Mechanism insights and therapeutic intervention of tumor metastasis: latest developments and perspectives
For Cancer Patients, Oncologists Often Have The Final Word
At the end of life, doctors' actions and patients' wishes may be misaligned, according to a Rutgers Health studyFor terminally ill cancer patients, the final days of life are immensely personal, having the choice to continue cancer treatments, or to stop treatments and prioritize a more comfortable passing.
What a patient wants, however, isn't always what they receive, according to a Rutgers Health study published in the journal Cancer.
"A patient's end of life is often not a reflection of what they want, but rather, who their oncologist happens to be," said Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, and lead author of the national study. "The data doesn't indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients," says George, who is also a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, the state's only National Cancer Institute-designated Comprehensive Cancer Center.
Clinical guidelines for many cancers recommend stopping chemotherapy in the final days of life as it can do more harm than benefit. But while such treatment discontinuation decisions should be based on clinical presentation and patients' preferences, oncologists could be making decisions based on their characteristic ways of proceeding in such contexts, George said.
To assess how oncologists treat terminally ill cancer patients, George and colleagues at Rutgers Health analyzed national data from the National Cancer Institute's Surveillance, Epidemiology and End Results program. By examining billing codes in Medicare hospital outpatient and carrier claims, they identified 17,609 patients from across the country who died of breast, lung, colorectal or prostate cancer from 2012 to 2017 and the 960 oncologists who treated them at 388 different practices and clinics.
With this data as a starting point, the researchers then used multilevel models to estimate oncologists' rates of prescribing chemotherapy and other systemic cancer therapies to their dying patients in the last two weeks of life. Oncologists were categorized as having "high" or "low" prescribing behavior depending on whether they prescribed to a higher or lower proportion of their patients, relative to their peers.
By accounting for variation coming from patient- and practice-level influences, the researchers were able to isolate the effects that the treating oncologist had on patients' end-of-life.
Results showed a patient receiving care from an oncologist with a high prescribing behavior had a striking 4.5-times higher odds of receiving cancer treatment in the final days of life, compared with a patient receiving care from an oncologist with a low prescribing behavior.
Additionally, individuals with breast cancer had higher odds of receiving late-stage treatment than those with lung cancer.
Other findings include:
Because the data was anonymized, the researchers couldn't identify the prescribing oncologists by name or practice. But the results indicate that despite clinical prescribing guidelines, there remains significant variations in what terminally ill cancer patients receive at the end of their lives.
George said making this kind of information publicly available could help better align patients' treatment wishes with reality.
"When we go out to eat or go shopping, we don't just blindly pick a restaurant or randomly grab the first thing we see on the shelf. We look at the ratings and reviews to see what other people experienced as we make decisions," George said.
"Shouldn't patients with cancer have the same luxury?" he added. "As health care consumers, we have a right to know about the providers that we pick."
George said future research will examine the factors that fuel patients' and clinicians' decisions between more cancer treatments and hospice care.
The research was supported by the Rutgers Cancer Institute and the National Cancer Institute. Paul R. Duberstein from the Rutgers School of Public Health, Benjamin Bates from Rutgers Robert Wood Johnson Medical School and the Rutgers School of Public Health, Biren Saraiya and Sanjay Goel from the Rutgers Cancer Institute, and Ayse Akincigil, an associate professor at the School of Social Work, also co-authored the study.
Colorectal Cancer Can Be Detected, Eliminated With Early And Proper Testing - Don't Wait
Screening for colon cancer saves lives. This March, during Colorectal Cancer Awareness Month, talk with your provider about a colonoscopy screening.
Colonoscopies are the most effective screening tool to catch colon cancer early in the disease and even prevent it, but people often avoid them. Having colonoscopies as recommended can decrease the risk of developing colon cancer because pre-cancerous polyps can be identified and removed.
Dr. Megan Sippey, a general surgeon at University Hospitals Samaritan Medical Center, encourages people to have colonoscopies as a tool in the prevention and early detection of colon cancer.
Christina Vanderpool
What is a colonoscopy?A colonoscopy is a procedure during which you are given a light sedation, and the doctor inserts a small tube with a camera to visualize the inside of the large intestine, Sippey said. You are given instructions about diet and preparation to complete in the days leading up to the exam. The helps to clean the inside of the colon to allow the doctor to see its inner wall. Although the test is simple and typically painless, they are often avoided.
Here are a few reasons why:
The test seems invasive and embarrassing
No symptoms of colon cancer
Colonoscopies require a doctor's order and preparation before to the exam. While you do have to have the test done in a hospital or surgery center with light sedation, the procedure is the gold standard for colon cancer prevention and early diagnosis.
Who qualifies for screening colonoscopies?Age 45 or older without family history
Age 40 or older with a family history of colon cancer, specifically parents or siblings
There are alternative screenings for people who are at lower risk for colon cancer. These are at-home tests that require a stool sample to be sent to a laboratory to be evaluated. Examples are Cologuard and the fecal immunochemical test or FIT test. If the home test is positive, then your doctor will arrange for you to have a colonoscopy.
What are the risk factors for colon cancer?
Colon cancer is often "symptom free" until later stages of the disease, but there are certain people who are at greater risk for developing colon cancer.
If you have one of the following, you may be at greater risk:
Bowel diseases like IBS, or Crohn's
Diet high in fat, low in fruits and vegetables
With screenings, colon cancer can be prevented. Modifiable risk factors can be controlled to help stop the disease. For example:
Maintain a healthy weight
Do not smoke, or quit smoking
Maintain bowel and other chronic diseases
Sippey says colon cancer has few symptoms until it is very advanced. Therefore, screening tests are important and can save lives. Not only can screening find cancer early while it is easy to treat, but having a colonoscopy allows pre-cancerous polyps to be removed before the polyps ever have a chance to grow into cancer.
To determine if a colonoscopy is right for you, talk to your University Hospitals healthcare provider. If you do not have a provider, call 419-207-0491 for assistance in finding one.
To read more about colon cancer, screenings test and why it is that people avoid coloscopies, go uhhospitals.Org.
Christina Vanderpool, RN, BSN, is the community outreach nurse at University Hospitals Samaritan Medical Center in Ashland.
This article originally appeared on Ashland Times Gazette: Colonoscopies vital to early cancer detection; screening saves lives
Man, 43, Dies Of Colon Cancer Months After His Diagnosis - He Suffered Little-known 'untraditional' Symptom
A heartbroken wife who lost her husband to bowel cancer just weeks after his shock diagnosis has urged others to be aware of the 'untraditional' signs of the disease.
Toby Bevans, from Windsor in Berkshire, was just 42 when he began experiencing backache and fatigue near the end of 2023.
But it was only after the father-of-two developed the flu that December and his chest pain failed to subside that he visited the GP.
Tests results in January 2024 revealed he had stage 4 bowel cancer, which meant it had spread to other parts of his body — specifically his liver and bones.
Despite gruelling chemotherapy and radiotherapy treatment, he was given the devastating news in May that there was 'nothing else' medics could do.
Mr Bevans died weeks later on June 16 — Father's Day — at the age of just 43.
Now, his wife Ali Bevans, 42, is calling on Brits to recognise the little-known signs of the cancer, amid an explosion in cases of the disease in young people.
The development manager at Marks and Spencer has also raised more than £85,000 to date for Bowel Cancer UK in her husband's memory.
Toby Bevans, from Windsor in Berkshire, was just 42 when he began experiencing backache and fatigue near the end of 2023. Pictured, with wife Ali
But it was only after the father-of-two developed the flu that December and his chest pain failed to subside that he visited the GP. Pictured, Toby with his wife Ali and children Freddie and Tilda
Speaking about his death, Mrs Bevans said: 'Toby's diagnosis came with very few symptoms and none of the traditional bowel cancer flags and was a huge shock.
'It was literally like a bullet train and the bullet train crashed.
'None of us know what's around the corner, but we can do our best to live our life today.'
Following his shock diagnosis, 'your world just stops in an instant,' she added. 'Your life is never the same from that moment.'
There are around 44,000 cases of bowel cancer every year in the UK and 142,000 in the US, making it the fourth most common cancer in both countries.
But cases are rising in young people, an alarming trend that experts have linked to modern diets, chemical exposure and lifestyles.
Symptoms often include changes in bowel movements such as consistent and new diarrhoea or constipation, needing or feeling the need to poo more or less frequently and blood in the stool.
Stomach pain, a lump in the stomach, bloating, unexpected weight-loss and fatigue are among other signs.
Despite gruelling chemotherapy and radiotherapy treatment, he was given the devastating news in May that there was 'nothing else' medics could do. Mr Bevans died weeks later on June 16 — Father's Day — at the age of just 43
Bowel cancer can cause you to have blood in your poo, a change in bowel habit, a lump inside your bowel which can cause an obstructions. Some people also suffer with weight loss a s a result of these symptoms
Anyone experiencing these symptoms should contact their GP for advice.
But Mrs Bevans, who met her husband at university before they married in 2011, said, the only symptoms her husband suffered prior to his diagnosis were fatigue, back ache and then chest pain.
Despite the 'brutal' diagnosis, she added that they both enjoyed spending time together and found comfort in the small moments, such as making each other smile or getting outside.
'I think it puts everything into perspective and it gives you so much clarity,' she said.
'In the end, from his diagnosis to the day that he died, it was just under five months and, at the end of May, we knew that he was going to die.'
This meant she focused on 'making him comfortable' in his final days, with 'incredible' support from Thames Hospice.
Mrs Bevans said: 'He died on Father's Day, which was very poignant, very Toby.
'I don't think it's something you can ever prepare yourself for. But I was with him at the end and I was very grateful for that.'
Mrs Bevans, who met her husband at university before they married in 2011, said, the only symptoms her husband suffered prior to his diagnosis were fatigue, back ache and then chest pain. Pictured, Toby running a marathon in 2010
While Mr Bevans was undergoing treatment in hospital, she added that she was inspired to 'take a challenge on' and launched a JustGiving page to run the 2025 TCS London Marathon on April 27.
Within 24 hours of setting up the page she had already raised over £6,000.
Prior to his death, she said the donations had reached £22,000 and he told her: 'Double your target, go for £50,000, you'll get there.'
Their children — Freddie, now 10, and Tilda, 9 — have since taken on their own challenges, with friends and work colleagues also hosting quizzes, bake sales, 24-hour danceathons and a silent auction, taking the current total to £85,446.
Mrs Bevans' sister Vicky Plenderleith will be swimming the distance of a marathon in 10 days, and the couple's friends and her other sister Caroline Divitt will also now join Mrs Bevans and run the marathon.
Reflecting on the support, she said: 'It's just amazing because the one thing that Toby was always big on was his friendships.
'Even Freddie summed it up and said, "Mummy, if we make a difference to just one person's life, it will be worth it".'
The marathon has given her 'something positive to focus on', she added, and she wants to continue 'living for (herself) and the kids', with Mr Bevans always in their hearts.
While Mr Bevans was undergoing treatment in hospital, Mrs Bevans (pictured) said she was inspired to 'take a challenge on' and launched a JustGiving page to run the 2025 TCS London Marathon on April 27
She added that crossing the finish line with her friends will be 'hugely emotional' on April 27 and hopes she can reach her latest fundraising target of £100,000.
'For Toby at the end, he genuinely said, "I've got no regrets", and I think for somebody at 43 to say that is incredible,' Mrs Bevans added.
'He said: "Life is a gift. Do the things that make you feel alive".
'Toby made the most of every opportunity, and I think living in that way, ultimately, is all you can do.'
Pascale Harvie, president and general manager of JustGiving, said: 'Through hard work and determination, Team Toby has raised both important awareness and vital funds for Bowel Cancer UK.
'Their story is a powerful reminder of the incredible impact communities can have when they come together.'
Mrs Bevans' awful ordeal comes as experts continue to warn of a disturbing rise in bowel cancers in under 50s, which has baffled doctors around the globe.
The disease, the third most common cancer in the UK, is the same type that killed Dame Deborah James at age 40 in 2022.
Although the vast majority of diagnoses affect those aged over 50, rates in older age-groups has either declined or held stable while diagnoses in younger adults have risen by 50 per cent over the last 30 years.
Cancer Research UK estimates that over half (54 per cent) of bowel cancer cases in the UK are preventable.
Doctors have suggested obesity, antibiotic over-use, mobile phone radiation and even invisible particles of plastic in drinking water are potential triggers.
However a growing number of experts are also pointing ultra-processed foods as a cause.
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