Future need for more cancer research

MicroRNA signatures as biomarkers and therapeutic target for CNS embryonal tumors: the pros and the cons

Embryonal tumors of the central nervous system represent a heterogeneous group of childhood cancers with an unknown pathogenesis; diagnosis, on the basis of histological appearance alone, is controversial and patients’ response to therapy is difficult to predict. They encompass medulloblastoma, atypical teratoid/rhabdoid tumors and a group of primitive neuroectodermal tumors. All are aggressive tumors with the tendency to disseminate throughout the central nervous system. The large amount of genomic and molecular data generated over the last 5–10 years encourages optimism that new molecular targets will soon improve outcomes. Recent neurobiological studies have uncovered the key role of microRNAs (miRNAs) in embryonal tumors biology and their potential use as biomarkers is increasingly being recognized and investigated. However the successful use of microRNAs as reliable biomarkers for the detection and management of pediatric brain tumors represents a substantial challenge. This review debates the importance of miRNAs in the biology of central nervous systemembryonal tumors focusing on medulloblastoma and atypical teratoid/rhabdoid tumors and highlights the advantages as well as the limitations of their prospective application as biomarkers and candidates for molecular therapeutic targets.

Long-term and late effects of germ cell testicular cancer treatment and implications for follow-up

Germ cell testicular cancer (TC) represents a malignancy with high cure rates. Since the introduction of cisplatin-based chemotherapy in the late 1970s, the 5-year survival rate has increased considerably, and it is currently above 95%. Because TC is usually diagnosed before the age of 40 years, these men can expect to live for another 40 to 50 years after being successfully treated. This success, however, is hampered by an increased risk of long-term and late effects of treatment. Secondary malignant neoplasms and cardiovascular disease represent the most common potentially life-threatening late effects, typically occurring more than 10 years after treatment. Other long-term effects include pulmonary toxicity, nephrotoxicity, neurotoxicity, decreased fertility, hypogonadism, and psychosocial problems. The incidence and time to onset of these various adverse effects vary according to treatment type and intensity. There is still little knowledge about underlying mechanisms and genetic susceptibility of the various adverse effects. Apart from treatment burden, it is not yet possible to identify patients who are at high risk for certain late effects after TC treatment. In this clinical review, we present the current status regarding different somatic and psychosocial long-term late effects after treatment for TC, based on Medline searches and our own research. Moreover, we postulate recommendations for general medical evaluations that should begin after treatment is completed and continue during follow-up.

Cancer survivorship research: state of knowledge, challenges and opportunities

INTRODUCTION

Seminal advances in early detection of and treatment strategies for cancer have led to burgeoning numbers of cancer survivors. While most therapeutic modalities for cancer are beneficial and lifesaving, they are associated with adverse long-term and late sequelae.

MATERIALS AND METHODS

Literature review using MEDLINE to identify studies examining adverse medical outcomes and post-treatment follow-up care among long-term survivors. Emerging concepts in survivorship research such as definitional issues, research paradigms and methodologic concerns were also examined.

RESULTS

Long-term or late adverse sequelae are more prevalent, serious, and persistent than expected in survivors of pediatric and adult cancer, but remain understudied especially among those diagnosed as adults. Follow-up care relevant to survivorship outcomes is neither standardized nor guideline or evidence based for most adult cancers, and optimal practices have yet to be defined.

DISCUSSION

Adverse sequelae contribute to burden of illness, health care costs, and decreased length and quality of survival. To-date, very few studies have compared survivor outcomes pre-and post diagnosis. It is critical to examine under-researched questions and understudied survivor groups. Regular follow-up care and monitoring of health status post cancer treatment should 1) permit the timely diagnosis and treatment of adverse outcomes; 2) enable timely diagnosis and treatment of recurrences; 3) facilitate screening and early detection of second cancer(s); 4) allow for detection and management of co-morbidities; and 5) provide the opportunity for preventive strategies such as lifestyle changes. Research findings to-date underscore the need for continued cancer survivorship research that will: inform our understanding of the mechanisms underlying adverse sequelae; lead to the design of less toxic treatments; test the effectiveness of interventions - medical, pharmacologic, and behavioral - that reduce adverse outcomes; test models of post-treatment follow-up care; develop an evidence base for optimal follow-up care practices; and inform survivor and provider decision making.

Lifestyle interventions in cancer survivors: designing programs that meet the needs of this vulnerable and growing population

In the world today, there are roughly 25 million cancer survivors. Although the increasing numbers of survivors testifies to the success of early detection and treatment, there is a downside. Cancer survivors are at increased risk for second cancers, other forms of comorbidity (e.g., cardiovascular disease, diabetes, osteoporosis), and functional decline. Lifestyle factors, such as a healthy diet, regular exercise, and smoking cessation may prevent these conditions and improve survivors' quality of life. Data also are accumulating to suggest that healthful lifestyle practices and successful weight management may prevent progressive or recurrent disease. Previous surveys conducted among both adult and pediatric cancer survivors indicate that most survivors have high levels of interest in diet and exercise interventions. Additionally, survivors who smoke report high levels of interest in interventions aimed at smoking cessation. Many factors, such as intervention timing and duration and channels of delivery, must be carefully considered in developing interventions that best meet the needs of this vulnerable population. Total transparency also is necessary in reporting the results of trials to ensure the inclusion of information regarding proportional accrual, attrition, and study sample sociodemographic characteristics to move toward the development of interventions most likely to gain broad-scale acceptance and adherence. Home-based interventions that rely on telephone counseling, mailed materials, or computer-assisted approaches offer promising means of reaching the geographically dispersed population of cancer survivors. More research is necessary to develop interventions that can reach and effectively promote long-term behavior change in this ever-increasing population.

Promoting Health and Physical Function Among Cancer Survivors: Potential for Prevention and Questions That Remain

Cancer survivors are at increased risk, not only for progressive and recurrent disease, but also other cancers, cardiovascular disease, diabetes, osteoporosis, and functional decline. Lifestyle interventions to improve dietary and physical activity behaviors, and smoking cessation, have the potential to improve the overall health and quality of life of this vulnerable population. Studies on overall health and physical function from 1966 and beyond regarding the impact of behavioral interventions that used randomized and controlled designs were identified through MEDLINE and PubMed searches. Published reports currently exist for 22 exercise interventions, 11 diet-related interventions (excluding those limited to dietary supplements or single nutrients), two diet and exercise interventions, and 10 behavioral-based smoking cessation interventions. Although many interventions have been successful in promoting behavioral change and have resulted in improvements in various health-related outcomes, more research is needed to determine the key components of interventions that are able to produce the greatest behavioral change and the most favorable health-related benefits. The oncology care provider can play a pivotal role in improving the long-term health of cancer survivors by (1) being aware of opportunities to encourage healthful behaviors (ie, smoking cessation, weight control, and increased physical activity); (2) vigilantly tracking long-term effects among cancer survivors and exploring whether they are amenable to intervention; (3) staying abreast of current health behavior guidelines for cancer survivors and existing resources for professional and patient education; and (4) supporting and contributing to efforts aimed at primary and tertiary prevention research.

Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer

PURPOSE

Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population.

METHODS

Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches.

RESULTS

Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance.

CONCLUSION

With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.