Dr. Shayma Kazmi, from Penn Medicine-Abramson Cancer Center, breaks down three hot topics during the 2022 ASCO Direct Philadelphia Conference.
“Cancer survivors” have been generally defined as anyone diagnosed with cancer from the time of diagnosis through the time of their death, inclusive of those whose cancer is in remission. It can also include patients living with an advanced, or incurable cancer. At this year’s ASCO Direct series in Philadelphia, Dr Shayma Kazmi from Penn Medicine-Abramson Cancer Center reviewed three cancer survivorship abstracts relating to the topic of holistic/alternative therapies.
In the first study by D’Andre et al., investigators looked at patterns of dietary supplement use in an oncology clinic. Dr Kazmi noted that often patients are reluctant to disclose that they are using supplements for fear of judgement, or being told to discontinue their use. In the study of 100 patients at an integrative medicine clinic, 91% of patients said they were taking dietary supplements, on average, 5 or more, and 89% of the patients were on active cancer therapy. She added that, as in her clinic, most common were calcium and vitamin D, but other supplements noted were vitamin C, multivitamins, probiotics, and B vitamins. The study found that 35% of patients were told to discontinue their supplements, mainly for potential toxicity reasons (46%), and also because of the potential to interfere with cancer treatment (37%). She cited two examples, one being high dose vitamin C infusions (a high dose antioxidant) which can counteract the effects of radiotherapy or chemotherapy which is designed to cause oxidative damage as a means to kill cancer cells. Second, she noted the potential for high-dose vitamin B supplements to interact with certain types of chemotherapies. Some of her key takeaways from this study were the fact that patients are often taking a lot of supplements, and it is important to better collect this information so that it can be communicated to the cancer care team. Dr Kazmi also noted the importance of educating patients and involving them in the discussion, so they can better understand why they may need to discontinue some of their supplements.
Dr Kazmi also reviewed a study by Zylla and coworkers, examining the patterns of medical cannabis use among cancer survivors. She noted the increasing accessibility and legalization of medical cannabis across the country, which has led to increased use overall and particularly in the cancer population. She added that many oncologists are largely unfamiliar with the different types, dosages, and formulations of cannabis and that patients may or may not be willing to share their use of cannabis with their physician for fear of judgement, so it is important to ask them about it. In the study, participants had a median age of 62, 71% were married, 95% were white, 40% were retired, 46% had Stage IV cancer, and the most common cancer types were breast (24%), lung (14%), and colon cancer (10%). Seventy five percent of the patients reported at least daily cannabis use, most commonly oral products and to a lesser extent, topical products; 88% used at least 1 product with high THC content. Results showed that most patients reported improvement in their symptoms, most notably insomnia, pain, and stress/anxiety/depression (73-83% reporting improvement), and to a lesser extent, anorexia and digestive symptoms (50-57% reporting improvement), although Dr Kazmi noted there could be some inherent bias in the results, and a placebo effect of the cannabis products could not be ruled out. In terms of costs, 31% reported spending $200 or more per month, and, as compared to those who reported “living comfortably”, those who were “finding it difficult/getting by” financially were more likely to stop their cannabis use due to the high cost, and lack of insurance coverage. As a final thought, Dr Kazmi noted that, while increasing legalization is a step in the right direction, cost and accessibility to cannabis therapies (which may, or may not, be beneficial) will continue to be an issue for patients, as opposed to other treatments like opioids, which are covered by insurance.
Dr Kazmi also highlighted a study examining the role of acupuncture for the treatment of hot flashes in women with hormone-receptor positive breast cancer receiving endocrine therapy, presented by Dr Weidong Lu. Dr Kazmi noted that, unlike chemotherapy side effects which are transient, patients are typically on endocrine therapy for 5 years or more, or potentially for life – and unpleasant side effects such as hot flashes can have a significant negative impact on quality of life over an extended period. For this reason she noted that compliance with endocrine therapy is often poor, and non-compliance has been shown to negatively impact the efficacy of endocrine treatment. In this study, which was a pooled analysis of three trials in the US, China, and South Korea, the patients were on endocrine therapy and experiencing more than 14 hot flash episodes per week. They received either 2 sessions of acupuncture per week for 10 weeks, or usual care with no acupuncture. The study included 158 patients and the population was roughly evenly split between Asian and White ethnicity. The overall results showed that acupuncture led to meaningful improvements in hot flashes, endocrine symptoms, and patient-reported quality of life. Dr Kazmi noted the findings were consistent with other studies that have shown similar results, and that acupuncture can be considered as a non-medicinal option to improve quality of life and reduce hot flashes for these patients. She added, however, that issues with accessibility and cost of care may be a problem for some patients seeking the treatment, since the acupuncture may not be covered by their insurance.
See more from the 2022 ASCO Direct Philadelphia Conference here.
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