The IL-17 family in diseases: from bench to bedside | Signal Transduction and Targeted Therapy

Evaluating Survival Outcomes Of Systemic Anti-Cancer Therapy In Metastatic Cancer

PATIENTS with metastatic or advanced cancer treated at practices administering more systemic anticancer therapy did not display significantly improved survival outcomes compared to patients treated at practices utilising less. The American Society of Clinical Oncology and the National Quality Forum (NQF) aim to reduce systemic anticancer therapy administration at the end of patient's lives. A cancer quality control metric, NQF 0210, looked at the survival outcomes of patients receiving chemotherapy in the last 14 days of life. Researchers conducted a retrospective study on adult cancer patients treated at health care practices using the NQF 0210 metric to evaluate whether patients receiving higher rates of oncologic therapy for advanced disease experienced survival benefits.  

Researchers conducted a retrospective population-based cohort study, analysing data from 78,446 adult patients across the United States, focusing on six common metastatic solid tumours: breast cancer, colorectal cancer, non–small cell lung cancer, pancreatic cancer, renal cell carcinoma, and urothelial cancer. This study used the Flatiron Health de-identified electronic health record database, comprising patients treated at health care practices from 2015 to 2019. Practices were stratified into quintiles based on retrospectively measured rates of NQF 0210. Multivariable Cox proportional hazard models, adjusted with a Bonferroni correction for multiple comparisons, were used to compare overall survival by disease type among patients treated at each practice quintile from the time of diagnosis.   

Results revealed no statistically significant survival benefit for patients treated at practices with higher rates of systemic therapy for very advanced cancer. There were no significant differences in overall survival between the highest and lowest quintiles of NQF 0210 rates. The hazard ratios for death varied across cancer types, with renal cell carcinoma patients showing a hazard ratio of 0.74 (95% confidence interval [CI], 0.55-0.99) and urothelial cancer patients showing a hazard ratio of 1.41 (95% CI, 0.98-2.02), but these differences were not statistically significant. The results suggest that oncologic treatment at the end of life does not necessarily translate into improved survival outcomes. As a result, oncologists might reconsider the administration of additional systemic therapies for very advanced cancers and instead focus on transparent conversations with patients about prognosis. Moreover, helping oncologists identify when further therapy is futile could ensure that patients can make informed decisions, ultimately enhancing the quality of their end-of-life care. 

Reference: 

Canavan ME et al. Systemic anticancer therapy and overall survival in patients with very advanced solid tumors. JAMA Oncol. 2024;DOI:10.1001/jamaoncol.2024.1129 

Encourage Men To Be More Proactive About Their Health

Stereotypes aside, I think it's safe to say that men often tend to be less proactive about their health than women.

That's why public health campaigns like Men's Health Month in June play an admirable role. The annual monthlong observance raises awareness on the many ways in which males — boys and adults — need to take charge of their health care.

June is also home to International Men's Health Week, which took place last week, and June 14's Wear Blue Day, which is sponsored by the Men's Health Network and encourages individuals, organizations, and employers to wear blue and host awareness and/or fundraising events on behalf of the cause.

If we're being honest, society hasn't done the greatest job of promoting proactive health care among males, no matter the age group. According to the Centers for Disease Control and Prevention, the average life expectancy for men in the United States is 5.4 years less than it is for women. Meanwhile, males are at a higher risk for a number of serious diseases, among them heart disease, lung cancer, and HIV, and experience illnesses completely unique to the gender, such as prostate cancer.

And for men from underrepresented groups, the numbers are even worse. So, it's a good thing that for this year's Men's Health Month, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) is focused on bettering health outcomes for racial and ethnic minority and American Indian/Alaska Native (AI/AN) men through its theme, "Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections." The initiative aims to understand better how the unique environments, cultures, histories, and circumstances — the social determinants of health or SDOH — of minority men impact their overall health.

OMH has committed to working with public health and community-based partners to provide racial and ethnic minority and AI/AN men and boys with high-quality medical care and services that are "responsive to diverse cultural health beliefs and practices, preferred languages, economic and environmental circumstances, and health literacy levels." The thinking is that when patients are provided with culturally and linguistically appropriate information, they'll ultimately have healthier outcomes for themselves, their families, and their communities as a whole. And by communities, we can certainly include our own right here in Northeast Pennsylvania.

With encouragement from health care professionals, as well as family members and friends, there's no reason why men can't adopt more healthful practices, whether it's improving their diet and getting a gym membership or better managing their stress levels through yoga, meditation, or therapy. That also includes making a long-term investment in their medical care, from annual visits to their primary care physician to receiving regular prostate testing and colonoscopies, or Cologuard stool testing, to reduce the chance of metastatic prostate or colorectal cancer. Health education should also start at a very young age so families can instill the importance of lifelong healthy habits in their boys.

Most people do not seem to appreciate exercise's profound impact on reducing the risk of most diseases and even slowing the aging process. Thirty minutes of exercise can prevent decline and decay for both men and women.

Let's all do our part to promote better men's health by encouraging the important men in our lives — fathers, husbands, sons, friends, coworkers, etc. — to take their long-term health seriously.

Douglas Klamp, M.D., is a board-certified internal medicine physician who serves as senior vice president, chief medical education officer, and physician chair of resident and fellow talent acquisition of The Wright Center for Graduate Medical Education, as well as program director of the Internal Medicine Residency Program. Klamp is accepting adult patients at The Wright Center for Community Health — Scranton, 501 S. Washington Ave.

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