Current Literature

Despite Challenges, COVID-19 Pandemic Did Not Increase Late-Stage Lung and Breast Cancer Diagnoses

Mallouh MM, Linshaw D, De La Cruz G, et al. Changes in Stage at Presentation among Lung and Breast Cancer Patients during the COVID-19 Pandemic. J Am Coll Surg. 2023, in press.

In this study, data from a single-institution cancer registry were analyzed to determine whether diminished access to cancer screening and preventive care that occurred during the COVID-19 pandemic was associated with more advanced stage diagnoses for breast and lung cancer. Cancer stages at the time of diagnosis before and during the COVID pandemic were compared for each tumor type.

The data analysis showed that there was a significant decrease in the number of breast cancers diagnosed during the pandemic but there was no increase in the proportion of advanced cancers; for lung cancer patients, the decrease in diagnoses was not statistically significant and there was no increase in the proportion of advanced cancers.

The authors documented an increase in the number of diagnoses of early stage lung cancer during the pandemic, and they hypothesized that this might be due to the increased number of chest radiographs obtained to evaluate COVID symptoms during this interval. These data are encouraging, but additional analyses are needed to determine if similar findings are found in other geographic areas and across all patient demographic categories.

Cancer Patients Appreciate Palliative Surgical Procedures

Cohen JT, Beard RE, Cioffi WG, et al. Was It Worth It? Critical Evaluation of a Novel Outcome Measure in Oncologic Palliative Surgery. J Am Coll Surg. 2023, in press.

Available evidence has shown that palliative surgical procedures for patients with cancer who are nearing the end of life have value for providing symptom resolution and improving quality of life. Standard outcome measures such as disease progression do not adequately describe the benefits, or lack thereof, that patients undergoing palliative procedures experience. Standard measures of quality of life, functional status, and time to symptom recurrence are difficult to obtain and document.

This study describes results of a patient-reported assessment of palliative surgery outcomes obtained by posing a simple question: “Was it worth it?”. Responses to this question were recorded (n = 180) within 30 days of the initial procedure; a positive response was obtained in 81.7% of patients. Older patients and patients with early recurrence of symptoms were more likely to respond negatively. Strong social support and family engagement were predictive of positive responses.

The authors concluded that this simple assessment identified patients who were more likely to experience improved quality of life after palliative surgery for advanced malignant disease.

Omission of Radiotherapy in Older Patients with Early Stage Breast Cancer Is Safe, Study Suggests

Kunkler IH, Williams LJ, Jack WJL, Cameron DA, Dixon JM. Breast-Conserving Surgery with or without Irradiation in Early Breast Cancer. N Engl J Med. Feb 16 2023;388(7):585-594.

Lead author Ian H. Kunkler, MB, BChir, and coauthors performed a randomized, prospective study to assess outcomes in patients over 65 years of age with early stage breast cancer (T1 or T2 ER+ tumors) treated with breast conservation and endocrine therapy, with or without postoperative radiation therapy.

The results of the study showed that there was no difference in risk for distant recurrence or mortality in patients who received or did not receive radiotherapy. There was an increase in local recurrence of breast cancer over the first 10 years after operation in patients who did not receive radiotherapy, but risk of distant recurrence or mortality was not increased in patients who developed local recurrence.

The authors concluded that omission of radiotherapy in older patients with early stage breast cancer was safe; they emphasized the fact that patients should be informed of the small increase in risk for local recurrence so that patients can determine their preferences for treatment based on this information.

Editorial

Ho AY, Bellon JR. Overcoming Resistance - Omission of Radiotherapy for Low-Risk Breast Cancer. N Engl J Med. 2023;388(7):652-653.

In the editorial that accompanied this article, authors Alice Y. Ho, MD, and Jennifer R. Bellon, MD, noted that omission of radiotherapy protects patients from complications such as breast pain, dermatitis, and heart/lung complications. They encouraged clinicians to use these data to individualize therapy plans for older patients with early breast cancer.

Article Reviews Stool-Based Screening Tests for Colorectal Cancer

Carethers JM. Stool-Based Screening Tests for Colorectal Cancer. JAMA. 2023.

This brief article provides a clear review of the utility of and indications for the use of stool-based tests for screening patients at risk for colorectal cancer (age ≥45 years).

The three types of testing discussed included the guaiac fecal occult blood test (gFOBT), the fecal immunochemical test (FIT), and the multitarget stool DNA-fecal immunochemical test (s-DNA-FIT). The authors noted that the s-DNA-FIT test requires a prescription from the patient’s physician. Stool samples are collected according to instructions specific for each test and the specimens are mailed to the testing center. Specificity of the tests range from 0.50 to 0.93, with the s-DNA-FIT test having the highest sensitivity.

The author emphasized the fact that a positive test must be followed by a diagnostic colonoscopy with treatment based on the colonoscopy findings. This article is a valuable source of information for surgeons who are advising patients on strategies for colorectal cancer screening.