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Palliative Care Has Greater Effect When Started Early

Timing seems to matter for palliative care’s ability to curtail aggressive and unnecessary ovarian cancer treatment for patients at the end of life. A study published Oct. 28 in JAMA Network Open showed palliative care that was started more than three months before death decreased the use of aggressive treatments. Palliative care focuses on symptom management and quality of life and can be provided at any time during treatment—though it is often confused with hospice care that is administered at the end of life when a person decides to stop treatment. For the study, researchers examined health data from 8,297 people who died from ovarian cancer in Ontario, Canada, between 2006 and 2018. The study found early palliative care was associated with lower rates of emergency department (ED) visits in the last 14 days of life and fewer hospital and intensive care unit (ICU) admissions in the last month of life. The findings also showed patients who received early palliative care were less likely to die in a hospital. “When patients with advanced or incurable cancers experience aggressive end-of-life care, spending their final weeks of life in and out of the ED or admitted to acute care hospital wards or the ICU, where they undergo invasive tests or procedures that may not meaningfully prolong life or address symptoms or suffering, this can be very distressing for patients and their caregivers,” Sarah J. Mah, the lead author and a researcher at McMaster University in Hamilton, Ontario, told Medscape. These findings build on her previous research that showed more patients with aggressive gynecologic cancers are receiving palliative care. Still, Mah noticed that many of these patients who received palliative care were still receiving similar levels of aggressive care at the end of life, which led her to explore the impact of timing in this new study, she told Medscape.

Extensive Lymph Node Dissection Unnecessary in People With Localized Bladder Cancer

A randomized clinical trial comparing two types of surgery in 592 people with localized muscle-invasive bladder cancer found that more extensive surgery did not improve survival. Removing lymph nodes during cancer surgery, called lymphadenectomy or lymph node dissection, can lower the risk of the cancer returning in the pelvis. The study divided patients who were getting surgery to receive standard lymphadenectomy that removes lymph nodes near the bladder, or extended lymph node dissection, which removes a larger group of lymph nodes over a more extensive area. At a median follow-up of 6.1 years, recurrence or death occurred in 45% of patients in the extended-lymphadenectomy group compared with 42% of patients in the standard-lymphadenectomy group. The estimated five-year disease-free survival was 56% in the extended lymph node dissection group and 60% in those who had standard lymph node dissection, according to results published in the New England Journal of Medicine. The findings challenge some surgeons’ practice of removing a larger group of lymph nodes in these patients, according to the Cancer Currents blog, which is published by the National Cancer Institute. “Less is often more,” said Ashish Kamat, a surgeon at the University of Texas MD Anderson Cancer Center in Houston who enrolled study participants in the trial. “The study clearly demonstrates that extended lymph node dissection does not improve survival for most patients, while increasing the risk of complications.”

People With Obesity Are Often Excluded From Clinical Trials

More than 40% of American adults are considered obese, yet medications are rarely tested in people with obesity, according to an AP article. Recently, the Food and Drug Administration and the National Institutes of Health have been encouraging drug companies to include people with obesity in clinical trials. However, data that looked at more than 200 studies on new drugs in the U.S. last year found that nearly two-thirds failed to mention weight or body mass index—a common assessment of obesity, the AP reported. These effects can carry over to those with cancer, according to a STAT article published Oct. 28, which noted that one of these drugs—an antifungal drug that is commonly prescribed to patients with cancer—can last twice as long in people with obesity. This could make chemotherapy less effective, but some clinicians—and their patients—are unaware of that possibility, STAT reported.