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Tubal ligation could reduce mortality in endometrial cancer
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One of the most important discussions between an oncologist and patient relates to the goals of care, whether these are to alleviate symptoms and maximise quality of life, prolong life, or provide a reasonable chance at a cure. A novel study of a large American cohort explores perceptions of patients with recently diagnosed lung or colorectal cancer and suggests that most patients feel that their cancer-directed surgery has cured them, even when this might be at odds with the actual evidence for their disease. From September, 2003, to December, 2005, 3954 patients with confirmed lung (1199, 30·3%) or colorectal (2755, 69·7%) cancer who reported having had cancer-directed surgery were surveyed. 959 (80·0%) of the lung and 2470 (89·7%) of the colorectal cancer cohort responded that they believed the surgery had
probably cured their cancer. This was the most common response across all cancer stages at diagnosis. This remained true for the small subset of patients with stage IV disease; 66 (57·4%) with stage IV lung cancer and 304 (79·8%) with stage IV colorectal cancer felt that their surgery would cure them. Although the prognosis of cancer outcomes is a complicated issue, the study’s senior author Timothy Pawlik (John Hopkins Hospital, Baltimore, MD, USA) believes that these findings suggest that “surgeons need to take extra effort in discussing with patients the goals of care and do a better job exploring patients’ understanding of their disease and prognosis”. Interestingly, using multivariate analysis, those patients who perceived optimal communication with their surgeon were significantly more likely to believe that their surgery would cure
them (odds ratio 1·89, p<0·001). Pawlik explains that “it has been suggested that surgeons and physicians may, at times, facilitate overly optimistic estimations of prognosis”. Craig Lynch (Peter MacCallum Cancer Centre, Melbourne, Australia), however, feels that “most patients want their cancer cured and most doctors are very specific about discussing the aims of surgery, especially in patients with advanced diseases, and while we never set out to cure these patients in the strict medical sense, they certainly engage with an approach to improve longer term survival.” Lynch feels that the study highlights “how important full and accurate discussion is” but looks forward to more research where “patient responses are correlated with their actual survival” to best assess the accuracy of their perceptions.
Jim West/Science Photo Library
The perceptions of a surgical cure
Published Online June 26, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00118-7 For the study by Pawlik and colleagues see Cancer 2015; published online June 19. DOI:10.1002/cncr.29530
Ashray Gunjur
Tubal ligation could reduce mortality in endometrial cancer Women with endometrial carcinoma who previously underwent tubal ligation were diagnosed at a lower tumour stage and had reduced mortality, a new study reports. How uterine tumour cells disseminate into the abdominal cavity, which might involve passage through the fallopian tubes, is not well understood. “Previous research has shown that tumour cells identified within the fallopian tube lumen are more common among patients with aggressive histological subtypes of endometrial cancer than those with low-grade forms of the disease, and the presence of these tumour cells is related to peritoneal metastasis”, says Ashley Felix (National Institutes of Health, Bethesda, MD, USA), who led the study. To test the hypothesis that blockade of transtubal passage of cells might lower endometrial www.thelancet.com/oncology Vol 16 August 2015
carcinoma stage at presentation and mortality, researchers analysed data from 4489 patients with endometrial carcinoma, testing for associations between tubal ligation and stage, peritoneal metastasis, and mortality. Analyses showed that tubal ligation was inversely associated with stage III carcinomas (OR 0·63, 95% CI 0·52–0·78), stage IV carcinomas (OR 0·14, 95% CI 0·08–0·24), and peritoneal metastasis (OR 0·39, 95% CI 0·22–0·68). Although endometrial carcinoma-specific mortality was significantly reduced in women with tubal ligation (HR 0·74, 95% CI 0·61–0·91), “further analyses showed no independent association with improved survival, suggesting that tubal ligation impacts mortality mainly through its effects on stage”, says Felix. Jacobus Pfisterer (Gynecologic Oncology Center, Kiel, Germany) says
the study should be commended for its large size and good analysis but says that “one possibility that was not considered is the existence of multiple synchronous tumour growths in the endometrium as well as in the tubes”. This could have been addressed by analysing different types of tubal ligation, says Pfisterer. Nevertheless, the results hint at the importance of examining fallopian tubes for evidence of tumour spread, especially for aggressive histological subtypes, explains Felix. Her future work will focus on assessing the relation between the presence of intraluminal tumour cells and prognosis of patients with endometrial cancer, “which could potentially inform staging protocols”, she says.
Published Online June 26, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00117-5 For the study by Felix and colleagues see J Natl Cancer Inst 2015; published online June 18. DOI:10.1093/jnci/djv158
Karl Gruber e380
One of the most important discussions between an oncologist and patient relates to the goals of care, whether these are to alleviate symptoms and maximise quality of life, prolong life, or provide a reasonable chance at a cure. A novel study of a large American cohort explores perceptions of patients with recently diagnosed lung or colorectal cancer and suggests that most patients feel that their cancer-directed surgery has cured them, even when this might be at odds with the actual evidence for their disease. From September, 2003, to December, 2005, 3954 patients with confirmed lung (1199, 30·3%) or colorectal (2755, 69·7%) cancer who reported having had cancer-directed surgery were surveyed. 959 (80·0%) of the lung and 2470 (89·7%) of the colorectal cancer cohort responded that they believed the surgery had
probably cured their cancer. This was the most common response across all cancer stages at diagnosis. This remained true for the small subset of patients with stage IV disease; 66 (57·4%) with stage IV lung cancer and 304 (79·8%) with stage IV colorectal cancer felt that their surgery would cure them. Although the prognosis of cancer outcomes is a complicated issue, the study’s senior author Timothy Pawlik (John Hopkins Hospital, Baltimore, MD, USA) believes that these findings suggest that “surgeons need to take extra effort in discussing with patients the goals of care and do a better job exploring patients’ understanding of their disease and prognosis”. Interestingly, using multivariate analysis, those patients who perceived optimal communication with their surgeon were significantly more likely to believe that their surgery would cure
them (odds ratio 1·89, p<0·001). Pawlik explains that “it has been suggested that surgeons and physicians may, at times, facilitate overly optimistic estimations of prognosis”. Craig Lynch (Peter MacCallum Cancer Centre, Melbourne, Australia), however, feels that “most patients want their cancer cured and most doctors are very specific about discussing the aims of surgery, especially in patients with advanced diseases, and while we never set out to cure these patients in the strict medical sense, they certainly engage with an approach to improve longer term survival.” Lynch feels that the study highlights “how important full and accurate discussion is” but looks forward to more research where “patient responses are correlated with their actual survival” to best assess the accuracy of their perceptions.
Jim West/Science Photo Library
The perceptions of a surgical cure
Published Online June 26, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00118-7 For the study by Pawlik and colleagues see Cancer 2015; published online June 19. DOI:10.1002/cncr.29530
Ashray Gunjur
Tubal ligation could reduce mortality in endometrial cancer Women with endometrial carcinoma who previously underwent tubal ligation were diagnosed at a lower tumour stage and had reduced mortality, a new study reports. How uterine tumour cells disseminate into the abdominal cavity, which might involve passage through the fallopian tubes, is not well understood. “Previous research has shown that tumour cells identified within the fallopian tube lumen are more common among patients with aggressive histological subtypes of endometrial cancer than those with low-grade forms of the disease, and the presence of these tumour cells is related to peritoneal metastasis”, says Ashley Felix (National Institutes of Health, Bethesda, MD, USA), who led the study. To test the hypothesis that blockade of transtubal passage of cells might lower endometrial www.thelancet.com/oncology Vol 16 August 2015
carcinoma stage at presentation and mortality, researchers analysed data from 4489 patients with endometrial carcinoma, testing for associations between tubal ligation and stage, peritoneal metastasis, and mortality. Analyses showed that tubal ligation was inversely associated with stage III carcinomas (OR 0·63, 95% CI 0·52–0·78), stage IV carcinomas (OR 0·14, 95% CI 0·08–0·24), and peritoneal metastasis (OR 0·39, 95% CI 0·22–0·68). Although endometrial carcinoma-specific mortality was significantly reduced in women with tubal ligation (HR 0·74, 95% CI 0·61–0·91), “further analyses showed no independent association with improved survival, suggesting that tubal ligation impacts mortality mainly through its effects on stage”, says Felix. Jacobus Pfisterer (Gynecologic Oncology Center, Kiel, Germany) says
the study should be commended for its large size and good analysis but says that “one possibility that was not considered is the existence of multiple synchronous tumour growths in the endometrium as well as in the tubes”. This could have been addressed by analysing different types of tubal ligation, says Pfisterer. Nevertheless, the results hint at the importance of examining fallopian tubes for evidence of tumour spread, especially for aggressive histological subtypes, explains Felix. Her future work will focus on assessing the relation between the presence of intraluminal tumour cells and prognosis of patients with endometrial cancer, “which could potentially inform staging protocols”, she says.
Published Online June 26, 2015 http://dx.doi.org/10.1016/ S1470-2045(15)00117-5 For the study by Felix and colleagues see J Natl Cancer Inst 2015; published online June 18. DOI:10.1093/jnci/djv158
Karl Gruber e380