ESMO 2017 Press Release: Study Identifies Factors that Limit Work Ability of Young Adult Cancer Survivors

  • Date: 09 Sep 2017

LUGANO-MADRID – Factors that limit the work ability of young adult cancer survivors are reported today at the ESMO 2017 Congress in Madrid. (1)

Late side effects can occur months or years after cancer treatment. In patients diagnosed with cancer in young adulthood, these late effects may interfere with career development.

The NOR-CAYACS study investigated the work abilty of patients diagnosed with cancer at the ages of 19 to 39 years. (2) Patients diagnosed with melanoma, colorectal cancer, breast cancer stages I–III, non-Hodgkin lymphoma or leukaemia in 1985 to 2009, and alive in September 2015, were identified through the Cancer Registry of Norway.

Participants were mailed a questionnaire about late effects of treatment and work status, and then scored themselves from 0 (no work ability) to 10 (highest work ability) on the Work Ability Index.

A total of 1,198 participants answered the questionnaire. The median age at the time of the survey was 49 years, it was a median of 13 years since cancer treatment, and 60% had a full-time job.

A low Work Ability Index was associated with a low level of education, female sex, lymphoedema, fatigue, depression, and reduced physical quality of life and self-reported health. Non-Hodgkin lymphoma survivors had a higher risk for reduced work ability compared to the melanoma group. Treatment intensity was not associated with work ability.

“We found that psychological and physical late effects of cancer and other conditions were significantly associated with reduced work ability,” said lead author Dr Cecilie Kiserud, chair, National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway. “In comparison, treatment intensity and cancer type, apart from non-Hodgkin lymphoma, were not significantly related to work ability.”

She concluded: “Greater awareness is needed about the fact that cancer survivors may be less able to work after treatment because of the late effects they might experience.”

Commenting on the study, Professor Gilles Vassal, Director of Clinical Research, Gustave Roussy, Villejuif, France, and Past President of the European Society for Paediatric Oncology (SIOPE), said: “Around 80% of young people with cancer can be cured, but the treatments are intensive and two-thirds of survivors have long-term physical and psychological consequences. This study shows that the psychological and somatic effects of treatment are associated with reduced work ability, rather than the cancer itself.”

“Young cancer survivors should be informed about potential toxicities and monitored to minimise the severity of long-term sequelae,” he added. “Prospective clinical trials are needed to find treatments that lower the risk of late toxicity without jeopardising the probability of cure.”

A second study presented at the ESMO 2017 Congress and published online in ESMO Open (3) has revealed that more than two-thirds (67%) of healthcare providers treating adolescents and young adults with cancer in Europe have no access to specialised centres. (4) The gap in care was more pronounced in Eastern and Southern Europe compared to Western and Northern Europe.

The finding comes from a survey on the status of care and research in these patients, conducted by the joint ESMO/SIOPE working group on adolescents and young adults with cancer. A link to an online survey was sent to members of both societies and several European oncology groups. Of 323 responses, 266 were from Europe and these results are reported at the ESMO 2017 Congress.

More than two-thirds (67%) of health professionals had no access to services specialised in managing the late effects of cancer treatment in this patient group. A similar proportion (69%) were not aware of research in their country in this age group, which has multiple unmet needs.

Most of the respondents were able to refer young patients to professional psychological support and specialised social workers. Nearly half had access to an age-specialised nurse. Overall, 38% of respondents said young cancer patients had no access to fertility specialists, rising to 76% in Eastern Europe. Respondents wanted education on how to advance the care provided to young patients with cancer, address the late effects of cancer treatment, prevent second cancers, and improve molecular profiling of tumours developed in young individuals.

Lead author Dr Emmanouil Saloustros, consultant medical oncologist, General Hospital of Heraklion ‘Venizelio’, Heraklion, Crete, Greece, said: “The survey found gaps and disparities in cancer care for adolescents and young adults across Europe. Improving care through education and research in this age group is a growing priority for ESMO and SIOPE.”

Commenting on the study, Vassal said: “These patients have specific needs that are not covered by paediatric or general oncology centres or classical medical oncology centres, and this survey shows that most do not have access to the recommended special care. Countries without these services can look at existing examples – such as in the UK and France – to build teams equipped to improve survival and survivorship for adolescents and young adults with cancer.”

Further studies will be presented at the ESMO 2017 Congress on the availability of paediatric radiation therapy in Europe (5), productivity in patients with advanced gastric cancer (6), and fertility in BRCA mutant breast cancer (7).

-END-

Notes to Editors

Please make sure to use the official name of the meeting in your reports: ESMO 2017 Congress

The full paper is available here

References

  1. Abstract 1110PD_PR ‘Factors associated with reduced work ability in a nation-wide cohort of long-term cancer survivors treated in young adulthood (19-39 years) - the NOR-CAYACS study‘ will be presented by Dr Cecilie Kiserud during the Poster Discussion session on ‘Public health policy and health economics’ on Saturday, 9 September 2017, 16:30 to 17:45 (CEST) in Tarragona Auditorium.
  2. NOR-CAYACS is a sub study of a larger investigation on cancer survivorship in young adults in Norway.
  3. The care of adolescents and young adults with cancer: results of the ESMO/SIOPE survey.ESMO Open 2017;0:e000252. doi:10.1136/esmoopen-2017-000252
  4. Abstract 1438O_PR ‘Report on ESMO/SIOPE European Landscape project key results: Mapping the status and needs in AYA cancer care‘will be presented by Dr Emmanouil Saloustros during Proffered Paper session on ‘Public health policy and health economics’ on Monday, 11 September 2017, 16:30 to 18:00 (CEST) in Alicante Auditorium.
  5. Abstract 1439O_PR ‘Paediatric radiation therapy across Europe - a European questionnaire survey supported by the SIOPE, ESTRO, PROS and several national paediatric hematology-oncology societies (NAPHOS)‘ will be presented by Dr Charlotte Demoor-Goldschmidt during Proffered Paper session ‘Public health policy and health economics’ on Monday, 11 September 2017, 16:30 to 18:00 (CEST) in Alicante Auditorium.
  6. Abstract 1112PD_PR ‘Real-World Productivity, Healthcare Resource Utilization (HRU), and Quality of Life (QOL) in Patients with Advanced Gastric Cancer (GC) in Canada and Europe‘will be presented by Mr Gregory Maglinte during Poster Discussion session on Public health policy and health economics on Saturday, 9 September 2017, 16:30 to 17:45 (CEST) in Tarragona Auditorium.
  7. Abstract 1541O_PR ‘Reproductive potential and performance of fertility-preserving procedures in BRCA mutation-positive (BRCA+) breast cancer (BC) patients (pts)‘will be presented by Dr Matteo Lambertini during the Proffered Paper session on ‘Supportive and palliative care’ on Saturday, 9 September 2017, 16:20 to 18:00 (CEST) in Cordoba Auditorium.

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Abstract 1110PD_PR

Factors associated with reduced work ability in a nation-wide cohort of long-term cancer survivors treated in young adulthood (19-39 YEARS) – THE NOR-CAYACS STUDY

C.E. Kiserud1, H.C. Lie1, A. Finset2, S. Fosså1, J.H. Loge1, E. Ruud3, A.A. Dahl1
1Department Of Oncology, Oslo University Hospital, Oslo/NORWAY, 2Department Of Behavioral Science In Medicine, University of oslo, Oslo/NORWAY, 3Dept Of Peadiatrics, Oslo University Hospital, Oslo/NORWAY

Background: Young adulthood (19-39 years) is a phase of life focused on career development and establishment of a family. Cancer during these years may interfere considerably with solving these tasks. We examined factors associated with reduced work ability among cancer survivors treated in young adulthood (YACSs).

Methods: The Cancer Registry of Norway identified 3,617 YACSs alive at September 1, 2015 and diagnosed with cancer from 1985 to 2009, who were mailed a questionnaire. The response rate was 41% and we included 1,198 YACSs (198 melanoma, 494 breast cancer, 148 colorectal cancer, 222 non-hodgkin lymphoma and 136 leukemia), excluding YACSs who were in treatment, did not report on treatment, or had their last cancer diagnosed < 2 years before survey. Self-reported treatment was categorized in 6 groups by increasing intensity from minor surgery to 4-6 treatment modalities. The dataset was analyzed with block-wise linear regression analysis with current work ability (0=none to 10=optimal) as dependent variable.

Results: Mean age at diagnosis was 34 years, mean age at survey 50 years and 60% were in full time job. Our five steps block-wise model explained 54% of the variance in work ability. Late effects and cancer-related variables explained 16%, socio-demography 5%, self-reported health and somatic diseases 27%, mental distress 5%, and lifestyle 1%. Cancer diagnosis and treatment burden did not contribute significantly to the model, while cognitive problems, neuropathy, lymphedema, and radiation sequelae in skin, connective tissue and/or muscles contributed significantly to reduced work ability. The same was true for being female, having a low level of education, having poor self-rated health and cardiovascular disease including hypertension. Higher levels of anxiety, fatigue, depression and fear of recurrence were also significantly associated with poorer work ability. Drinking alcohol ≥ once a week was the only life-style variables with such association.

Conclusions: Among YACSs many psychosocial and somatic features, but not cancer type or treatment intensity, were significantly associated with reduced work ability.

Keywords: work ability, cancer in young adulthood, survivorship

Disclosure: All authors have declared no conflicts of interest.

Abstract 1438O_PR

Report on ESMO/SIOPE European Landscape project key results: Mapping the status and needs in AYA cancer care.

E. Saloustros1, D. Stark2, K. Michailidou3, G. Mountzios4, L. Brugières5, F.A. Peccatori6, S. Jezdic7, S. Essiaf8, J.-Y. Douillard7, S. Bielack9
1Oncology Unit, General Hospital of Heraklion ‘Venizelio’, Heraklion, Crete/GREECE, 2Section Of Oncology And Cancer Research, Institute of Molecular Medicine, Leeds/UNITED KINGDOM, 3Department Of Electron Microscopy/molecular Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia/CYPRUS, 4Medical Oncology Department, 251 General Airforce Hospital, Athens/GREECE, 5Children And Adolescent Oncology Department, Gustave Roussy Cancer Campus, Villejuif/FRANCE, 6Gynecologic Oncology, European Institute of Oncology, Milan/ITALY, 7Scientific Affairs, ESMO European Society for Medical Oncology, Viganello-Lugano/SWITZERLAND, 8Executive, SIOPE European Society for Paediatric Oncology, Brussels/BELGIUM, 9Zentrum Für Kinder-, Jugend- Und Frauenmedizin Pädiatrie 5 (onkologie, Hämatologie, Immunologie), Klinikum Stuttgart – Olgahospital, Stuttgart/SWITZERLAND

Background: Adolescents and young adults (AYA) are a distinct group at the interface between children’s and adult’s cancer services that require specific clinical management and care. This survey explored health care providers' practice patterns, knowledge and available services regarding AYA cancer care.

Methods: A link to an online survey was sent by e-mail to all members of ESMO and SIOPE, ESMO national representatives and circulated to several European oncology groups. The questions covered the following topics: demographics, education and access to specialized care for AYA, research and supportive care opportunities, as well as demands for further education. Contingency tables for each question were calculated and were further explored by sub region in Europe using chi-squared and Fisher’s exact test.

Results: 323 responses were collected from all countries across the world. We report the results from the 266 practitioners responding from Europe. Over two-thirds report that they: Do not have access to specialized centers for AYA with cancer (67%), Are not aware of any cancer research studies or clinical trials focused on AYA (69%), Have no access to a specialist cancer service for late effects management (67%). The majority of the professionals responding are able to refer AYA patients to professional psychological support and specialized social workers. However more than half report no access to an age-specialized nurse, specialized AYA education or a learning mentor. Furthermore, a substantial number of professionals report that their AYA patients do not have access to fertility specialists (38%), rising to 76% in Eastern Europe (EE). The lack of specialized AYA care was more profound for practitioners from EE and South Eastern European (SE) countries.

Conclusions: Less than one half of European health-care providers who treat AYA with cancer have access to specialized centers and research initiatives for this group of patients with special needs. This survey revealed important under-provision and inequity of AYA cancer care across Europe. Improving care using education and research focused on AYA is a growing priority for both ESMO and SIOPE.

Clinical trial identification: N/A

Keyword: Cancer care, professional education, cancer in adolescents and young adults

Funding: ESMO, SIOPE

Disclosure: D. Stark: The author declares the receipt of research grant income in AYA cancer from the National Institute for Health Research, Cancer Research UK, the Teenage Cancer Trust and research support from Pharmamar Inc and Astra- Zeneca Inc.
F.A. Peccatori: The author declares fees from Roche, Astra Zeneca, Clovis and Ipsen.
S. Bielack: The author declares fees for participation at Advisory Boards in Pfizer, Bayer, Lilly, Novartis, Isofol.
All other authors have declared no conflicts of interest.

Abstract 1439O_PR

Paediatric radiation therapy across Europe: A European questionnaire survey supported by the SIOPe, ESTRO, PROS and several national paediatric hematology-oncology societies (NAPHOS)

C. demoor-goldschmidt1, C. Carrie2, G. Whitfield3, P. Meijinders4, K. Dieckmann5, B. Timmermann6, L. Zaletel7, P. Banovic8, M. Solak Mekic9, Y. Lassen10, K. Alexopoulou11, J. Giralt12, J. Vizkeleti13, L. Jarusevicius14, B. Ondrova15, P. Daly16, P. Brandal17, G. Janssens18, U. Ricardi19, R. Dieter-Kortmann20
1Cancer And Radiation, Inserm U 1018 cancer and radiation team, Villejuif/FRANCE, 2Radiotherapy, centre leon berard, lyon/FRANCE, 3Radiotherapy, the Christie, manchester/UNITED KINGDOM, 4Radiotherapy, Iridium Cancer Network Antwerp-GZA- University of Antwerp, antwerp/BELGIUM, 5Radiotherapy, Vienna General Hospital (AKH) - Medizinische Universität Wien, Vienna/AUSTRIA, 6Radiotherapy, Clinic for Particle Therapy, West German Proton Center Essen, University Hospital Essen, essen/GERMANY, 7Radiotherapy, institute of oncology, ljublajna/SLOVENIA, 8Radiotherapy, IMC Banja Luka - Member of the Affidea Group, banja luka/BOSNIA AND HERZEGOVINA, 9Radiotherapy, Clinical Hospital Center “Sestre milosrdnice”-University Hospital for Tumors, University Hospital Center Sestre Milosrdnice, Zagreb/CROATIA, 10Radiotherapy, Aarhus University Hospital, radiotherapy, aarhus/DENMARK, 11Radiotherapy, Athens General Hospital for Children & Adolescents, athens/GREECE, 12Radiotherapy, Vall d'Hebron University Hospital, Barcelona/SPAIN, 13Radiotherapy, national institute of oncology, budapest/HUNGARY, 14Radiotherapy, Hospital of Lithuanian University of Health Sciences, Kaunas/LITHUANIA, 15Radiotherapy, Proton therapy center Czech, prague/CZECH REPUBLIC, 16Radiotherapy, St Lukes Radiation Oncology centre, dublin/IRELAND, 17Radiotherapy, Norwegian Radium Hospital, oslo/NORWAY, 18Radiotherapy, University Medical Center Utrecht – Princess Maxima Center for Pediatric Oncology, utrecht/NETHERLANDS, 19Radiation Oncology, A.O.U. Citta della Salute e della Scienza di Torino, Turin/ITALY, 20Radiotherapy, univeristy of Leipzig, leipzig/GERMANY

Background: Increased focus has been made to improve the quality of care and access to European trials in paediatric oncology. Information about paediatric radiotherapy (Ped-RT) through Europe is not widely available. The aim of this study was to provide an overview of resources and organization for Ped-RT.

Methods: Experts in Ped-RT oncology were invited by email to complete a 21-points questionnaire.

Results: Sixty-nine answers from 24 countries (7 centres with proton) were collected and 16 centres were visited. A minority of radiation oncologists (11.74%) treat only children, which is in contrast with paediatric oncologists (93.44%) or surgeons (71.67%) who are more often dedicated. In 5 countries, ped-RT is centralized in one centre. Access to ped-RT formations in unequal through Europe even if everyone agree with the fact that specific knowledges are needed. Regarding the techniques, 12% use sometimes, meaning for some patients, 2D- conventional radiotherapy, 4% still use Cobalt and 15% never or rarely use IMRT (Intensity Modulated Radiotherapy), 64% use hypofractionated treatments, defined as at least 3Gy per fraction and 32% when considering 5 Gy or more. Eighty-four percent have access to paediatric devices for personalized immobilization. Radiation treatments can be easily delivered under anaesthesia in 75% of the centres if necessary, or under hypnosis in 9% of centres (2 countries). The environment is mostly adapted to children, with dedicated dedicated waiting area (47%), patient information (83%), gifts (98%), the possibility to listen to music or songs (93%) or watch cartoons (12%).

Conclusions: This survey provides quantitative data demonstrating the current healthcare inequalities for children and adolescents who need radiotherapy in Europe. Nevertheless, an effort to guarantee a treatment of quality with the local environment has been pointed out.

Clinical trial identification: not applicable

Keywords: pediatric radiotherapy, europe, organization

Disclosure: All authors have declared no conflicts of interest.

Abstract 1112PD_PR

Real-World Productivity, Healthcare Resource Utilization (HRU), and Quality of Life (QOL) in Patients with Advanced Gastric Cancer (GC) in Canada and Europe

G. Maglinte1, A. Rider2, M. Contente3, A. Boyers2, B. Clarke2, E. Calvo4
1Wwheor, Bristol-Myers Squibb, Princeton/UNITED STATES OF AMERICA, 2Adelphi Real World, Adelphi Group, Manchester/UNITED KINGDOM, 3Wwheor, Bristol-Myers Squibb, Uxbridge/UNITED KINGDOM, 4Oncology, Centro Integral Oncologico Clara Campal - Hospital Madrid-Norte San Chinarro, Madrid/SPAIN

Background: As GC is the fifth most common cancer globally, it is important to better understand the impact of advanced disease on patient and caregiver productivity, HRU, and QOL.

Methods: Real-world data were collected through a cross-sectional survey administered to physicians and patients in France, Germany, Italy, Spain, the UK (EU5) and Canada (Nov 2016 to Mar 2017). Physicians provided patient data regarding disease history, characteristics, HRU, and caregiver burden. Health utility and overall health were assessed with the EQ-5D utility index (scores ranging 0 [dead] to 1.0 [full health]; scores <0 implying a health state worse than dead) and Visual Analog Scale (VAS; scores ranging 0 to100, higher scores indicating better overall health), respectively.

Results: A total of 265 physicians provided information for 724 patients currently on their third line active drug treatment for advanced GC. The average age of patients was 63 years (50% ≥65 years), most were male (65%), with ECOG PS of 1 (39%) or ≥2 (55%), had gastric vs. gastroesophageal (GEJ; 68% vs. 31%) for primary site of disease, no prior gastrectomy (78%), and ≥2 organs with metastases (65%). Most patients (74%) were retired, unemployed, or on sick leave; of these patients, 30% were unable to work due to their GC. 39% of patients had caregivers spending an average of 47.6 hours of care/week (SD=46.2). Many caregivers were partners/spouses (76%) who were unable to work or were working less in order to care for the patient (82%). Advanced GC also had an impact on HRU and EQ-5D scores. In the prior 12 months, patients made an average of 13.4 visits to an oncologist (SD=8.1) and had 0.76 GC-related hospitalizations (SD=2.34). Relative to EU5 general population norms for ages 65-74 (EQ-5D index, 0.78-0.90; VAS, 67.8-77.3), patients had worse health utility (mean EQ-5D index score=0.61; SD=0.35) and overall health (mean VAS score=50.6; SD=20.4)

Conclusions: As indicated by real-world data, advanced GC is associated with productivity loss for both patients and caregivers, significant HRU, and meaningful reductions in patients’ QOL. Novel treatment options are needed to reduce the overall burden of this disease.

Clinical trial identification: Not applicable

Keywords: burden of disease, healthcare resource utilization, health utility, quality of life (QoL)

Funding: Bristol-Myers Squibb

Disclosure: G. Maglinte: Employee and stock holder of Bristol-Myers Squibb
M. Contente: Employee and stock option holder at Bristol Myers Squibb
E. Calvo: Consulting/Research funding/Speakers Bureau from various companies.
All other authors have declared no conflicts of interest.

Abstract 1541O_PR

Reproductive potential and performance of fertility-preserving procedures in BRCA mutation-positive (BRCA+) breast cancer (BC) patients (pts)

M. Lambertini1, O. Goldrat2, A.R. Ferreira3, J. Dechene2, J. Desir4, A. Delbaere2, M.-D. t’Kint de Roodenbeke5, E. De Azambuja5, M. Ignatiadis5, I. Demeestere2
1Breast Cancer Translational Research Laboratory, Institute Jules Bordet, Brussels/BELGIUM, 2Fertility Clinic, CUB-Hôpital Erasme, Brussels/BELGIUM, 3Medical Oncology, Centro Hospitalar Lisboa Norte - Hospital Sta Maria (HSM-CHLN), Lisbon/PORTUGAL, 4Medical Genetics Department, CUB-Hôpital Erasme, Brussels/BELGIUM, 5Department Of Medicine, Institute Jules Bordet, Brussels/BELGIUM

Background: Preclinical evidence suggests a possible negative impact of germline BRCA mutations on female fertility. However, the reproductive potential and performance of fertility-preserving procedures in BRCA+ BC pts remain largely uncertain. We aimed to assess fertility outcomes in BRCA+ BC pts who underwent oocyte cryopreservation (OC) or ovarian tissue cryopreservation (OTC) before (neo)adjuvant chemotherapy.

Methods: This was a retrospective analysis of two prospective single center studies investigating OC and OTC in early BC pts. The present analysis included known BRCA+ or BRCA mutation-negative (BRCA-) BC pts who underwent OC or OTC between January 2006 and December 2016. Pts with unknown BRCA status, BRCA variants of unknown significance or other germline mutations were excluded. Baseline anti-mullerian hormone (AMH), OC and OTC performance were compared between BRCA+ and BRCA- BC pts.

Results: Out of 98 pts included in this analysis, 29 were BRCA+ and 69 BRCA-. Median age was 31 (range: 29-33) and 30 (range: 28-33) years in BRCA+ and BRCA- BC pts, respectively. Baseline AMH was 1.8 ng/ml (range: 1-2.7) in BRCA+ and 2.6 ng/ml (range: 1.4-4.3) in BRCA- BC pts (p=0.108). Among pts who underwent OC (n=27), despite receiving a numerically higher dose of gonadotropins (2775 vs 2150 UI; p=0.125) and longer duration of stimulation (11.5 vs 9; p=0.164), BRCA+ pts tended to retrieve (6.5 vs. 10; p=0.135) and to cryopreserve (3.5 vs 6; p=0.134) less oocytes than BRCA- pts. Poor response rate (i.e. retrieval of ≤ 4 oocytes) was 40% in BRCA+ and 12.5% in BRCA- BC pts (p=0.105). Among pts who underwent OTC (n=71), BRCA+ pts had numerically lower oocyte density per fragment (0.08 vs 0.14; p=0.224) and per mm2 (0.33 vs 0.75; p=0.160) than BRCA- pts. Two BRCA+ pts were transplanted after chemotherapy and one delivered at term a healthy baby. No difference between BRCA1+ and BRCA2+ pts was observed in any of the above-mentioned outcomes.

Conclusions: This is the largest study addressing fertility issues in BRCA+ BC pts. We observed a trend for reduced reproductive potential and performance of OC and OTC in BRCA+ BC pts. Further research efforts in this field are urgently needed.

Clinical trial identification: Not applicable

Keywords: ovarian tissue cryopreservation, BRCA 1/2, anti-mullerian hormone, oocyte cryopreservation

Disclosure: E. De Azambuja: Dr. de Azambuja received honoraria from Roche and travel grants from Roche and GlaxoSmithKline outside the submitted work.
M. Ignatiadis: Dr. de Azambuja received honoraria from Roche and travel grants from Roche and GlaxoSmithKline outside the submitted work.
All other authors have declared no conflicts of interest.