Over 1000 delegates from 50 countries attended the MASCC (Multinational Association of Supportive Care in Cancer) 25th Annual Scientific Meeting in Adelaide with the 30th meeting of ISOO (International Society of Oral Oncology). This was the first time this meeting had been held in the Asia-Pacific region, and so we were able to learn of developments in cancer support in the region as well as the disparities which exist between developing and high socioeconomic status countries.
The initial feature differentiating it from other meetings was an art exhibition based on the body, and adorning the Convention Centre. This theme was reflected in the meeting by a group from Flinders Medical Centre reporting on 20 years of exploring the role of art in cancer care, showing how the arts support the psychological, social and emotional needs of patients and carers dealing with the diagnosis and treatment of cancer.
A patient seminar for sharing experiences of cancer journey occurred on the day prior to the meeting, but the delegates were also to share in a session where cancer experts reflected on their experiences of becoming cancer patients.
The scientific meeting focused both on managing the side effects of treatment and the symptoms of cancer, including those that persist for cancer survivors. Some topics such as nausea and vomiting following cancer treatment have been researched for decades and with the development of two classes of drugs, the 5 hydroxytryptamine 3 and neurokinin 1 receptor antagonists, vomiting has been controlled in the majority of patients. The new focus in this meeting was on nausea where there has been less success. Here the answer may not solely rely on drug therapy, with evidence presented in studies by Alex Molassiotis and myself that for patients, nausea is a symptom cluster which includes other symptoms such as anorexia and anxiety, which may all have to be identified and treated.
Even post chemotherapy hair loss, a long standing reversible side effect of some chemotherapy, has an array of newer scalp cooling technologies to try to reduce its severity. This was the subject of parallel session.
The emergence of immunotherapies and targeted drugs has resulted in a range of new side effects to manage. This was the focus of a workshop which highlighted new oral and skin complications of immunotherapy, immune related infections, neurological, pulmonary and endocrine adverse events and other side effects such as uveitis, colitis, liver and gastrointestinal problems, which oncologists have to learn how to manage.
When it comes to symptoms associated with cancer, pain is a continued focus of supportive care. The most serious of the disparities in cancer supportive care relates to where oral morphine is unavailable for outpatient care. However, there is an increasing focus on other symptoms that can ruin the quality of life of patients. They include cancer related fatigue and cachexia.
A presentation by Stephen Clarke highlighted the impact of cancer inflammation on cachexia and reported on how this symptom is associated with a poorer prognosis. Multiple strategies were reported to manage cancer fatigue. Fausto Roila presented a meta-analysis showing efficacy for psychostimulants like methylphenidate and dexmethylphenidate while Siram Yennu reported the role of corticosteroids. However, he also presented non-pharmacological approaches such as the use of cognitive behavioural therapy, while Karen Mustian explored the “dose” of exercise which would be most effective for alleviating fatigue.
The issues of both the physical and emotional symptoms of cancer survivors was one of the plenary themes of the conference and there were many additional presentations on survivorship. Continuing on the topic of the impact of exercise, Greg Levin studied 32 cancer survivors who exhibited high levels of depression.
He compared a group that exercised at home with another that used a gym and compared them with those who did not exercise. Depression was either stable or worsened in the no-exercise group but there was a positive effect of exercise on depression, some patients improving from severe depression to becoming asymptomatic. Home based exercise yielded better results than gym-based exercise and the exercise only had to be moderate, like walking the dog and for only 150 minutes each week.
Lifestyle choices that can impact on cancer symptoms have focused largely on exercise and diet. The winner of the Outstanding Young Investigator award, Luke Peppone, reported on a randomized study of 108 breast cancer survivors with cancer related fatigue.
The benefits of fish oil with omega 3 fats was compared to soybean oil with omega 6 fats, when either were used as supplements. The fish oil is more often taken as a supplement whereas as soybean oil is more often used as a cooking oil. Although expecting the fish oil to be superior it was the omega 6 supplement in soybean oil that was associated with a significant improvement in cancer related fatigue. This will undoubtedly lead to further research to confirm these findings and explore the mechanism of action.
Tom Perloff analysed a questionnaire given to surviving lung cancer patients, where the 5-year survival is expected to be 1%. Of 108 respondents, 55% reported survivor guilt and yet 63.9% scored above the average on the IGQ-67 Survivor Guilt Scale. Further research will define the characteristics of patients most likely to have to cope with this and so tools to assess and identify such these patients are being developed. A preliminary report of a 10 year follow up after treatment of prostate cancer survivors was presented by Jim Denham. In general, their quality of life was similar to other men.
The most important finding from this study was that half of the patients expressed feeling of loss of masculinity, which was not linked to the duration of hormone therapy. Up to 40% had urinary incontinence and those who had severe incontinence were more likely to suffer depression unless they were resilient enough to continue to have a sense of purpose.
Studies of cancer survivorship have sometimes extended to studying the carers of patients with cancer. A poignant example of this was presented by Pandora Patterson from Can Teen who studied 56 young adults living with a parent with cancer. The distress of this group was 3 to 6 times higher than matched controls from the population and 77% reported more than 10 unmet needs. Using unmet need models, an assessment process can be implemented to provide appropriate psychosocial support for these patients.
Health services research is also relevant to supportive care. A session was devoted to the role of e-communication in the delivery of cancer care. Presenting prognostic information in a way that can be easily understood is a challenge. Communications skills training is helpful hear but communication can be assisted by displaying the data in different formats. Lisa Beatty explored on-line formats to deliver psychosocial interventions, while I reviewed the use of telemedicine and studies which showed it to be a cost effective way of managing the challenges of treating patients living in rural and remote areas.
In Canada, text messaging has been found to improve adherence with long term medication like endocrine therapy for breast cancer. For supportive care research, Marleen Frost presented data that showed that once surveys were conducted using electronic devices patients were happy to utilize the technology next time.
The summary of the MASCC meeting can only focus on highlights in some of the sessions but the meeting revealed a large international research effort in supportive care in cancer. MASCC members have the opportunity to participate in multiple projects by engaging with any of 16 topic-related study groups between meetings.
Next year the MASCC meeting will be in Washington. Already new themes are merging. There will be considerably more work done on supporting patients who are receiving immunologic therapies. The new issue of financial toxicity will be featured, as it is becoming a great stress on individual patients in addition to the stress on health systems.