Cancer Treatment In People Research Articles

Checkpoint Inhibitors in Dogs: Are We There Yet?

Immune checkpoint inhibitors (ICI) have revolutionised cancer treatment in people. Immune checkpoints are important regulators of the body's reaction to immunological stimuli. The most studied immune checkpoint molecules are programmed death (PD-1) with its ligand (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) with its ligands CD80 (B7-1) and CD86 (B7-2). Certain tumours can evade immunosurveillance by activating these immunological checkpoint targets. These proteins are often upregulated in cancer cells and tumour-infiltrating lymphocytes, allowing cancer cells to evade immune surveillance and promote tumour growth. By blocking inhibitory checkpoints, ICI can help restore the immune system to effectively fight cancer. Several studies have investigated the expression of these and other immune checkpoints in human cancers and have shown their potential as therapeutic targets. In recent years, there has been growing interest in studying the expression of immune checkpoints in dogs with cancer, and a few small clinical trials with ICI have already been performed on these species. Emerging studies in veterinary oncology are centred around developing and validating canine-targeted antibodies. Among ICIs, anti-PD-1 and anti-PD-L1 treatments stand out as the most promising, mirroring the success in human medicine over the past decade. Nevertheless, the efficacy of caninized antibodies remains suboptimal, especially for canine oral melanoma. To enhance the utilisation of ICIs, the identification of predictive biomarkers for treatment response and the thorough screening of individual tumours are crucial. Such endeavours hold promise for advancing personalised medicine within veterinary practice, thereby improving treatment outcomes. This article aims to review the current research literature about the expression of immune checkpoints in canine cancer and the current results of ICI treatment in dogs.

Colorectal cancer treatment in people with severe mental illness: a systematic review and meta-analysis.

People with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC), even though the incidence is lower or similar to that of the general population This pattern is unlikely to be solely explained by lifestyle factors, while the role of differences in cancer healthcare access or treatment is uncertain. We undertook a systematic review and meta-analysis on access to guideline-appropriate care following CRC diagnosis in people with SMI including the receipt of surgery, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsychInfo and CINAHL that compared CRC treatment in those with and without pre-existing SMI (schizophrenia, schizoaffective, bipolar and major affective disorders). Designs included cohort or population-based case-control designs. There were ten studies (sample size = 3501-591 561). People with SMI had a reduced likelihood of surgery (RR = 0.90, 95% CI 0.92-0.97; p = 0.005; k = 4). Meta-analyses were not possible for the other outcomes but in results from individual studies, people with SMI were less likely to receive radiotherapy, chemotherapy or sphincter-sparing procedures. The disparity in care was greatest for those who had been psychiatric inpatients. People with SMI, including both psychotic and affective disorders, receive less CRC care than the general population. This might contribute to higher case-fatality rates for an illness where the incidence is no higher than that of the general population. The reasons for this require further investigation, as does the extent to which differences in treatment access or quality contribute to excess CRC mortality in people with SMI.

Giant Squamous Cell Carcinoma on The Scalp of A Young African American Male

Abstract Introduction/Objective Skin cancer comprises 1-2% of all cancers in African American (AA) patients. Among all skin cancers, squamous cell carcinoma (SCC) is the most common one in AA, with an incidence of approximately 3 per 100,000. It mainly affects patients over 50-year-old. The most common locations of SCC (60-70% of cases) in AA were the sun-protected areas such as the lower limbs and anogenital region, rather than sun-exposed areas. Methods/Case Report We report a case of a 40-year-old AA male with longstanding folliculitis decalvans presenting with giant SCC. In 2016, the patient noted the enlargement of the atrophic hyperpigmented plaques on the right posterior scalp. They grew into a 10.5 x 10 x 4.5 cm exophytic, verrucous-like mass when the patient presented to the clinic in 2021. A skin biopsy of the giant mass showed pseudoepitheliomatous hyperplasia with cytologic atypia. CT scan ruled out underlying bone invasion. After that, the mass was resected with minimal 3-cm negative margins. Histological evaluation reveals a moderately differentiated keratinizing SCC with clear cell changes in a background of severe acute and chronic inflammation, folliculitis, and scar. No lymphovascular invasion is noted. An over 10-cm SCC arising within folliculitis decalvans on the scalp of a young AA patient is rare. To our knowledge, this the first report of such a case. Despite the limited data available, chronic scarring process and inflammation, instead of sun damage, are believed to be the most important risk factors for SCC development in the AA population. SCC greater than 4cm in chronic inflammation/scar is strongly associated with a poor prognosis. Therefore, early diagnosis, treatment, and close follow-up are critical. Results (if a Case Study enter NA) NA Conclusion Our report emphasizes (1) biopsy has limitations in diagnosing giant cutaneous neoplasms due to inadequate sampling; (2) the need for growing awareness, earlier diagnosis, and skin cancer treatment in people of color.

Balancing the needs of individuals and services in cancer treatment for people with dementia: A focused ethnographic study

BackgroundManaging multiple conditions is difficult for patients and their families, increasing complexity in care. Two of the most common long-term conditions, cancer and dementia, both disproportionately affect older adults. However, little is known about the needs and experiences of those living with both conditions, which could inform practice in the area. ObjectivesThis focused ethnographic study sought to understand how oncology services balance the unique and complex needs of these patients with those of the service more widely. DesignFocused ethnography. SettingTwo National Health Service hospital trusts. ParticipantsSeventeen people with dementia and cancer, 22 relatives and 19 staff members participated. MethodsParticipant observation, informal conversations, semi-structured interviews, and medical notes review. ResultsImproved satisfaction and outcomes of care were reported when staff were delivering person-centred care. Staff tried to balance the need for personalised and flexible support for individuals with dementia with managing targets and processes of cancer care and treatment. The importance of continuity of people, places, and processes was consistently highlighted. ConclusionNavigating and managing the delicate balance between the needs of the individual and the needs of services more widely was difficult for both staff and patients. Improved awareness, identification and documentation of dementia would help to ensure that staff are aware of any specific patient needs. Consistency in staffing and appointment locations should develop familiarity and routine for people with dementia.

Immune Status and Associated Mortality After Cancer Treatment Among Individuals With HIV in the Antiretroviral Therapy Era

Immunologic decline associated with cancer treatment in people with HIV is not well characterized. Quantifying excess mortality associated with cancer treatment-related immunosuppression may help inform cancer treatment guidelines for persons with HIV. To estimate the association between cancer treatment and CD4 count and HIV RNA level in persons with HIV and between posttreatment CD4 count and HIV RNA trajectories and all-cause mortality. This observational cohort study included 196 adults with HIV who had an incident first cancer and available cancer treatment data while in the care of The Johns Hopkins HIV Clinic from January 1, 1997, through March 1, 2016. The study hypothesized that chemotherapy and/or radiotherapy in people with HIV would increase HIV RNA levels owing to treatment tolerability issues and would be associated with a larger initial decline in CD4 count and slower CD4 recovery compared with surgery or other treatment. An additional hypothesis was that these CD4 count declines would be associated with higher mortality independent of baseline CD4 count, antiretroviral therapy use, and risk due to the underlying cancer. Data were analyzed from December 1, 2017, through April 1, 2018. Initial cancer treatment category (chemotherapy and/or radiotherapy vs surgery or other treatment). Post-cancer treatment longitudinal CD4 count, longitudinal HIV RNA level, and all-cause mortality. Among the 196 participants (135 [68.9%] male; median age, 50 [interquartile range, 43-55] years), chemotherapy and/or radiotherapy decreased initial CD4 count by 203 cells/μL (95% CI, 92-306 cells/μL) among those with a baseline CD4 count of greater than 500 cells/μL. The decline for those with a baseline CD4 count of no greater than 350 cells/μL was 45 cells/μL (interaction estimate, 158 cells/μL; 95% CI, 31-276 cells/μL). Chemotherapy and/or radiotherapy had no detrimental association with HIV RNA levels. After initial cancer treatment, every 100 cells/μL decrease in CD4 count resulted in a 27% increase in mortality (hazard ratio, 1.27; 95% CI, 1.08-1.53), adjusting for HIV RNA level. No significant increase in mortality was associated with a unit increase in log10 HIV RNA after adjusting for CD4 count (hazard ratio, 1.24; 95% CI, 0.94-1.65). In this study, chemotherapy and/or radiotherapy was associated with significantly reduced initial CD4 count in adults with HIV compared with surgery or other treatment. Lower CD4 count after cancer treatment was associated with an increased hazard of mortality. Further research is necessary on the immunosuppressive effects of cancer treatment in adults with HIV and whether health care professionals must consider the balance of cancer treatment efficacy against the potential cost of further immunosuppression. Monitoring of immune status may also be helpful given the decrease in CD4 count after treatment and the already immunocompromised state of patients with HIV.

Cancer and dementia: an exploratory study of the experience of cancer treatment in people with dementia.

Patients with comorbid cancer and dementia have poorer outcomes than those without dementia. We observe oncology teams managing patients with dementia and memory loss and explore these patients' needs and experiences of outpatient cancer services. A single site investigation of case study design to examine practices in four clinics using multi-methods of data collection: retrospective note review, observation, interviews, and recorded consultations. A framework analytic approach identifies themes within and across cases. Thirty-three clinical encounters with patients with memory loss were observed. Ten consultations were audio-recorded and 16 individuals interviewed (n=6 patients-carer dyads, n=1 lone patient, and n=5 staff). Medical records were reviewed for 338 cases. Cancer referrals did not document memory health, so clinicians rely on patient/carer disclosure to identify patients with memory problems. In practice, the problem often remains hidden. Treating teams who do become aware of memory difficulties are unsure how to support patients, but marked memory loss can limit treatment options and preclude radical intent. Carers are key facilitators of successful cancer consultations and management. Their support needs are largely unrecognized. Training that educates cancer teams on how to identify and support individuals with memory problems before and during treatment and recognize the carer role may facilitate complex cancer care and help reduce inequalities of outcomes.

Cancer screening, prevention, and treatment in people with mental illness.

People with mental illness die decades earlier in the United States compared with the general population. Most of this disparity is related to preventable and treatable chronic conditions, with many studies finding cancer as the second leading cause of death. Individual lifestyle factors, such as smoking or limited adherence to treatment, are often cited as highly significant issues in shaping risk among persons with mental illness. However, many contextual or systems-level factors exacerbate these individual factors and may fundamentally drive health disparities among people with mental illness. The authors conducted an integrative review to summarize the empirical literature on cancer prevention, screening, and treatment for people with mental illness. Although multiple interventions are being developed and tested to address tobacco dependence and obesity in these populations, the evidence for effectiveness is quite limited, and essentially all prevention interventions focus at the individual level. This review identified only one published article describing evidence-based interventions to promote cancer screening and improve cancer treatment in people with mental illness. On the basis of a literature review and the experience and expertise of the authors, each section in this article concludes with suggestions at the individual, interpersonal, organizational, community, and policy levels that may improve cancer prevention, screening, and treatment in people with mental illness.

Mainstreaming genetic testing of cancer predisposition genes.

Cancer predisposition genes (CPGs) describe genes in which germline mutations result in increased risk of cancer. Over 100 CPGs have already been discovered and transformative advances in DNA analysis are leading to many new CPG discoveries. These fast, affordable methods for analysing the DNA sequence can also be utilised in diagnostics to increase substantially clinical testing of CPGs. In turn, this has potential to provide substantial cost-effective health benefits with respect to cancer treatment in people with the disease and cancer prevention in healthy individuals. In this review, I outline the clinical benefits of testing for CPGs and how increased testing can be achieved.

Principles and Practice of Radiation Therapy in Exotic and Avian Species

Radiation therapy has long played a significant role in the treatment of cancer in people, dogs, and cats. Recently, this technology has been applied to small mammal, avian, and reptile species with some success. Radiation therapy may play an important role in the control of locally aggressive tumors and has been used in both definitive and palliative settings. However, there are some special challenges that must be overcome to successfully treat these species with radiation therapy and, in many cases, little is known about the natural behavior of the tumors being treated. This article introduces some of the basic tenets of radiation oncology, while addressing some of the aspects of radiation biology that are problematic when treating very small or air-filled patients. Much work needs to be done to define fractionation schemes and field geometries that will allow avian and exotic pets to be safely and effectively irradiated.

Opinion

It has been said that "dog is man's best friend'. Comparative oncologists are demonstrating that pet dogs could hold the keys for advances in cancer treatment in people. Specific types of cancer that arise spontaneously in pet dogs could serve as important models of human cancer, having much greater similarity to their counterparts in humans than many currently used experimentally induced tumor models. In vivo models that are relevant to human cancer are greatly needed, particularly for evaluating new strategies for cancer therapy, such as augmentation of the immune system or blockade of the metastatic cascade. In addition, pet dogs could also be used to identify environmental carcinogens by acting as sentinels of cancer induced by these toxins.