*new* The Lancet Oncology Cancer Control Hub

The Lancet Oncology Cancer Control Hub

All Comments linked to a Series or Commission published by The Lancet Oncology, and selected articles, are free to access with registration. All other articles can be purchased via The Lancet Choice.

 

More women are choosing to ‘go flat’ after cancer (breast cancer)

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Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy

open access:
Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy
 

Purpose

Cognitive impairment is reported frequently by cancer survivors. There are no proven treatments. We evaluated a cognitive rehabilitation program (Insight) and compared it with standard care in cancer survivors self-reporting cognitive symptoms...

  Up to 70% of patients with cancer report cognitive symptoms after  chemotherapy.¹

Eligible participants were ≥ 18 years old with any solid primary tumor (excluding central nervous system malignancies), who had received definitive treatment of their primary malignancy, including three or more cycles of chemotherapy completed within the previous 6 to 60 months.

 Baseline characteristics were well balanced between the groups (Table 1). Median age was 53 years (23 to 74 years); 230 (95%) were female; 216 (89%) had breast cancer; and 13 (5%) had colorectal cancer. The mean time since completion of chemotherapy was 27 months (6 to 60 months).........Despite our broad selection criteria, the majority of study participants were patients with breast cancer; this was driven by patient interest and recruitment strategies. The number of participants with other primary tumor types was too small for subgroup analysis. However, there is no inherent mechanism suggesting that this intervention would not yield similar results for other tumor types

Correspondence: Multigene Panels to Evaluate Hereditary Cancer Risk: Reckless or Relevant?

Open access

A recent editorial by Axilbund¹ accompanies two important studies of hereditary multiple gene panel tests conducted in patients with breast cancer (BC).^2,3 In one study, by Tung et al,² 488 women with incident BC were tested with a commercial non–BC-specific 25-gene panel. Mutations were identified in 10.7% patients, including 4.6% outside of BRCA1/2 in predominantly moderate penetrance BC genes, such as CHEK2, ATM, and BRIP1. Of interest, 4 (7.3%) mutations were in genes not associated with BC, including one mutation each in the Lynch syndrome (LS) genes, MSH6 and PMS2......

Studies, to date, have consistently documented the discovery of BRCA1/2 mutations among patients with CRC, LS mutations among patients with BC, and other clinically actionable, yet unexpected, findings from panel tests (approximately 3% to 13% of mutations detected).^2,5-7 Like Axilbund, we support the importance of involving genetics specialists in clinical decision making as the landscape of cancer risk assessment evolves, as well as the need for ongoing discourse about the value of testing genes with uncertain clinical implications. However, data have clearly shown that testing a patient with BC or CRC with anything other than a panel test that includes the LS genes and BRCA1/2 will miss prevalent mutations that are clinically relevant to our patients and will place them at risk for preventable cancers.

(Cancer Moonshot Initiative) Financial toxicity: a potentially devastating side effect of treating cancer

medical news

As part of the cancer moonshot initiative launched by Vice President Joe Biden, Family Reach has launched the Financial Treatment Project.

 One option to help patients burdened by financial toxicity is to create a program like Social Security Disability Insurance or unemployment insurance that serves those least equipped to endure financial hardship. It would kick in at the onset of a major cancer diagnosis and provide cash assistance for a defined period. This would go beyond the cost of care, as many families say that loss of income plus out-of-pocket costs for transportation, childcare, and caregiving are even bigger burdens than the copays.

The Fallopian Tube Origin and Primary Site Assignment in Extrauterine High-grade Serous Carcinoma: Findings of a Survey of Pathologists and Clinicians

abstract
 

Accumulating recent evidence suggests that the majority of extrauterine high-grade serous carcinomas (HGSCs) do not arise from the ovary as historically accepted but from the distal, fimbrial end of the fallopian tube from a precursor known as serous tubal intraepithelial carcinoma. There has been variable acceptance of this evidence among pathologists and clinicians dealing with "ovarian" cancer and this has resulted in wide variation in the assignment of primary site between different institutions when HGSC involves >1 anatomic site. This has obvious implications for cancer epidemiology, registration, and entry into clinical trials. We undertook a survey of members of several national and international gynecologic pathology and clinical cancer societies with a view to ascertaining the degree of acceptance of the fallopian tube origin of extrauterine HGSC and to explore various aspects regarding site assignment, pathologic sampling, diagnosis, FIGO staging, and reporting of these neoplasms. The results indicate wide acceptance among both pathologists and clinicians of the fallopian tube theory of origin of HGSC (86% pathologists, 92% clinicians), although there is significant variation regarding the perceived importance of assigning a primary site given the limited prognostic and therapeutic significance. Interestingly, clinicians feel it is more important to assign a primary site than pathologists (71% vs. 49%). The survey also indicates widespread acceptance of recently proposed criteria for site assignment in extrauterine HGSC.

Ovarian Epithelial Inclusions With Mucinous Differentiation: A Clinicopathologic Study of 42 Cases

abstract
 

Ovarian epithelial inclusions lined by mucinous epithelium are rare and of uncertain origin. Ovaries containing such inclusions were studied in 42 women. The inclusions were divided into 3 groups: serous epithelial lined with typical ciliated morphology but with distinct basophilic cytoplasmic mucin in some or all of the lining cells, those lined by typical mucinous epithelium, and those lined by a combination of typical mucinous epithelium and serous epithelium. The mean patient age was 61.5 years. Pure mucinous inclusions were found in 27 patients, serous-type inclusions with cytoplasmic mucin in 20, and mixed type in 10. All 3 types of inclusions were found in 1 patient. Two types of inclusions were found in 13. Four patients had associated mucinous neoplasms (1 mucinous cystadenoma, 1 atypical proliferative seromucinous tumor, and 2 seromucinous cystadenomas), and 11 patients (26%) had endometriosis. The fallopian tubes in 4 patients (9.5%) also displayed mucinous metaplasia; this was not significantly different from the 3.1% we found in our previously reported series of unselected tubes from the same population. These findings suggest that mucinous inclusions may arise as a direct metaplastic change in serous-type inclusions. Other possible origins of mucinous inclusions in the ovarian cortex include endometriosis and Brenner (transitional cell) nests. Whether such inclusions can be a source of mucinous ovarian neoplasms as are Brenner tumors and mature cystic teratomas is unknown and may warrant further investigation.