The following article features coverage from the American Society of Clinical Oncology 2020 meeting.
Significantly higher levels of pain were reported by women with a history of ovarian cancer who were classified as having a late chronotype compared with an early or mid-chronotype (P <.05). These baseline findings from an ongoing randomized trial evaluating lifestyle interventions were presented during the ASCO20 Virtual Scientific Program.
Few studies have evaluated the effect of chronotype, a manifestation of underlying circadian rhythm, on quality of life and other lifestyle outcomes in women with ovarian cancer.
This analysis assessed the association between chronotype and self-reported pain, sleep duration and quality, diet quality, physical activity, and the levels of systemic metabolic biomarkers at baseline in 438 patients with previously treated stage II, III, or IV ovarian, fallopian tube, or primary peritoneal cancer enrolled in the large, randomized, phase 3 Lifestyle Intervention for ovarian cancer Enhanced Survival (LIVES) study (ClinicalTrials.gov Identifier: NCT00719303). All patients had completed ovarian cancer treatment at least 6.5 months prior to enrollment.
Chronotype was defined in this study according to patient-reported bedtime as assessed using the Pittsburg Sleep Quality Index, with early, mid-, and late chronotypes corresponding to self-reported bedtimes of prior to 9 pm, between 9 pm and 12 am, and after 12 am, respectively. Patient-reported outcomes regarding health-related quality of life (HRQoL), including pain, were evaluated using the Rand-36 questionnaire, other validated measures were used to assess diet and physical activity, and levels of circulating biomarkers were evaluated at routine clinic visits.
Of the 438 patients included in the analysis, chronotype was classified as early, mid, and late for 33, 351, and 54 patients, respectively. While chronotype was not found to be associated with age, smoking history, and ethnicity, individuals with early chronotype had the lowest mean body mass index (22.9 kg/m2), followed by those in the mid-chronotype (27.6 kg/m2), and late chronotype (29.6 kg/m2) categories.
Other key study findings included significantly lower mean levels of sleep duration in those with late chronotype (7.4 hours) compared with mid- (10.3 hours) and early 8.6 hours) chronotypes (P <.05), although reported sleep efficacy was significantly higher in those with late chronotype compared with early and mid-chronotype (P <.05). Nevertheless, global sleep scores for those in all 3 categories of chronotypes were suggestive of disrupted sleep.
Regarding measures of HRQoL, only pain was significantly associated with chronotype, with higher levels of pain reported by individuals with a late chronotype compared with the other 2 groups (P <.05). Furthermore, significant associations between higher reported pain level and higher levels of C-reactive protein (P <.001) and fasting blood insulin (P =.015) were found that were independent of chronotype.
In her concluding comments, Tracy E. Crane, PhD, RDN, of the College of Nursing at the University of Arizona Cancer Center in Tucson, who was the lead author and study presenter, stated that plans were in place to perform longitudinal analyses of these measures according to LIVES study treatment arm assignment, and to include assessments of the circadian rhythms of study participants using actigraphy.
COVID-19 is presenting challenges for doctors treating ovarian cancer patients. And the ways in which they are adapting is changing in real time as the pandemic unfolds. First and foremost, a lot of patients with symptoms are staying at home, as they are being instructed to by the shelter-in-place directives. “But that means a lot people are at home with symptoms that aren’t being addressed,” says Dr. Lori Weinberg, gynecologic oncologist with Minnesota Oncology in the Minneapolis area
Covid-19 continues to pose challenges for doctors caring for ovarian cancer patients.
Due to shelter in place directives, women experiencing symptoms at home may not be getting lab work, or visiting with their doctor. Surgery is being delayed as a result of the pandemic. Starting treatment with chemotherapy rather than surgery is often the best option. COVID-19 is presenting challenges for doctors treating ovarian cancer patients. And the ways in which they are adapting is changing in real time as the pandemic unfolds.
First and foremost, a lot of patients with symptoms are staying at home, as they are being instructed to by the shelter in place directives. “But that means a lot people are at home with symptoms that aren’t being addressed,” says Dr. Lori Weinberg, gynecologic oncologist with Minnesota Oncology in the Minneapolis area. “I think there are many scenarios where women with symptoms are not getting the ideal workup—meaning CAT scans, biopsies, even a visit with their doctor— to help manage their symptoms. In addition, we’re also struggling with the surgical side of things.”
At start of the pandemic, the American College of Surgeons called on physicians to halt nonessential procedures. Most people assume that means facelifts or perhaps knee replacements that could be temporarily delayed without too much harm to the patient. But elective surgery is, by definition, any surgery that is scheduled. That includes cancer surgery, organ transplants, and other lifesaving procedures, many of which are now on hold. Though the guidelines specify that treatment shouldn’t be delayed if it would harm a patient, many surgeries remain in limbo.
“We are not able to take patients to the operating room right away, even when we feel like it’s necessary, because of hospital restrictions that are based on the number of COVID cases in our communities,” Weinberg says. Those restrictions aren’t always due to a lack of capacity to treat patients but more about trying to preserve ventilators, PPE—the protective equipment like masks and gowns that are in short supply—and ICU beds for patients with the virus. Of course doctors are also concerned about bringing patients who may already be immunocompromised into hospitals where they may be exposed to the virus, Weinberg says.
“For ovarian cancer we do have the benefit of the fact that we can treat our patients with upfront chemotherapy” rather than doing the surgery first. “We know from several studies that the outcomes are just as good if we consider doing neoadjuvant chemotherapy” —where doctors start with chemotherapy and then follow that up with surgery after about three or four cycles of treatment—”in certain scenarios. This gives us the opportunity to wait out these surges in COVID patients and still care for our patients the best way we can.”
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Coronavirus – What People With Cancer Need to Know
- The virus is spread from person to person similar to the common cold.
- The CDC recommends everyone take precautions, such as washing hands regularly and keeping a safe distance (3 feet) from people showing symptoms.
- People with compromised immune systems — like those with cancer — may want to wear surgical masks when out in crowded areas.
The spread of the coronavirus is causing fear among those with compromised immune systems. With the number of coronavirus cases spreading worldwide and new alerts being issued in the U.S., cancer survivors, many of whom have compromised immune systems, are worried.
“I worry about every virus, not just the coronavirus, but yes, with that one, I’d be in trouble,” Nick Costas, who just completed a stem cell transplant for multiple myeloma, tells SurvivorNet. “Right now, I have the immune system of an infant.”
The coronavirus has infected more than 85,000 people worldwide so far, and killed nearly 3,000. In the U.S., only one of the roughly 70 cases that have been confirmed to date have resulted in a death, but as Costas notes, those with compromised immune systems may want to take extra precaution anyway.
Here are 5 things people with cancer need to know about the coronavirus outbreak:
1. The Virus Can Easily Spread Through The Air
This type of coronavirus can spread from person to person similar to how the common cold is spread. If a person is infected and coughs or even exhales deeply in the vicinity of another, there’s a chance that the virus may be spread. Specifically, it’s transmitted through small respiratory droplets that commonly travel from people in a close vicinity.
Of the roughly 70 confirmed cases in the U.S., only two people contracted the virus through unknown origins — meaning they were not recently in China, on the Diamond Princess cruise ship or in close contact with someone who had recently been to China.
Because the virus is relatively easy to spread, the Centers for Disease Control and Prevention (CDC) recommends staying 3 feet away from anyone who is sick.
2. There are Preventative Measures Everyone Can Take
No. 1 among those is washing your hands, according to the CDC. As most people with compromised immune systems know, keeping you hands clean makes a major difference.
The CDC also recommends limiting contact with your eyes, nose and mouth. Because it’s so easy to pick up germs with our hands, it’s a safe bet to avoid touching areas where we can easily transmit germs into our bodies.
For the good of the general public, the CDC also recommends staying home if you’re feeling sick. Symptoms of the coronavirus include fever, runny nose, fatigue, cough and difficulty breathing. Even if these symptoms are not severe, which the CDC says can happen in some cases of coronavirus, it’s a good idea to wait any illness out away from public places.
3. Wearing a Mask May Help, In Some Cases
People monitoring the coronavirus outbreak have likely seen photos of people in China and other parts of the world walking around with surgical masks on. While these masks are far from fool-proof, they have been shown to prevent the spread of some airborne illnesses like the flu.
Those with compromised immune systems may want to wear masks when out in crowded places, Dr. Sairah Ahmed, who works in MD Anderson’s Cancer Center’s Department of Lymphoma and Myeloma, Division of Cancer Medicine, told SurvivorNet in a previous interview about the virus.
However, the CDC notes that masks should only be utilized by those who need them — such as immunocompromised people, people who have symptoms of coronavirus or people caring for others who have symptoms — because these are a necessary resource for people who may be sick or may care for those who are sick, and shouldn’t be wasted.
4. Disposing of Masks Correctly Is Important
The CDC notes that putting on and taking off masks in a safe way is important for those who have to use them. Hands should be washed thoroughly with soap and water before putting on a mask, and after disposing of it.
Masks should be disposed of in closed bins immediately after use.
5. Remember, the Risk to the General Public Is Still Low
According to health officials, the risk to the general public in America is still considered low at this time.
The CDC says that they plan to have every state and local health department equipped with testing kits for the virus by next week, as the cases that were contracted by unknown origins in the U.S. suggest that the virus is spreading within communities, even with the efforts to contain it. The ability to test for the virus will hopefully allow local health officials to contain anyone who tests positive quickly and efficiently.
President Trump also expanded travel bans over the weekend to Iran, South Korea and certain areas of Italy that have seen the worst outbreaks.
What Is Coronavirus?
There are currently seven coronaviruses known to infect humans. Four of them are linked to what most people refer to as the common cold; and the other three are Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the current virus — 2019 Novel Coronavirus.
Dr. Waleed Javaid explains what coronaviruses are and what precautions immunocompromised people should take now.
Dr. Waleed Javaid, director of Infection Protection and Control at Mount Sinai, told SurvivorNet that one thing people worried about contracting the virus can do is restrict travel or interaction with people who have recently traveled to affected areas.
“I think for protecting yourself … right now there is restriction in travel,” Dr. Javaid said. “CDC has restricted all nonessential travel to China, and I think we should follow that recommendation. We should also closely follow the CDC recommendations for other places where this virus has been.”
Only a minority of women with ovarian or breast cancer undergo recommended genetic testing, a new study suggests.
Researchers examined data for about 77,000 women diagnosed with breast cancer and 6,000 diagnosed with ovarian cancer in 2013 and 2014. Only about 24% of breast cancer patients and 31% of ovarian cancer patients had genetic test results, the research team reports in the Journal of Clinical Oncology, online April 9.
“We initiated this study – the largest population-based study of multigene testing in breast and ovarian cancer patients – because we wanted to see what cancer genetic testing and results looked like in the real world,” Dr. Allison Kurian of Stanford University in California said in a news release.
“Our major finding was substantial under-testing of ovarian cancer patients: fewer than one third were tested, while guidelines advise that nearly all should be tested. For breast cancer, guidelines have not recommended testing all patients and thus a rate of 24.1% is less concerning,” Dr. Kurian told Reuters Health by email.
“It is crucial that doctors seeing ovarian cancer patients discuss genetic testing with them and facilitate their obtaining it, and that ovarian cancer patients and their relatives advocate for appropriate genetic counseling and testing in their care,” she added.
When genetic tests were performed, 7.8% of women with breast cancer and 14.5% of those with ovarian cancer had pathogenic variants, information that “could be used to drive care decisions and influence family members’ health care and screening choices,” Dr. Kurian said in the release.
The study also found “concerning” disparities in genetic testing by race/ethnicity and insurance status.
For example, nearly 34% of non-Hispanic white women had genetic testing, compared with only about 22% of black women and 25% of Hispanic women. About 20% of Medicare patients were tested compared with about 34% of those with other forms of health insurance.
The prevalence of genetic was around 20% in areas where 20% or more of residents were poor compared with about 38% in regions with less poverty.
“More research is needed to understand all the factors contributing to this gap in care quality and how best to fix it,” Dr. Kurian told Reuters Health.
The study did not have commercial funding. Dr. Kurian has received research funding from Myriad Genetics and has other relationships with Ambry Genetics, Color Genomics, GeneDx/BioReference, Invitae and Genentech.