In brief

Toxicity indicates success in breast cancer
Vasomotor and joint symptoms in breast cancer patients receiving endocrine treatment may indicate treatment success, according to a retrospective analysis of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial. The analysis showed 1,486 out of 3,964 women reporting new vasomotor symptoms (hot flushes, cold and night sweats) at three-month follow-up. These women had a lower risk of subsequent disease recurrence (HR 0.84, p = 0.04) than those not reporting such symptoms. A greater decrease in breast cancer recurrence was seen among the 1,245 women who reported new joint symptoms at three-month follow-up (HR 0.60, p <0.0001) compared with those without such symptoms.
Cuzick J, Sestak I, Cella D et al. Lancet Oncol 2008; doi:10.1016/S1470-2045(08)70259-6

End of life care needs better understanding
The definitions of end of life care need to be clarified and standardised, say UK researchers who undertook a consultation exercise involving 210 representatives from primary and secondary care, specialist palliative care and academic and voluntary sectors in England and Scotland. Perceptions of what end of life care refers to ranged from more than a year to the last few days of life. Prominent concerns included difficulties in prognosis and availability of support for patients with advanced non-malignant disease. The consultation highlighted the challenges that generalists in primary and secondary care face in maintaining their skills and expertise. The researchers also said that more needs to be known about the context of end of life care provision and the influence of competing priorities and incentives in general practice.
Shipman C, Gysels M, White P et al. BMJ 2008; 337: a1720

Bone loss risk highlighted
The risk of bone loss resulting from breast and prostate cancer treatment has been highlighted by researchers in Canada. They reviewed 90 articles reporting on 80 studies (37 randomised controlled trials and 43 observational studies). Several therapies commonly used to treat breast and prostate cancer, in particular, aromatase inhibitors and androgen deprivation therapy, were associated with significant bone loss and increased fracture risk. Bisphosphonates seemed to attenuate bone loss, although the researchers say that the long-term impact is unclear because of insufficient follow-up. They add that patients should be educated about the risk of bone loss and lifestyle measures that can help to avoid it.
Saad F, Adachi JD, Brown JP et al. J Clin Oncol 2008; doi: 10.1200/JCO.2008.18.4184

Risk of venous thromboembolism
Treating patients with the recombinant monoclonal antibody bevacizumab carries a significant risk of venous thromboembolism (VTE), a meta-analysis has shown. Researchers included data on 7,956 patients with a variety of advanced solid tumours from 15 randomised controlled trials in their analysis. Among patients receiving the angiogenesis inhibitor, the incidence of all-grade and high-grade VTE was 11.9 and 6.3 per cent, respectively. Patients' overall risk of VTE was 33 per cent higher than for controls. The researchers found that VTE risk was similarly increased for low-dose bevacizumab (2.5 mg/kg per week; RR 1.31, p 0.007) and high-dose treatment (5 mg/kg per week; RR 1.31, p 0.04).
Nalluri SR, Chu D, Keresztes R et al. JAMA 2008; 300(19): 2277-85

Fatigue before cancer treatment
Almost a quarter of cancer patients may already be experiencing severe fatigue before their treatment starts, researchers in the Netherlands have found. They assessed 179 patients with various malignancies before treatment initiation and found that 23.5 per cent were severely fatigued. Prevalence of fatigue varied between diagnoses with prostate cancer at 14.3 per cent, breast cancer at 20.3 per cent and gastrointestinal cancer at 28.1 per cent. Factors that appeared to contribute to severe fatigue were lower physical activity, depressive mood, impaired sleep and rest during the day and night, and fatigue one year before diagnosis.
Goedendorp MM, Gielissen MFM, Verhagen CAH et al. Br J Cancer 2008; 99: 1408-14

Cancer survival not affected by age
Age should not influence treatment decisions in cancer patients, researchers in Spain say, because it is not an independent factor affecting cancer survival. Their prospective study involved 224 patients ultimately diagnosed with cancer, confirmed by histology or cytology. Patients' functional status and various other factors were assessed. One-year survival in the cohort was 38.8 per cent and independent predictive factors for survival were found to be functional status, extent of disease dissemination, physical quality of life and serum albumin level. However, age did not influence survival.
Domingo E, Surinach JM, Murillo J et al. Int J Clin Pract 2008; 62: 1723-9

Failure to complete tamoxifen course
Half of all women taking tamoxifen fail to complete the five-year treatment course, according to a retrospective cohort study of all women with incident breast cancer in Tayside, Scotland, carried out between 1993 and 2002. The median duration of use among the 1,633 women in the study who were prescribed the drug was 2.42 years. Adherence below 80 per cent was associated with poorer survival (HR 1.10, 95% CI 1.001-1.21). Only 49 per cent of women taking the drug continued therapy for five years and younger women were more likely to stop early.
McCowan C, Shearer J, Donnan PT et al. Br J Cancer 2008; doi: 10.1038/sj.bjc.6604758

Housework can cut breast cancer risk
Good old-fashioned housework, such as scrubbing floors, can reduce a woman's risk of breast cancer, a US study has shown. Researchers assessed usual physical activity among 32,269 women at baseline using a self-administered questionnaire; participants were then followed up for 11 years. The data showed an inverse relationship between postmenopausal breast cancer and vigorous activity, defined as heavy housework or gardening, such as scrubbing floors or digging, and strenuous exercise, such as fast jogging or aerobics. However, the association only held true for women with a BMI <25kg/m2 (RR 0.68; 95% CI 0.54-0.85).
Leitzmann MF, Moore SC, Peters TM et al. Breast Cancer Res 2008; 10: R92. doi: 10.1186/bcr2190.

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