efforts in advancing value-based payment and population care models, and co-developed ASA’s Perioperative Surgical Home (PSH) model of care. He received ASA’s Excellence in Government Award in 2012 and Lifetime Achievement Award in Practice Management in 2019. 

    Dr. Stead has held numerous positions in the Society. In 1993, he created ASA’s CROSSWALK®, a guide for surgery and anesthesia Current Procedural Terminology (CPT ®) codes, for which he served as author and editor for 30 years. He chaired ASA’s Committee on Economics and ASA’s Section on Professional Practice. He also served on the ASA Board of Directors, as well as the Board of Directors of the Anesthesia Quality Institute, an ASA foundation.

    “I cannot imagine a more deserving recipient of ASA’s highest honor,” said ASA President Michael W. Champeau, M.D., FAAP, FASA. “I’ve worked alongside Dr. Stead for over 30 years. The breadth and depth of his knowledge about the specialty and health care economics have made him an invaluable resource to anesthesiology and our members.”

    In addition to his commitments to ASA, Dr. Stead is a national expert on medical coding and reimbursement, having served on the American Medical Association’s (AMA) CPT Panel and Relative Value System Update Committee, and author of AMA’s 2007 and 2008 References on Physician Quality Reporting Initiative. He received the California Society of Anesthesiologists’ Distinguished Service Award in 2019. He has published more than 120 articles and delivered more than 150 lectures and presentations worldwide on a variety of health care topics. 

    Dr. Stead received a Bachelor of Science in biochemistry, Doctor of Medicine degree and a Master of Business Administration from UCLA, where he also completed his anesthesiology residency and fellowship in cardiothoracic anesthesiology. He completed his surgery internship at Cedars-Sinai Medical Center in Los Angeles.

    The Distinguished Service Award is presented annually for outstanding clinical, educational, or scientific achievement, contribution to the specialty and/or exemplary service to the Society. ASA’s House of Delegates establishes policies governing the selection of a recipient for the Distinguished Service Award.

     

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific professional society with more than 56,000 members organized to advance the medical practice of anesthesiology and secure its future. ASA is committed to ensuring anesthesiologists evaluate and supervise the medical care of all patients before, during and after surgery. ASA members also lead the care of critically ill patients in intensive care units, as well as treat pain in both acute and chronic settings.

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about how anesthesiologists help ensure patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2023 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES23.

     

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  • Liquid biopsy may help identify which patients with non-small cell lung cancer will benefit most from radiation

    Liquid biopsy may help identify which patients with non-small cell lung cancer will benefit most from radiation

    Newswise — SAN DIEGO, October 2, 2023 — A novel liquid biopsy test may help determine which patients with non-small cell lung cancer that has spread beyond the lungs are most likely to benefit from targeted, high-dose radiation, rather than drug-based therapy, a new study suggests. Findings will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting and published in npj Precision Oncology. 

    The study found that a liquid biopsy test – which identifies tumor DNA circulating in the blood – can help distinguish if a patient’s cancer has spread to just a few tumor sites or spread more widely. This indicator would help physicians determine which type of treatment would be most effective for each patient.

    “Our findings suggest the level of circulating tumor DNA, rather than the number of tumors themselves, is a more precise measure of disease burden,” said senior study author Aadel Chaudhuri, MD, PhD, an assistant professor of radiation oncology at the Siteman Cancer Center of Washington University School of Medicine in St. Louis.

    Non-small-cell lung cancer (NSCLC) accounts for about 84% of all lung cancers, which are the leading cause of cancer death in the U.S. and worldwide. Patients diagnosed with NSCLC who have widespread metastatic disease, where cancer spreads past a person’s lungs and lymph nodes, generally cannot be cured, said Dr. Chaudhuri. But some patients with oligometastatic disease – where the cancer has spread to just a few sites – experience long periods of cancer-free survival when treated with high-dose radiation targeted to the individual tumor sites.

    Identifying which patients with oligometastatic disease will benefit from this type of focused radiation treatment has been challenging, said Dr. Chaudhuri.

    Tumor tissue biopsy – long considered the gold standard for analyzing solid tumors – only examines the site where the tissue sample was taken, and imaging tests also have limitations for detecting micro-metastatic disease, Dr. Chaudhuri explained. Likening a visible tumor to an iceberg, he said it’s difficult for imaging tests to show “if the disease is just the part of the iceberg that’s visible above the water, or if there’s substantially more micro-metastatic disease beneath the surface.”

    Liquid biopsy tests can detect elements of solid tumor cancers in blood, urine or cerebrospinal fluid. Blood tests are the most widely used type of liquid biopsy and can identify circulating tumor DNA (ctDNA), circulating tumor cells (CTC), circulating RNA and other biomarkers that signal the presence of cancer.

    “Liquid biopsy,” said Dr. Chaudhuri, “could help us know if there is micro-metastatic disease.”

    Dr. Chaudhuri and his colleagues previously used liquid biopsy technology to monitor the status of patients with colorectal cancer, bladder cancer and peripheral nerve tumors.

    In the current study, a real-world, multi-institutional analysis, the researchers analyzed data from 2016 to 2022 for 309 patients with oligometastatic NSCLC who received radiation therapy following liquid biopsy. Oligometastatic disease was defined in this study as metastatic disease in at least one, and up to five, organ systems. Patients were an average of 64.7 years old.

    Patients with detectable ctDNA prior to radiation therapy had worse overall survival than those whose blood showed no detectable ctDNA prior to treatment. For those whose blood showed traces of ctDNA, median overall survival was 16.8 months, compared to 25 months for patients with no ctDNA detected prior to treatment (p=0.030, HR=1.65, CI=1.05–2.61).

    Likewise, progression-free survival was worse for those whose blood showed traces of ctDNA prior to radiation therapy. Median progression-free survival was 5.4 months for patients with detectable ctDNA, compared to 8.8 months for those with no detectable ctDNA prior to treatment (p=0.004, HR=1.57, CI=1.15–2.13). These findings were corroborated by multivariate models that included eight additional clinical and genomic parameters.

    The findings suggest that patients with no or low levels of detectable ctDNA are most likely to benefit from radiation therapy, whereas those with higher detectable levels of ctDNA are more likely to need systemic therapy, such as chemotherapy or immunotherapy, Dr. Chaudhuri said.

    “When you have a detectable ctDNA level, you have a higher burden of disease. Our findings indicate that we can use this biomarker to support patient-centered treatment decisions in the oligometastatic cancer setting,” he said.

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    See this study presented:

    • News Briefing: Tuesday, October 3, 9:00 a.m. Pacific time. Details here. Register here.
    • Scientific Presentation: Monday, October 2, 11:25 a.m. Pacific time, San Diego Convention Center. Email [email protected] for access to the livestream or recording.
    • Abstract Title: Circulating tumor DNA for early risk stratification of oligometastatic lung cancer (Abstract 149)

    Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is requested in all coverage. View our meeting press kit at www.astro.org/annualmeetingpress.

    ABOUT ASTRO

    The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. Radiation therapy contributes to 40% of global cancer cures, and more than a million Americans receive radiation treatments for cancer each year. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.

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  • Short-course radiation as effective as standard treatment for patients who opt for breast reconstruction after mastectomy

    Short-course radiation as effective as standard treatment for patients who opt for breast reconstruction after mastectomy

    Newswise — SAN DIEGO, October 1, 2023 — In a first-of-its-kind study, people with breast cancer who underwent implant-based breast reconstruction immediately following a mastectomy reported that getting fewer, higher doses of radiation was just as effective as standard radiation, did not increase side effects and saved them time and money. There also was a small improvement in quality of life for women under 45 who received the shortened treatment regimen.

    The FABREC study is the first prospective randomized study comparing quality-of-life and clinical outcomes following accelerated versus conventional radiation therapy specifically for patients with post-mastectomy implant- or tissue-based breast reconstruction. Findings will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

    “Both the accelerated and standard courses of treatment were equally effective at preventing the cancer from returning and had the same level of side effects. But with shortening the treatment from five weeks to three, patients experienced fewer treatment disruptions, a lower financial burden and other meaningful improvements to their lives,” said senior study author Rinaa Punglia, MD, MPH, FASTRO, an associate professor of radiation oncology at Dana-Farber Brigham Cancer Center in Boston.

    Breast cancer is the second most diagnosed cancer for women in the U.S. About 40% of people with breast cancer have mastectomies and of that group, 62% undergo immediate reconstruction. Reconstruction using tissue expanders or breast implants has grown in popularity in recent years.

    Roughly one-third of patients who get mastectomies also need radiation therapy to the chest wall and lymph nodes, to help prevent their cancer from returning. While standard radiation therapy generally occurs over a period of five weeks, research has shown a shorter course of treatment can be just as effective at preventing the cancer from returning in women who have undergone breast-conserving surgery. Prior research also shows the shorter regimen does not increase side effects and can improve quality of life for these patients.

    FABREC is the first study to compare the shorter and longer courses of post-mastectomy radiation specifically for people who had their breasts reconstructed immediately following mastectomy. Investigators also compared results for people under 45 years old to those 45 and older.

    “Our main goal was to look at patient-reported outcomes, especially in terms of patient well-being,” said lead study author, Julia Wong, MD, FASTRO, also an associate professor of radiation oncology at Dana-Farber Brigham Cancer Center. “We often focus on cancer outcomes, but there are a lot of quality-of-life issues involved in having a mastectomy and reconstructive surgery, a combination a lot of patients are now choosing. We have to look at how these treatments affect patients.”

    The multi-center trial involved 400 participants treated at 16 U.S. health centers who underwent mastectomies followed by immediate breast reconstruction using a tissue expander or implant. Patients were randomly assigned to receive either conventional radiation consisting of 25 fractions across five weeks (50 Gy total; n=201) or hypofractionated radiation consisting of 16 fractions across roughly three weeks (42.56 Gy total; n=199).

    All patients were diagnosed with stage 0 to 3 breast cancer with tumors of any size but not growing into the chest wall or skin. The median age was 47 years. Patients completed questionnaires about their physical well-being and quality of life at baseline and at six, 12 and 18 months following treatment. Median follow-up was 40.4 months.

    Patients in both groups reported similar levels of physical well-being six months after treatment, the primary endpoint of the study (p=0.71). There were some differences between the groups at baseline, including higher energy levels reported by those randomized to receive hypofractionated radiation (p=0.02). Dr. Punglia said this finding likely reflects their positive reactions to the shortened treatment.

    “In our protocol, patients could complete their baseline questionnaire either before or after randomization, as long as it was before they started radiation. And so, patients could be aware of their treatment arm when they answered the questions,” she said. “It seems patients felt more energetic because they knew they would be done with treatment faster.”

    Treatment breaks, which are associated with worse outcomes in breast cancer, were significantly fewer (2.7% vs. 7.7% with conventional treatment, p=0.03) and shorter with the accelerated treatment (average 2.8 days vs. 3.3 with conventional treatment, p=0.03). Patients who needed unpaid time off work also reported taking 50 fewer hours of unpaid leave (73.7 hours vs.125.8 hours, p=0.046).

    There were small improvements in quality-of-life scores among younger patients treated with hypofractionated radiation. Patients younger than 45 reported feeling less bothered by treatment-related side effects (p=0.045) with the accelerated treatments. They also reported better physical well-being (p=0.049).

    There were no differences in the rates of recurrence or side effects between the two groups. Two people (one in each arm) experienced a local recurrence, and 23 (12 in the conventional arm, 11 in the hypofractionated arm) had cancer return to distant sites. Four patients (two in each arm) died during the study period; all were diagnosed with distant metastases.

    The overall rates of chest wall toxicity were lower in both arms than rates previously reported with implant-based reconstruction, said Dr. Wong. Twenty patients in the hypofractionated group and 19 in the conventional group had toxicity in the chest wall area. The analysis found several factors predicted chest wall toxicity on univariate analysis, including higher body mass index (HR=1.02, p=0.003), having a post-operative infection (HR=3.14, p=0.01), whether lymph nodes needed to be dissected (HR=2.07, p=0.03), having more lymph nodes removed (HR=1.05, p=0.01), having a tissue expander versus an implant (HR=3.32, p=0.04), and using preoperative endocrine therapy (HR=2.99, p=0.001).

    Though they had hoped to see more dramatic results, the researchers were happy that delivering higher doses of radiation in less time did not increase side effects. “In fact, overall, the rates of chest wall toxicity were lower in both arms than what’s been seen historically, which is likely because of improvements over time in technique,” said Dr. Wong.

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    See this study presented:

    • News Briefing: Monday, October 2, 11:00 a.m. Pacific time. Details here. Register here.
    • Scientific Presentation: Clinical Trials Session, Sunday, October 1, 10:20 a.m. Pacific time, San Diego Convention Center. Email [email protected] for access to the live stream or recording.
    • Abstract Title: Patient-reported and toxicity results from the FABREC study: A multicenter randomized trial of hypofractionated vs. conventionally fractionated postmastectomy radiation therapy after implant-based reconstruction (LBA 05)

    Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is requested in all coverage. View our meeting press kit at www.astro.org/annualmeetingpress.

    ABOUT ASTRO

    The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. Radiation therapy contributes to 40% of global cancer cures, and more than a million Americans receive radiation treatments for cancer each year. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.

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  • High-dose radiation offers new treatment option for older patients with inoperable kidney tumors

    High-dose radiation offers new treatment option for older patients with inoperable kidney tumors

    Newswise — SAN DIEGO, October 1, 2023 — Older adults diagnosed with kidney tumors that are not suitable for surgery may benefit from targeted, high-dose radiation, a new study from Australian and Dutch researchers suggests.

    A multi-institutional phase II study – TransTasman Radiation Oncology Group (TROG) FASTRACK II – found 100% local control and cancer-specific survival for longer than three years among patients who were treated non-invasively for inoperable kidney cancer with stereotactic ablative body radiotherapy (SABR). Findings will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

    Previous smaller, single institution studies showed promise for stereotactic radiation treatments with patients whose kidney tumors are inoperable, yet FASTRACK II is the first study to test SABR’s efficacy in a large, multi-institutional clinical trial.

    “Our study demonstrated that a novel treatment delivered in an outpatient setting is able to achieve unprecedented efficacy for patients with inoperable kidney cancer,” said lead study author Shankar Siva, PhD, a radiation oncologist at the Peter MacCallum Cancer Centre and a professor at the University of Melbourne in Australia. “There’s an unmet need for curing this type of cancer, and our findings point to the potential of radiation therapy to address that need.”

    As the population ages, the incidence of kidney cancer in older adults is increasing globally, with the greatest increase in people over 70, who also have lower rates of survival. Worldwide, kidney cancer is the sixth most diagnosed cancer in men and 10th in women. Surgery has been the standard of care, either to remove the tumor and surrounding margins or to remove the entire kidney and surrounding tissue.

    Yet many older people with renal cell carcinoma have unique challenges that make it difficult to treat them surgically, said Dr. Siva. “People might have other medical issues such as high blood pressure or diabetes, things that place them at higher risk for complications from surgery. They may have tumors in areas that are difficult to operate on, or where surgery may lead to dialysis.”

    He said, “our research clearly defines a new population of patients who will benefit from stereotactic radiation. These patients often don’t have other viable treatment options, so we are excited to see that radiation therapy can be effective for them.”

    SABR, also known as stereotactic body radiation (SBRT), can shrink or destroy tumors by targeting them directly with high doses of radiation delivered in a small number of outpatient sessions.

    In this non-randomized, prospective study, Dr. Siva and his colleagues treated 70 patients who were diagnosed with inoperable, high-risk kidney tumors or who declined surgery for their renal cell cancer. The median patient age was 77 years (range 47-91), and patients had a single lesion.

    Participants in the trial were treated with SABR in one or three sessions at seven Australian centers and one in the Netherlands. Treated tumors were relatively large, said Dr. Siva, on average 4.7 centimeters. Patients with tumors smaller than 4 cm received a single fraction of radiation (n=23), and those with tumors larger than 4 cm received three fractions (n=47).

    None of the patients experienced a local progression of their kidney cancer during the trial lifetime (median follow-up 43 months), nor did any patients die from cancer. Overall survival was 99% one year after SBRT and 82% at three years. One patient experienced a distant recurrence of their cancer.

    Side effects were relatively modest, with no grade 4 or 5 toxicities observed. Seven patients (10%) experienced grade 3 adverse events, most commonly abdominal pain (3 patients). 51 patients (73%) had a grade 1-2 treatment-related event, and 11 patients (16%) experienced no adverse events.

    Kidney function was assessed by measuring patients’ estimated glomerular filtration rate (eGFR); the average eGFR declined by 10.8 mLs/min at one year and 14.6 mLs/min at two years after treatment, indicating mild-to-moderate kidney stress. Only one patient required dialysis following treatment. Overall, said Dr. Siva, there was a modest drop in kidney function and that plateaued after two years.

    Dr. Siva attributed the high efficacy rate and the ability to preserve kidney function to rigorous quality control, as well as the effectiveness of stereotactic radiation. He also said the findings of this phase II trial justify designing a randomized phase III trial to compare stereotactic radiation to surgery as the primary treatment modality for patients with operable kidney cancer.

    “Given a choice between the two, I believe a lot of patients would opt for non-invasive radiation,” he said.

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    See this study presented:

    • News Briefing: Tuesday, October 3, 9:00 a.m. Pacific time. Details here. Register here.
    • Scientific Presentation: Sunday, October 1, 9:50 a.m. Pacific time, San Diego Convention Center. Email [email protected] for access to the livestream or recording.
    • Abstract Title: TROG 15.03/ANZUP international multicenter phase II trial of focal ablative stereotactic radiotherapy for cancers of the kidney (FASTRACK II) (Abstract 5)

    Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is requested in all coverage. View our meeting press kit at www.astro.org/annualmeetingpress.

    ABOUT ASTRO

    The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. Radiation therapy contributes to 40% of global cancer cures, and more than a million Americans receive radiation treatments for cancer each year. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.

    American Society for Radiation Oncology (ASTRO)

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  • True Progression or Pseudoprogression in Glioblastoma Patients?

    True Progression or Pseudoprogression in Glioblastoma Patients?

    Newswise — MIAMI, FLORIDA (STRICTLY EMBARGOED UNTIL SEPT. 29, 2023 AT 5PM ET) – Is it true progression or pseudoprogression in tumor growth?

    That’s the critical question for radiation and medical oncologists treating patients with glioblastoma, the most common and aggressive form of brain cancer. Distinguishing between these types of progression is vitally important for treatment management.

    “Knowing if it’s true progression, indicative of a poor response to treatment, or pseudoprogression, a favorable response that may look worse due to swelling or tumor necrosis, is essential for clinicians,” said Eric Mellon, MD, PhD, a radiation oncologist and researcher with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine. “That knowledge can guide us in adjusting current treatment in real time.”

    He and his research colleagues are presenting results from two recent studies on this topic at ASTRO 2023, the annual meeting of the American Society for Radiation Oncology, Oct. 1-4, in San Diego.

    One study was designed to determine if daily monitoring of tumor changes during a course of radiation therapy could result in early prediction of treatment response. The MRI-guided linear accelerator systems, known as MR-linac, that deliver radiation therapy allow for this type of monitoring and detection of patterns within these volume changes. 

    Sylvester researchers used sophisticated analytical and machine learning tools, including a linear fitting model to test their prediction theory on a prospective cohort of glioblastoma patients undergoing chemoradiation for their cancers.

    “The model was trained to predict between no progression, pseudoprogression and true progression, and the results were cross-validated,” explained Kaylie Cullison, an MD/PhD student who is conducting her PhD research in Mellon’s Sylvester laboratory, is the study’s first author, and will present the data at ASTRO 2023. 

    Of the 28 patients analyzed in the study, 11 had no tumor growth on first diagnostic MRI after treatment (no progression), five were found to have pseudoprogression based on long-term stability of MRI findings, and 12 had true progression determined by continuing tumor growth beyond six months, tissue sampling showing active malignancy or rapid death.

    The model achieved an overall accuracy of 86%, when predicting three outcome classes (no progression, true progression and pseudoprogression), and an accuracy of 93% when predicting between no progression versus any kind of progression.

    “We identified patterns of tumor behavior during therapy that were indicative of differences in growth patterns between true progression and pseudoprogression,” said Mellon, co-leader of Sylvester’s Neuro-Oncology Site Disease Group who leads numerous clinical trials for brain tumors. “These volume changes during treatment may be early markers of treatment response.”

    Next steps, according to Mellon and Cullison, include automating real-time tumor monitoring by using a deep-learning solution for volume delineation on daily treatment scans.

    Their other study, conducted simultaneously with the above one, sought to determine the predictive value of weekly delta-radiomic features extracted from MR-linac systems used for treating glioblastoma patients.

    Whereas radiomics focus on quantitative features extracted from medical images to correlate with various biological features and clinical endpoints for cancer diagnosis, prognosis and clinical decisions, delta radiomics extend that analysis by examining feature variation at different time points, usually before and after therapy.

    In this case, however, the acquisition time points were during therapy. Sylvester researchers deployed supervised machine learning with a sophisticated classification model to predict true progression or pseudoprogression outcomes. Their model included 41 variables – 39 tumor texture features plus lesion volume and mean lesion intensity – per time point to generate the predictions.

    Of the 10 most prognostic features, 90% happened during an early time point, suggesting that prognostic changes in the underlying tumor microenvironment occur within the first 15 treatment sessions (or first half of treatment).

    “Our findings support the theory that delta-radiomic features from MR-linac radiotherapy can predict treatment response during therapy, which is earlier than current methods,” concluded Mellon. “And doing so would allow physicians to intensify current treatment for poorly responding patients.”       

    Mellon and Cullison say future research should include a larger patient cohort and the use of MR-linac systems with multiparametric MRI to further test the model’s prognostic value.

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    Sylvester Comprehensive Cancer Center

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