Few Cancer Services Provided to Nursing Home Residents
Elderly nursing home residents receive relatively few cancer care services, including screening, surgical treatment, or hospice care.
Few studies have examined cancer treatment and care among elderly patients residing in nursing homes. Yet as the U.S. population ages, more people will move into nursing homes, many of whom will later be diagnosed with cancer. Cancer risk increases as people age.
Cathy Bradley, Ph.D., of the Virginia Commonwealth University Massey Cancer Center in Richmond and colleagues assessed the cancer care received by elderly nursing home residents who were insured by Medicaid. Using data from the Michigan Tumor Registry and Medicare records, they identified 1,907 nursing home residents diagnosed with cancer. They analyzed the patient data by cancer stage at diagnosis, type of cancer, survival time, and whether the patient received surgery or hospice care, as well as other variables.
Sixty-two percent of the nursing home residents with cancer had late or unstaged disease when they were diagnosed, and almost half died within three months of diagnosis. Among patients with late stage cancer, only 28 percent received hospice care. Patients aged 71 to 75 were three times more likely to have surgery than patients aged 86 and older.
"An aging population, coupled with trends in cancer diagnosis and treatment, will shift more cancer care...to nursing homes and make investigations into the care of nursing home cancer patients particularly relevant. At present, nursing homes may be unequipped to recognize and care for their residents with cancer," the authors write.
In an accompanying editorial, Noreen Aziz, M.D., Ph.D., and Keith Bellizzi, Ph.D., of the National Cancer Institute in Bethesda, Md., describe the essential components of cancer care, which include treatment, follow-up care, and palliative care. They also discuss the importance of further studies on the cancer care needs of this unique population of elderly nursing home residents.
"Optimal palliative care will often require multidisciplinary approaches and treatment plans made in accordance with the wishes of, and in partnership with, the patient and family, with a goal of decreasing morbidity and a focus on quality of life," the editorialists write.
Environmental Factors Early in Life May Influence Testicular Cancer Risk
The risk of testicular cancer was significantly lower among first-generation immigrants to Denmark, compared with men born in Denmark to immigrant parents and Danish men with Danish parents. This suggests that early exposure to environmental factors may influence the development of the disease.
The incidence of testicular cancer varies considerably worldwide, but the cause of these differences is unknown. Denmark has one of the highest testicular cancer incidence rates in the world.
To assess the impact of genes and the environment on testicular cancer development, Charlotte Myrup, M.D., of Statens Serum Institut in Copenhagen, Denmark, and colleagues compared the incidence of testicular cancer among first- and second- generation immigrants to Denmark and residents of Danish ancestry. They collected data on 2.1 million men who lived in Denmark between 1968 and 2003, which included 344,444 immigrants to Denmark and 56,189 men born in Denmark to immigrant parents.
Overall, 4,216 cases of testicular cancers were reported among this group, 166 cases among first-generation immigrants and 13 cases among second-generation immigrants. The relative risk of testicular cancer was 63 percent lower among first-generation immigrants, but there was no statistically significant difference in risk among second-generation immigrants, compared with men of Danish ancestry.
"The difference in testicular cancer rates among men born to foreign parents inside Denmark compared with those immigrating to Denmark as children or adults point to the possibility of environmental influences in utero," the authors write.
Contact: Mads Melbye, co-author, MME@ssi.dk, +45 32 68 31 63
Cannabinoids May Inhibit Cancer Cell Invasion
Cannabinoids may suppress tumor invasion in highly invasive cancers.
Cannabinoids, the active components in marijuana, are used to reduce the side effects of cancer treatment, such as pain, weight loss, and vomiting, but there is increasing evidence that they may also inhibit tumor cell growth. However, the cellular mechanisms behind this are unknown.
Robert Ramer, Ph.D., and Burkhard Hinz, Ph.D., of the University of Rostock in Germany investigated whether and by what mechanism cannabinoids inhibit tumor cell invasion.
Cannabinoids did suppress tumor cell invasion and stimulated the expression of TIMP-1, an inhibitor of a group of enzymes that are involved in tumor cell invasion.
"To our knowledge, this is the first report of TIMP-1-dependent anti-invasive effects of cannabinoids. This signaling pathway may play an important role in the antimetastatic action of cannabinoids, whose potential therapeutic benefit in the treatment of highly invasive cancers should be addressed in clinical trials," the authors write.
Contact: Burkhard Hinz, firstname.lastname@example.org, +49 381 4945770
Novel Method Used to Classify New vs. Recurrent Cancer
Researchers developed a new method for distinguishing between breast cancer recurrences and new primary tumors.
One commonly used method is to detect changes in DNA copy number. Another is to compare clinical and pathologic characteristics of the two tumors.
Marc Bollet, M.D., of the Institut Curie in Paris and colleagues compared these two methods with a new method that uses DNA breakpoint data by assessing their ability to distinguish between breast cancer recurrence and new primary tumors in 22 breast cancer patients.
For 14 women, all three methods agreed on whether the tumor was a new primary tumor or a recurrence. The DNA breakpoints method more often agreed with the clinical and pathologic method than did the DNA copy number method. The DNA breakpoints method also outperformed the clinical method in determining the likelihood of metastasis.
The authors concluded that DNA breakpoints could better determine the nature of the breast cancer recurrence than clinical and pathologic characteristics or DNA copy number information.
Contact: Céline Giustranti, communications director, Institut Curie, email@example.com, +33 144 32 40 64
Also in December 25 JNCI:
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