June 9, 2006

Cancer meet focuses on survivorship issues

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Past ASCO President David Johnson, M.D., right, gives cancer survivor and Tour de France winner Lance Armstrong a Special Recognition Award at the ASCO meeting in Atlanta. Johnson also serves as a member of the Lance Armstrong Foundation board.
Photo courtesy of ASCO

Cancer meet focuses on survivorship issues

ATLANTA — More than 25,000 of cancer's best and brightest health care providers around the world gathered here June 2-6 for the annual meeting of the American Society of Clinical Oncology (ASCO).

For the first time in the meeting's 42-year history, survivorship was a primary focus. It featured a patient, a survivor care research track that received more than 300 abstract submissions and more than a dozen survivorship-focused educational sessions and clinical science symposia.

In the opening press program, Ellen Stovall, a 35-year cancer survivor, president and CEO of the National Coalition for Cancer Survivorship, said times have changed.

“We've gone from calling people victims if they have been diagnosed with cancer, to patients and, most recently, simply survivor. From the moment of diagnosis and for the remainder of life, an individual diagnosed with cancer is a survivor,” said Stovall.

To date there are nearly 10 million cancer survivors in the United States, a number that is only expected to grow. Experts are only beginning to understand the importance of addressing the lifelong issues facing survivors.

“The end of treatment is not the end of the cancer experience,” said Sandra Horning, M.D., ASCO president and co-chair of its Task Force on Cancer Survivorship. “As clinical cancer research makes great strides in improving the rates of survival for people living with cancer, an important challenge arises — addressing the long-term health challenges of cancer survivors,”

Barbara Murphy, M.D., director of head and neck cancer and pain and symptom management at Vanderbilt-Ingram Cancer Center, echoed Horning's statements.

“People have been focusing on survivorship for years, but mostly on late effects. The issue of survivorship is now changing to mean something beyond 'can you swallow and can you speak' to how are you transitioning into a new state of normalcy?” said Murphy.

“This is not a short-term issue. It's a long-term issue. It takes years, a really long time for some people to come to terms with.”

Murphy was on hand to chair the educational session on chemoradiation for head and neck cancer, including discussion of patient selection, supportive medical care and speech and swallowing rehabilitation.

One of the key recommendations by experts at the ASCO meeting, and outlined in the Institute of Medicine's recent report on adult cancer survivorship, “From Cancer Patient to Survivor: Lost in Translation,” is the need to develop something called a “Survivor Care Plan.”

The plan would help guide any cancer survivor through the years after treatment, including information on diagnosis and treatment, potential side effects, timing and content of follow-up visits, tips on maintaining a healthy lifestyle and preventing recurrence or new cancers, legal rights affecting employment and health insurance, and the availability of psychosocial support services.

Vanderbilt-Ingram had a strong presence at the meeting, with nearly a dozen research abstracts being presented. Physicians from a range of cancer specialties were in attendance as chairs or co-chairs of major programs, panel participants reviewing other research, and a variety of other leadership roles.

David Carbone, M.D., Ph.D., spoke in a panel discussion about the new biology of lung cancer.

“We all know how awful lung cancer is,” he said. “We have a broader need for molecular signatures and understanding features to help diagnose and treat it.” Carbone said the key may be building on the advantages proteomics provides. “If we could directly measure these proteins, theoretically, we might get the best picture of lung cancer… the clearest picture of what makes this cell different from the rest,” Carbone said. But it is not a simple task, and Carbone said the work is more complex than tackling the genome, due, in part, to lung cancer's high range of expression levels.

“It's complicated. We're not ready for prime time,” he added.

At a clinical science symposium on epidermal growth factor receptor biomarkers in lung cancer, Carlos Arteaga, M.D., who chaired the presentation, said, “Not all epidermal growth factor receptor kinase domain mutations in non-small cell lung cancer are created equal. There is almost no overlap,” said Arteaga. “We have a lot of work to do if we're going to figure out how lung cancer outsmarts us and EGFR inhibitors,” he added.

Alan Sandler, M.D., was on hand to present results of a clinical trial of lung cancer patients currently at the mid-way point using Avastin, a drug currently approved to treat colon cancer, combined with the drug Tarceva, which is approved for lung and pancreatic cancer. Early results shows promise that the drug combination could slow the progression of lung cancer, compared to patients taking Avastin and standard chemotherapy.

David Johnson, M.D., deputy director of the Vanderbilt-Ingram Cancer Center, concluded his term as past-president of the organization, while Bruce Roth, M.D., professor of Medicine and Urologic Surgery, began his term as secretary-treasurer. Roth also chaired an educational session on integrating chemotherapy into the management of muscle invasive bladder cancer.

Also at the meeting, Raymond DuBois, M.D., Ph.D., director of Vanderbilt-Ingram, participated in a special ASCO session with the European Cancer Societies Symposium on inflammation in cancer progression. Mace Rothenberg, M.D., and Yu Shyr, Ph.D., took part in an educational session on integrating evidence from clinical and lab studies.

Jordan Berlin, M.D., clinical director of Gastrointestinal Oncology, spoke during a special “Meet the Professor” session on adjuvant therapy for pancreatic cancer. Several other Vanderbilt physicians were in attendance.

More than 4,000 abstracts from cancer centers around the world were presented at the meeting.