Older patients with metastatic colorectal cancer do as well as younger ones when treated with chemotherapy

Although patients over 65 are 11 times more likely to be diagnosed with colorectal cancer, they are poorly represented in clinical treatment trials. The researchers analyzed data from 22 European trials containing 5Fu (fluorouracil) to compare benefits for patients 70 years of age and older and patients who were younger than 70.

There were 3,825 patients totally, with 629 at least 7o years old.

There was no significant difference in median overall survival (10.8 months for those over 70 compared to 11.3 months for younger patients) or response rate (23.9% compared to 21.1%). Progression-free survival was slightly higher for older patients than younger ones (5.5 months vs. 5.3 months.)

G. Folprecht and colleagues from University Hospital in Dresden, Germany reported their results in The Annals of Oncology September 15, 2004.

The authors concluded, "Therefore, standardized palliative chemotherapy should generally be offered to elderly patients and they should not be excluded from clinical trials."

Read an article about the study with references to additional studies of older patients.

Read the study abstract from The Annals of Oncology.

Radiofrequency ablation of lung metastases is successful in a pilot study in Italy.

Doctors in Italy treated 18 patients -- 4 with primary lung cancer and 14 who had metastases to the lungs -- with percutaneous (through the skin) radiofrequency ablation for tumors that could not be removed surgically.

Patients chosen for the treatment did not have any cancer outside the lung or more than 3 nodules in the lung. Some patients were excluded because of the size, position, or type of lesion or the existence of other lung problems.

While there were some side effects including 1 serious collapsed lung (pneumothorax), one moderate pneumothorax, cough, fever, and pain. Both pneumothorax situations were treated succcessfully.

There was only one case where cancer returned in the treated area. After a median follow-up time of 8 months, 17 of the 18 patients are alive and 12 have no evidence of disease.

Treatment was done under general anesthesia to keep patients still, allow for having a ventilator tube in place in case of emergency, and enable the area of the lung being treated to receive limited air. Multiple CT-scans were done during the surgery to place the RFA probes accurately and monitor for complications.

The authors concluded, " Radiofrequency thermal ablation is a promising technique in the treatment of patients with lung neoplasms and has been found to be both safe and technically feasible."

Cosmo Gadaleta and colleagues from Bari, Italy reported their study in the American Journal of Roentgenology 2004 - Volume 183, Number 2.

Read a detailed report of the study on Medscape.

High dose morphine helps cancer patients being treated in hospice without reducing life expectancy

Researchers studied morphine use in 661 patients cared for at home by a hospice team. About two-thirds of them (65.8%) received morphine as part of their care -- the overwhelming majority (91%) were given low or moderate doses. Low or moderate doses were 5 to 299 mg per day.

7.4% received a high dose (300-599 mg each day) and 1.6% received a very high dose. High and very high doses of morphine did not reduce survival. In fact, those receiving the highest doses had the longest median survival. Patients on very high doses had median survival of 37 days, those on high doses lived a median 27 days, while those on low doses survived 18 days. Those who did not receive morphine lived for 22 days.

Adverse events did not vary among the three groups.

"These high doses most likely did not change their life span," the authors say, and "they may have provided for the patients the opportunity for better pain control and most likely a fairly good quality of life in their own environment."

They concluded, "The use of high and very high morphine doses at home proved safe and did not appear to affect the patients' life expectancy adversely. The use of high or very high-dose morphine should not be a barrier to providing palliative terminal care for home-care hospice patients."

Read an article about the study on Medscape.

Read an abstract of the article in the September 15, 2004 issue of Cancer.

New meta-analysis shows that adding leucovorin (folinic acid) to 5FU improves both response rate and survival in patients with advanced colorectal cancer

The European Meta-Analysis Group in Cancer analyzed studies that compared the use of 5FU (fluorouracil) alone to 5FU modified by leucovorin (folinic acid) in patients with metastatic colorectal cancer.

Prior meta-analyses had shown an increased response rate when leucovorin was added to fluorouracil but no increase in overall survival.

However, the new analysis, based on treatment of 3,300 patients and including 10 new trials, showed a small but significant survival benefit for the 5FU-leucovorin combination. Patients who received the modified therapy lived for a median 11.7 months, compared to 10.5 months for those treated with 5FU alone.

Response rates for the combined treatment was doubled. Twenty-one percent (21%) of patients on 5FU and leucovorin had tumors respond, compared to 11% of those on 5FU alone.

The analysis was reported in the Journal of Clinical Oncology, Vol 22, No 18 (September 15), 2004: pp. 3766-3775.

Read the abstract of the meta-analysis in The Journal of Clinical Oncology.

Self-expanding stents can bypass obstruction in colon and rectal cancer

Japanese gastroenterologists successfully placed self-expanding metallic stents (SEMS) in 26 of 30 patients with obstructed colon or rectal cancers that were inoperable. Stents were placed in 9 of 11 patients with cancer in the proximal colon and 17 of 19 cases of distal colon or rectal cancer.

The doctors used both a colonoscope and fluoroscopy to place the stents accurately.

One stent moved once it was placed and a second patient had obstruction return, but overall the doctors concluded, "Placement of SEMS is a feasible and effective adjunct and alternative to stoma in malignant large bowel obstruction.".

A report of their work appears in the October 2004 issue of Digestive Endoscopy.

Read the abstract of the study in Digestive Endoscopy.

Cancer survivors have more health problems that similar people without a history of cancer

Nearly one in three cancer survivors report their health as fair or poor in a recent study. They suffer from a variety of health issues including arthritis, back and neck problems, high blood pressure, bone and joint problems, fractures, and difficulty breathing.

Their health was significantly worse than a comparable group of people who had not had cancer according to a study reported in the Journal of the National Cancer Institute. Fewer than 1 in 5 people in the non-cancer group said their health was fair or poor. The comparison group members had similar ages, sex, and educational levels.

At the same time, cancer survivors were no less likely than their peers to have had strokes , heart disease, diabetes, weight problems or depression. Half of cancer survivors will live as long as those without cancer.

Health problems reduced the time people worked and their productivity. They took more sick days, needed more help with everyday activities, and spent more days in bed. Many of these quality-of-life issues persisted many years after diagnosis and treatment.

The study did not focus exclusively on long-term survivors -- those who had lived more than 5 years. Sixteen percent of those surveyed were in their first year of cancer diagnosis. About half had lived 5 years or more after learning they had cancer. Answers from the 2000 National Health Interview Survey for 1823 cancer survivors and 5469 age, sex, and educational attainment–matched controls without cancer were analyzed

Today more than 64% of people with cancer will live more than five years after their diagnosis. There are more than 9.8 million such long term survivors in the United States.

Epidemiologist K. Robin Yabroff Ph.D. and her team at the National Cancer Institute in Bethesda, MD published the results of their research in the Journal of the National Cancer Institute on September 1, 2004.

Read the study abstract from the Journal of the National Cancer Institute.

Read an article about the study in USA Today.

Read an article from Reuters published on Yahoo! Health.

Read a review of the study on WebMD.