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Cancer survivors worry about treatment disruptions

A new ACS study reports that early in the 2020 pandemic in the U.S., one-third of cancer survivors worried about treatment and cancer care disruptions. 

Using a mixed methods approach, investigators utilized survivors’ own words to more deeply describe their experiences and worries about the pandemic’s impact on their overall health. 

The article, appearing in the Journal of Psychosocial Oncology, finds the impact of the pandemic on cancer survivors and the broader health care system is widespread and exacerbated by serious gaps in the health care system. 

For this study, investigators led by Corinne Leach, MPH, MS, PhD, and colleagues, examined cancer survivor worries in relation to treatment, infection, and finances early in the U.S. pandemic. Data for this study came from a survey dated March 25 to April 8, 2020 from the 2019-2020 American Cancer Society Cancer Action Network’s (ACS CAN) Survivor Views Panel. 

“This study demonstrates the importance of clear communication between healthcare providers and patients experiencing concerns and uncertainties that may affect mental health during the pandemic as the care provision landscape continues to change,” said Dr. Leach.  

Key findings from this study include:

  • Many survivors experienced disruptions in health care treatments. 
  • 77% worried they are high risk for serious health impact and were concerned about ICU admission or death if infected with COVID-19. 
  • 27% worried the pandemic will make it hard to afford cancer care. Respondents shared concerns of deciding what would be most important in terms of having medicine or food. 
  • The fear of getting sick and uncertainty over just how worried survivors should be because of COVID was pervasive for cancer survivors, leading to reported self-induced measures to reduce their risk of infection, such as social distancing and mask wearing.
  • Many respondents described social isolation, including overall loneliness and feelings of being isolated due to social distancing, during the COVID-19 pandemic.

An unanticipated theme that emerged in the qualitative analyses was the concern expressed by survivors around the inability to bring a companion to in-person appointments. Although participants understood and respected the decision of healthcare systems to institute measures to protect staff and patients from COVID-19 infection, survivors seemed to be caught off-guard by the new rule, especially when receiving bad news, such as a cancer recurrence.

Here are quotes from three of the 972 people surveyed:

  • “There is now SO MUCH MORE ANXIETY! I question everyone in my life in ways that I've never done before. No one comes in or out of my home. My husband (who works in a grocery store) moved out. I'm living in total isolation. Having to decide whether to move forward with treatment and risk contracting COVID-19 or stop treatment and let my cancer grow has been difficult. It's like trying to decide if I want to die by heart attack or stroke. There's no good option!” - 32-year-old female rectal cancer survivor in treatment
  • “I am incredibly worried to go out in public, even to my oncologist's office, in fear that if I am infected, I am at a higher risk for serious impact. I was scheduled to have an MRI next week as routine follow up, but was recommended to postpone it until May due to COVID-19.” - 32-year-old female lung cancer survivor
  • “My surgery is reconstruction. It's considered non-essential, but it is essential to me… I hate this COVID-19, its ruining everything for me. I was ready to move forward with surgery. I am disappointed they are postponing everything.” - 50-year-old breast cancer survivor

“The delays and cancellations noted by cancer survivors in the survey highlight the need for policy interventions and new delivery models that make it safe for cancer patients to receive care, and the need for public policies that address the financial worries associated with the pandemic,” write the authors. 

Those policies include increasing federal Medicaid funding to ensure people can get health coverage should they find themselves uninsured, continuing to offer and increase funding for Centers for Disease Control and Prevention cancer screening programs, and providing $15 billion to NIH to restart stalled clinical trials.

Article: Leach CR, Kirkland EG, Masters M, Sloan K, Rees-Punia E, Patel AV, Watson L. Cancer Survivor Worries about Treatment Disruption and Detrimental Health Outcomes due to the COVID-19 Pandemic. Journal of Psychosocial Oncology. doi: 10.1080/07347332.2021.1888184.

  • Voices from the Field: Why our mission matters now more than ever

    ​Please take a few minutes to watch this video, in which ACS staffer Carrie Franchi, associate director of Development in our North Central Region, shares the story of young Jake Pennar.

    It illustrates so powerfully why our mission matters, and why it is so important that ACS be able to restore its research funding to pre-COVID levels. 

    In 2020, ACS funded a little over $52.8 million in new grants, about half of what we usually fund in a year. We had to cancel the fall cycle last October, a devastating loss of scientific discovery and momentum, but unlike some organizations we did not pull back any funding that we had previously committed to.

    In 2021, we are hopeful that we will be able to invest $100 million in new extramural research grants. You can help, here.

  • $5 million gift funds new Diversity in Cancer Research Program

    We are excited to share that a $5 million gift from the Phillip and Elizabeth Gross Family Endowment will support the creation of the American Cancer Society’s new Diversity in Cancer Research program, a permanent umbrella that will support our effort to foster a more diverse scientific workforce community.  

    This initial investment will launch our Diversity in Research Internship program, which will fund biomedical cancer research internships for undergraduate students from racial or ethnic backgrounds that are underrepresented in the scientific community, with a goal of promoting a more diverse scientific workforce in the long run. 

    Diversity in science is key to invigorating problem-solving, driving innovation, and ultimately positioning the scientific community to better address inequity in cancer prevention, treatment, and care. We hope to sustain the program for about a decade, and continue to fundraise in support of the program. 

    The program will launch this summer with an initial class of 25-40 interns from 5-10 schools around the U.S. Starting in 2022, we anticipate funding about 100 internships at 20-25 programs around the country. We’ll share more about the application process in the months to come.  

    The investment comes as part of the research funding campaign ACS launched last July. The concept – an internship program aimed at increasing diversity within the science community – was developed by Bill Phelps, PhD, SVP, extramural discovery science, and Chris Thomas, senior director, philanthropy, with Tawana Thomas-Johnson, VP, diversity and inclusion, providing strategic guidance at every step of the development and implementation of the program. 

    The Gross family has taken a leadership role in diversity in multiple areas and felt that the ACS Diversity in Research Program was of critical importance and wanted to guarantee it would be a permanent part of ACS.

    “In the fight against cancer, advancements in research provide the best hope for saving millions more lives,” said Elizabeth Gross (pictured here.) “Phill and I believe that creating opportunities for a more diverse community of cancer researchers will not only spur innovation and ingenuity, but it will help eradicate health disparities, build trust across these various communities, and advance cancer care for everyone. It is our joy to assist in this important work alongside the American Cancer Society.”

    For more on the program, contact Bill Phelps. And for questions related to fundraising support for the program, contact Chris Thomas.

  • Female breast cancer now most diagnosed cancer in world

    Excess body weight, physical inactivity, alcohol consumption, postponement of childbearing, fewer childbirths, and less breastfeeding are reasons why.

    Cancer ranks as a leading cause of death in every country in the world, and, for the first time, female breast cancer is the most commonly diagnosed cancer, overtaking lung cancer, according to a collaborative report, Global Cancer Statistics 2020, from the American Cancer Society (ACS) and the International Agency for Research on Cancer (IARC). 

    Data show that 1 in 5 men and women worldwide develop cancer during their lifetime, and 1 in 8 men and 1 in 11 women die from the disease. 

    The article describes cancer incidence and mortality at the global level and according to sex, geography, and levels of social and economic development, and discusses associated risk factors and prospects for prevention for each of 10 major cancer types, representing more than 60% of the newly diagnosed cancer cases and more than 70% of deaths from cancer. 

    The report appearing in CA: A Cancer Journal for Clinicians, shows an estimated 19.3 million new cancer cases and almost 10 million cancer deaths occurred in 2020. Female breast cancer was the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%), followed by lung (11.4%), colorectal (10.0%), prostate (7.3%), and stomach (5.6%) cancers. 

    The incidence of breast cancer is increasing in countries where rates of breast cancer have been historically low. “Dramatic changes in lifestyle and built environment have had an impact on the prevalence of breast cancer risk factors such as excess body weight, physical inactivity, alcohol consumption, postponement of childbearing, fewer childbirths, and less breastfeeding,” the authors noted. “The increasing prevalence of these factors associated with social and economic transition results in a convergence toward the risk factor profile of transitioned countries and is narrowing international gaps in the breast cancer morbidity.” 

    Death rates of breast cancer among women in transitioning countries were even higher compared with the rates among women in transitioned countries (15 and 12.8 per 100,000, respectively), despite the substantially lower incidence rates (29.7 and 55.9 per 100,000, respectively). “As the poor outcome in these countries is largely attributable to a late-stage presentation, efforts to promote early detection, followed by timely and appropriate treatment, are urgently needed through the implementation of evidence-based and resource-stratified guidelines,” said Hyuna Sung, PhD, lead author of the report  and Principal Scientist at the ACS. 

    Data show that lung cancer remained the leading cause of cancer death with an estimated 1.8 million deaths (18%), followed by colorectal (9.4%), liver (8.3%), stomach (7.7%), and female breast (6.9%) cancers. Lung cancer death rates are 3 to 4 times higher in transitioned countries than in transitioning countries, however, this pattern may well change as the tobacco epidemic evolves given that 80% of smokers reside in low- and middle- income countries. With about two-thirds of lung cancer deaths worldwide attributable to smoking, the disease can be largely prevented through effective tobacco control policies and regulations. 

    According to the report, an estimated 28.4 million new cancer cases are projected to occur in 2040, a 47% rise from 2020 globally. Transitioning countries are experiencing a larger relative increase in cancer incidence (64% to 95%) versus transitioned (32% to 56%) countries due to demographic changes. The authors state that this may be further exacerbated by increasing risk factors associated with globalization and a growing economy. The authors warn that the growing rate of incidence could overwhelm health care systems, if left uncontrolled. Efforts to build a sustainable infrastructure for the dissemination of proven cancer prevention measures and the provision of cancer care in transitioning countries are critical for global cancer control. 

    Data in this report do not reflect the impact of the COVID-19 pandemic as they are based on cancer data collected in earlier years, and the full extent of the impact in different world regions is currently unknown. According to the report, delays in diagnosis and treatment, including suspension of screening programs and reduced availability of and access to care, are anticipated to cause a short-term decline in cancer incidence followed by increases in advanced-stage diagnoses and cancer mortality in some settings. 

    “The burden of cancer incidence and mortality is rapidly growing worldwide, and reflects both aging and growth of the population, as well as changes in the prevalence and distribution of the main risk factors for cancer, several of which are associated with socioeconomic development,” said Freddie Bray, BSc(Hons), MSc, PhD, senior author of the report and Head of the Section of Cancer Surveillance at IARC. “Effective and resource-sensitive preventative and curative interventions are pertinent for cancer diagnosis. Tailored integration into health planning can serve to reduce the global burden of cancer and narrow the evident cancer inequities between transitioning and transitioned countries observed today.” 

    Article: Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21660. 

  • 10 scientists awarded TheoryLab Collaborative Grant by ACS and the Emerson Collective

    Five research teams have been awarded a TheoryLab Collaborative (TLC) Grant by the American Cancer Society and Emerson Collective. Each team is comprised of two scientists affiliated with different universities who connected and will collaborate through TheoryLab®, the American Cancer Society's online platform for funded researchers.

    TLC Grant awardees are:

    • Rebecca Perkins, MD (Boston Medical Center) and Susan Vadaparampil, PhD (H. Lee Moffitt Cancer Center & Research Institute, Inc.) will research the impact of COVID-19 on cervical cancer screening and management of abnormal results in underserved women.
    • Rajan Kulkarni, MD, PhD (Oregon Health & Science University) and Jason Sheltzer, PhD (Cold Spring Harbor Laboratory) will study whether aneuploidy can drive resistance to BRAFi/MEKi therapy in melanoma.
    • Leah Cook, PhD (Board of Regents of the University of Nebraska University of Nebraska Medical Center) and Isabel Schlaepfer, PhD (University of Colorado Denver, AMC and DC) will explore the role of CPT1A in Neutrophil-mediated Immune response and BM-PCa.
    • Claudia Benavente, PhD (The Regents of the University of California, Irvine) and Michael Emanuele, PhD (The University of North Carolina at Chapel Hill) will study the potential of harnessing the ubiquitin system as a therapeutic approach in triple-negative breast cancer.
    • Alice Berger, PhD (Fred Hutchinson Cancer Research Center) and Lixin Wan, PhD (H. Lee Moffitt Cancer Center & Research Institute, Inc.) will explore targeting USP9X-mediated RIT1 stabilization for lung cancer therapy.

    Each team grant is funded for one year starting on Feb. 1, 2021.

    In 2020, the American Cancer Society and the Emerson Collective launched a partnership to support innovative, collaborative research projects using TheoryLab. The TLC Grant mechanism is designed to support new and transdisciplinary collaborations among TheoryLab users to explore high-risk ideas, including Covid-19 research relevant to cancer or persons living with cancer.

    Emerson Collective deploys a wide range of tools — from impact investing to philanthropy to advocacy — in pursuit of a more equal and just America. We focus on creating systemic change in education, immigration, climate, and cancer research and treatment.

  • TheoryLab celebrates its 100th episode - listen!

    Help make it a top science podcast by subscribing, giving it 5 stars, and sharing it.

    Our TheoryLab podcast – a weekly show in which ACS staff scientists and grantees chat about the most critical questions in cancer research in a way that’s easy to understand – is celebrating its 100th episode on Jan. 29. Listen here.

    The episode features ACS staff scientist Lynne Elmore, PhD, senior scientific director, Translational Cancer. She describes takeaways from the new publication, Blueprint for Cancer Research: Critical Gaps and Opportunities, which integrates conversations with more than 90 leading cancer experts.

    You can subscribe to the podcast on Spotify, Apple Podcasts, Stitcher, Soundcloud, and Google Podcasts.

    Launched in 2019. Susanna Greer, PhD, senior scientific director, Biochemistry and Immunology of Cancer, hosts the show, and it is produced by Joe Cotter, research constituent engagement manager. 

    Upcoming episodes will focus on HPV vaccination, colorectal cancer screening strategies in rural communities, and a new therapeutic approach for triple-negative breast cancer. 

    Congratulations to the Extramural Discovery Science and Research Integration teams within the Office of Cancer Research and Implementation (OCRI, formerly known as the Office of the Chief Medical and Scientific Officer) for achieving this milestone! 

    The podcasts are a terrific source of information, especially our volunteers who might not have a background in science but are interested in learning more about our cancer research program, the impact of ACS funding on cancer researchers, and the latest trends in cancer science. 

    Each episode runs about 20-30 minutes. You can also get them by following @ACS_Research on Twitter for a preview of each new episode. 

    Catch up on the TheoryLab podcast by checking out these highlights: 

    Help us make this a Top 10 science podcast! 

    Please subscribe, rate it 5-stars, and share the TheoryLab podcast on your social media accounts. 

    For questions about the TheoryLab Podcast, contact Joe Cotter, research constituent engagement manager.   

  • 4 in 10 cancer deaths due to smoking in parts of South

    ​And, at least 20% were due to smoking in 147 out of 152 urban areas evaluated across U.S.

    A new ACS study led by Farhad Islami, MD, PhD, (pictured here) and his colleagues measures the toll of cigarette smoking in urban areas, and finds that the South and Appalachia bear the biggest burden. 

    The authors note that strong tobacco control policies nationwide could avert smoking-related deaths.

    The study, appearing Jan. 26, 2021 in Cancer Causes & Control, finds that 4 in 10 cancer deaths are attributable to cigarette smoking in parts of the South region and Appalachia. 

    In both sexes combined, the proportion of smoking-related cancer deaths ranged from 8.8% in Logan (Utah-Idaho) to 35.7% in Lexington-Fayette (Kentucky). Despite this wide variation, at least 20% of all cancer deaths were attributable to cigarette smoking in 147 out of 152 evaluated metropolitan and micropolitan statistical areas (MMSAs).  

    Data show the proportion of cancer deaths attributable to cigarette smoking was greater in men than in women in all evaluated MMSAs.

    Our researchers examined the proportion of cancer deaths from 2013 to 2017 attributed to cigarette smoking in 152 MMSAs. (A metropolitan area is defined as a region that consists of a city of at least 50,000 people and surrounding communities that are linked by social and economic factors. A micropolitan area is defined as an urban area with a population of at least 10,000 but less than 50,000.) 

    Data indicate the variations in total cigarette tax rates and other tobacco control initiatives are likely to have contributed to variations in smoking-related cancer deaths. For example, the high total excise tax in New York City ($1.50 per pack in addition to the New York state tax of $4.35 per pack) may have contributed to the lower proportion of smoking-related cancer deaths in New York-Jersey City-White Plains metropolitan division compared to other evaluated MMSAs in New York state and the Northeast region.  

    “This information is important to inform and help evaluate state and local-level tobacco control policies such as state, city- or county-level tobacco taxes and smoke-free air laws, investments in tobacco prevention and increasing access to smoking cessation resources,” said Farhad. 

    The authors conclude: “Broad and equitable implementation and enforcement of proven tobacco control intervention at all government levels could avert many cancer deaths across the United States.”

    Article: Islami F, Bandi P, Sahar L, Ma J, Drope J, Jemal A. Cancer deaths attributable to cigarette smoking in 152 U.S. metropolitan or micropolitan statistical areas, 2013-2017. Cancer Causes & Control, 2021. doi: 10.10007/s10552-020-01385-y. 

  • New ACS study says drinking accounts for 3.2% of cancer deaths in the U.S.

    A new study finds that alcohol consumption accounts for a considerable portion of cancer incidence and mortality in the U.S. The article, which appears in Cancer Epidemiology, states that in the U.S. on average, alcohol consumption accounts for 4.8% of cancer cases and 3.2% of cancer deaths.

    This study led by Farhad Islami, MD, PhD, is the first to estimate contemporary proportions and counts of alcohol-attributable cancer cases and deaths for all 50 states and the District of Columbia.  Nationally, alcohol consumption accounted for an estimated 75,200 cancer cases and 18,950 cancer deaths annually during 2013 to 2016. Data shows the proportions were generally higher in New England and Western states and lower in Midwestern and Southern states.

    “This information is important for prioritizing state-level cancer prevention and control efforts to reduce alcohol consumption and help reduce this cancer burden,” Farhad said.

    The study finds that overall alcohol-related cancer cases were slightly higher among women than men, reflecting the association of alcohol consumption with increased risk for female breast cancer. The authors say, “healthcare providers and public health practitioners can educate the community to expand the currently limited awareness of the cancer-related risks of alcohol consumption.” 

    The ACS guideline for Diet and Physical Activity for Cancer Prevention states that it is best not to consume alcohol; for those who do drink, consumption should be limited to no more than 1 drink per day for women and 2 drinks per day for men.

    The study notes that concurrent tobacco use and alcohol consumption appears to increase the risk of cancers of the mouth, pharynx, larynx, and esophagus more than the independent effect of either behavior alone. Research is needed to better understand cancer burden resulting from the combined effect of tobacco use and alcohol consumption. 

    Article: Sauer AG, Fedewa SA, Bandi P, Minihan AK, Stoklosa M, Drope J, Gapstur SM, Jemal A, Islami F. Proportion of cancer cases and deaths attributable to alcohol consumption by US state, 2013-2016. Cancer Epidemiology, 2021. doi: 10.1016/j.canep.2021.101893. 

  • Cancer-related suicides down 2.8% per year in the past two decades

    Despite increases in overall suicide rates in the U.S. during the past two decades, cancer-related suicides declined by 2.8% per year, according to a new ACS study.

    The study, appearing in JNCI: The Journal of the National Cancer Institute, found that the largest declines in cancer-related suicide rates were among high-risk populations, suggesting an evolving role of psycho-oncology and palliative and hospice care for cancer patients and survivors during this period.

    To examine the trends in cancer-related suicides compared to overall suicides in the U.S., investigators led by Xuesong Han, PhD (pictured here), calculated average annual percentage change of suicide rates stratified by risk factors including age, sex, urban/rural status, and cancer type. They found that of cancer-related suicides, lung cancer (18.2%), prostate cancer (15.4%), and colorectal cancer (9.1%) were the most common contributing causes. They also found that cancer-related suicide rates had large declines among those who were older, male, living in urban areas, and with prostate or lung cancer.

    Although the gun and opioid epidemics emerged as major public health concerns during this period and overall suicide rates with firearm and drugs increased, the authors found that cancer-related suicide with firearms did not increase, and cancer-related suicides with drugs remained low. These results suggest different risk profiles of suicide for cancer patients compared to the general population.

    “Advances in supportive care and policies ensuring equitable access to increased psychosocial care, and palliative and hospice care services are essential in delivering high quality cancer care to maximize patients and families’ quality of life,” the authors conclude.  

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