PFS don’t be fooled

How one bit of medical jargon fuels public confusion about cancer treatments

https://tinyurl.com/y2x728q8

Most new cancer treatments haven’t been proved to help patients live longer or feel better. Instead they delay the growth of tumors, which is measured as an improvement in Progression Free Survival (PFS). In the last decade it’s become the norm in cancer trials.

Patients have no idea what PFS means; it is often a poor marker for outcomes that are most important to them, such as living longer or a better quality of life during and after treatment. 

Of the 42 fast-tracked cancer drugs the FDA approved in 2015-18, only 8 significantly prolonged overall survival. A recent review showed no link between a longer PFS and improved quality of life.

https://tinyurl.com/y3ljfhwa

Reports on trials should include cost, adverse effects, conflicts of interest and whether a drug improves overall survival. 

Lessons learned

Ovarian cancer survivor: 4 lessons I learned from treatment

https://tinyurl.com/y475pqfj

“I believe staying positive is just as important as the drugs that are administered. Except for the days on which I had chemotherapy infusions, I worked the entire time. I didn’t discuss my treatment. I didn’t want the fact that I had cancer to be the first thing people focused on when they saw or talked to me.

I had to be OK with letting others help me. I was taken aback by how many people stepped up. Having others share in this experience helped me to heal mentally and emotionally. Allowing others to assist me helped them cope with the situation, too, since my diagnosis had been so sudden and shocking.

Cancer treatment side effects are real. I had terrible chemo brain and exhaustion during my ovarian cancer treatment. It was incredibly frustrating, especially when I was working, because it felt like everything I did took twice as long.

I’ve always been a positive person, but since finishing my treatment, I’ve really tried to take everything in stride. Life can change in an instant, so I’ve learned to say “yes” to more things and step out of my comfort zone more often, don’t let cancer define you. It’s a bad thing that has happened to you, but it’s not you”.

Angela Hernandez

HRT and ovarian cancer

Menopausal hormone therapy treatment options and ovarian cancer risk: A Swedish prospective population‐based matched‐cohort study

https://doi.org/10.1002/ijc.32706

 Menopausal hormone replacement therapy (HRT) influences ovarian cancer. This survey of all Swedish women who received HRT between 2005-2012 looks at risk. HRT can be oestrogen only or combined oestrogen/progesterone, cutaneous administration is available. Some HRT is continuous some sequential. 

The incidence of ovarian cancer was obtained from the Swedish Cancer Register. The therapy group was compared with a larger control group of women who did not receive HRT.

Current users of continuous combined HRT have a small increased risk being 1.4 times more likely to develop ovarian cancer. This risk is reduced by cutaneous therapy. Oestrogen only HRT is protective with a reduced incidence of ovarian cancer. There is no increased risk with sequential therapy. Once HRT is discontinued there is no increased risk.

Old and vulnerable

Geriatric Vulnerability Score Validated for Use in Managing Care of Older Patients With Ovarian Cancer

https://tinyurl.com/y2s3hgkf

It is well known that elderly patients have worse survival outcomes from ovarian cancer. In Australia patients aged 75 or over have a 5 years survival rate of 21% compared to 52% for the young.

A measure of vulnerability; the geriatric vulnerability score (GVS) has been identified. This measures serum protein, circulating lymphocytes, physical activity and depression and assigns a score of 0 for normal 1 for abnormal, giving a maximum GVS of 4.

With a score of 3 or more the overall survival hazard ratio is 2.94 meaning that these patients are three times more likely than patients of the same age to die of the disease. This may be a significant consideration when choosing appropriate therapy.