Suss data

11 ESMO 2021 breakthroughs: practicing oncologist’s perceptions on data presentation

https://tinyurl.com/4z6pxhtw

         During the pandemic there has been an increasing use of pre-publication reports and presentations at scientific meetings for the release of potentially significant treatment change. This has meant that the normal checks and balances with independent review prior to audited publication have not always occurred.

         For urgent circumstances such practice may be appropriate. However, this trend is not confined to the COVID-19 pandemic but also is becoming common for much basic medical research. This article looks at 11 presentations at the recent European Society of Medical Oncology meeting and notes errors in the reports, which raise doubt about the value of the work.

         Of the 11 presentations, 2 did not comply with the initial study design, none took account of loss to follow up and none addressed the issue of crossover, which may have induced patients to join trials. The authors say that without proper peer review and transparent presentation of results many seemingly important studies should be viewed with caution.

 

Off-label Methadone

Dubious effects of methadone as an “anticancer” drug on ovarian cancer cell-lines and patient-derived tumor-spheroids

https://tinyurl.com/2zbu9c97

 

         Self-administered opioid drug addiction is commonplace. Treatment for opioid addiction usually includes methadone therapy, meaning there is widespread use and acceptance of the drug.

         Methadone an opioid replacement has previously been shown in vitro to promote cell death and increase sensitivity to chemo. This has led to off-label use of methadone as a cancer treatment.

         This study (also in vitro) shows that methadone has no anticancer effect on ovarian cancer cells, and in fact is detrimental, increasing cell growth rates and blocking platinum chemo.

A dilemma

Society of Gynecologic Oncology publishes practice statement on SCR in recurrent ovarian cancer

https://tinyurl.com/bddd88st

 

         Best practice is an elusive concept.  So as to promote it, the Society of Gynecologic Oncology (SGO) provides guidance, through practice statements, . This week the SGO issued a guide for patients and surgeons when contemplating secondary cytoreductive surgery (SCR) for women with recurrent ovarian cancer.

         Practice statements are based on clinical evidence from randomised trials. In the case of SCR there is a clinical dilemma. From the trials it is clear that for those women whose surgery results in complete clearance there is a survival benefit when compared to women who do not have the surgery. However, when the clearance is incomplete there is evidence that survival is worse than if there had been no surgery.

         The SGO does not unreservedly support the use of SCR. It suggests that every effort should be made to achieve complete clearance, and that patient selection prior to surgery, so as to make this more likely, is essential.

Brain Fog

Long-Term Cognitive Dysfunction in Cancer Survivors

https://tinyurl.com/5n93ma83

 

         “Brain Fog“ is an innocuous term for a problem, which is common to many patients with cancer and yet little recognised or understood. Cognitive decline causes patient distress and complications for management of the disease.

         This exhaustive article (21,000 words, three times the length of most scientific papers) looks at the prevalence, cause and possible treatment of dementia in cancer patients. Most of the data has been collected from patients with breast cancer but the disorder is recognised in cancer patients of all types, including ovarian cancer.

         The prevalence is unknown but has been described in many studies as between 15 and 75% of patients. Causes may include age, genetic predisposition, damage to the biome and metabolic consequences of the cancer or chemo. Treatment focuses on rehabilitation, exercise, mindfulness, and non-conventional drug therapy. Depression should be diagnosed and treated when present, as this will reduce dementia.