The Inside Edge, Sept 2009

Surgically removing and evaluating an increasing number of lymph nodes in patients with colorectal cancer (CRC) does not identify more stage III disease, researchers have found. In 1990, the World Congress of Gastroenterology proposed a minimum of 12 lymph nodes to be removed during surgery for CRC. US researchers compared patients undergoing resection before a multidisciplinary initiative emphasising the importance of lymph node counts (n = 553; early group) with those doing so afterwards (n = 148; late group). The proportion diagnosed with stage III CRC did not differ significantly between the groups, at 36.9 per cent (early) and 32.4 per cent (late). The researchers conclude that harvesting at least 12 lymph nodes as a quality measure appears unfounded. (Kukreja SS, Esteban-Agusti E, Velasco JM et al. Arch Surg 2009;144[7]:612-17)

Black women with breast cancer have a greater chance of dying from the disease than white women, US research has shown. Data on almost 250,000 women diagnosed with breast cancer were included. Risk of death was significantly higher among black women, especially in the first few years after diagnosis. The researchers say the differences could reflect racial differences in response and access to innovations in care, as well as other biological and non-biological factors. Another study, of more than 19,000 patients, found that even when African-American patients received the same care as others, their survival rates were lower for breast, prostate and ovarian cancers, but equivalent for all other major cancers. (Menashe I, Anderson WF, Jatoi I et al. J Natl Cancer Inst 2009;101:993-1000, Albain KS, Unger JM, Crowley JJ et al. J Natl Cancer Inst 2009;101:984-92)

Chemotherapy plus radiotherapy with or without resection (preferably lobectomy) are options for patients with stage IIIA (N2) non-small cell lung cancer. In this phase III trial, patients received concurrent induction chemotherapy (two cycles of cisplatin and etoposide) plus radiotherapy. If there was no progression, patients assigned to group 1 (n = 202) underwent resection, while those assigned to group 2 (n = 194) continued radiotherapy. Median overall survival did not differ between the groups. However, progression-free survival was better in group 1 at a median 12.8 months, as opposed to 10.5 months for group 2 (p = 0.017). Overall survival was better for patients who had lobectomy but not pneumonectomy, versus chemotherapy plus radiotherapy.
(Albain KS, Swann RS, Rusch VW et al. Lancet 2009;374:379-86)

Respecting the patient's preferences for treatment is a key component of high quality end of life care. A US study has shown that video can help patients choose the type of care they want in future. The study involved 200 healthy people aged 65 years or older living in the community, who either listened to a verbal narrative describing advanced dementia (control), or listened to the same narrative then watched a two-minute video depicting a patient with advanced dementia (intervention). Compared to the control group, significantly more patients in the intervention group chose care aimed at maximising comfort and relieving pain over care aimed at maintaining physical function or care to prolong life at any cost. Knowledge of advanced dementia was also greater in the intervention group. (Volandes AE, Paasche-Orlow MK, Barry MJ et al. BMJ 2009;338:b1964)

Frankincense oil could prove a useful gift in the treatment of bladder cancer. US researchers have investigated the effects of an enriched extract of the Somalian frankincense herb Boswellia carteri using cultured human bladder cancer cells and normal bladder cells. They found that it could distinguish cancerous from normal bladder cells and suppress cancer cell viability. Gene expression analysis revealed that the oil suppresses cancer cell growth by activating genes responsible for arresting the cell cycle, suppressing cell growth and inducing apoptosis. (Frank MB, Yang Q, Osban J et al. BMC Complement Altern Med 2009;9:6)

Originally published in the September 2009 edition of MIMS Oncology & Palliative Care.

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