Telephone-based genetic counseling is just as useful as in-person meetings for those who would like to better understand and potentially reduce their risks of developing cancer, according to research presented May 13 in advance of the American Society of Clinical Oncology's (ASCO) virtual scientific program, to be held May 29 through 31.
The study indicates that remote forms of counseling, including telephone or real-time video to consult with a healthcare professional, can be a highly effective tool to provide preventive cancer care and genetic counseling, say the authors of the study, which was led by MD Anderson Cancer Center in Houston.
The use of remote healthcare services, or telehealth, has soared in recent months due to the COVID-19 pandemic and the need for healthcare professionals and patients to find ways to communicate without risking transmission of the coronavirus.
The new study, which was performed prior to the pandemic, was designed to assess ways to make genetic testing more accessible and to validate the process of remote testing and counseling.
The study, dubbed MAGENTA (Making Genetic Testing Accessible), is a national, randomized trial focusing on people at risk for breast cancer and ovarian cancer. Genetic counseling can be particularly helpful to assess the risks of these two cancers because there are identifiable gene mutations known to increase risk, such as the BRCA gene mutations.
More than a dozen other gene mutations — including CHEK2, CDH1, and PTEN mutations — are known to increase the risk of breast or ovarian cancer or both.
Genetic counseling and, if indicated, testing can help people understand their risk, determine whether other family members are at an increased risk, and trigger medical care to lower risk, such as more frequent cancer screenings, lifestyle changes, use of preventive medication, and even prophylactic surgery.
The study included nearly 4,000 women age 30 and older who had not had genetic counseling or genetic testing in the past and who either had breast or ovarian cancer themselves or had a family member with one of those cancers.
The participants received a genetic test and were assigned to receive either in-person counseling or telephone counseling. Those who received remote counseling received a genetic home test kit, which required providing a saliva sample in a tube and mailing it in.
Among those participants who completed genetic testing, 7.2 percent were found to have a genetic mutation that increased breast or ovarian cancer risk. Researchers reported no changes in the participants’ levels of anxiety and distress when receiving remote counseling compared with in-person counseling. In fact, those in the telephone counseling group were more likely to follow through with scheduling related medical care compared with those in the in-person counseling group.
“The remote testing and education methods resulted in more follow-through in completing the testing than traditional genetic counseling, even though counseling was provided conveniently by phone,” says EElizabeth M. Swisher, MD, director of the Breast and Ovarian Cancer Prevention Program at the Seattle Cancer Care Alliance and coleader of the Stand Up to Cancer Ovarian Cancer–National Ovarian Cancer Coalition Dream Team, which sponsored the study.
“Our results provide a foundation for electronic access to testing that goes beyond telehealth access, with equivalent patient outcomes — less hassle for patients and less cost to the healthcare system,” says Dr. Swisher.
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In other news from the ASCO annual meeting:
Less Intense Treatment for Throat Cancer Fine for Many
A randomized, phase 2 clinical trial shows that an approach called transoral resection with low-dose radiation is safe and effective for some people with oropharynx (throat) cancer. The approach is easier to tolerate and leaves patients with fewer long-term side effects related to radiation.
The study of 353 people compared several approaches to throat cancer caused by human papillomavirus, which accounts for about 70 percent of the disease, according to the Centers for Disease Control and Prevention. Researchers examined pathological biomarkers unique to each patient, such as the extent of cancer in the lymph nodes and tumor characteristics.
Following surgery using a transoral robotic approach (TORS), people with a low risk of recurrence were observed. Those with an intermediate risk of recurrence received lower-dose radiation. People at a high risk of recurrence were assigned to the standard dose of radiation plus chemotherapy.
The study showed that for intermediate-risk patients, a reduced dose of radiation after surgery without chemotherapy appears sufficient. Less radiation typically preserves a patient’s throat function and reduces pain, the authors note.
The group receiving a reduced dose of radiation also had better outcomes than the group receiving high-dose radiation plus chemotherapy. People with low-risk disease had low recurrence rates after two years.
The study showed the value of stratifying patients according to risk and that the TORS surgical approach followed by low-dose radiation is safe and effective in people with intermediate-risk, locally advanced throat cancer, says lead investigator Robert L. Ferris, MD, PhD, director of the Hillman Cancer Center at the University of Pittsburgh Medical Center and a surgical oncologist specializing in head and neck cancer.
"These results present a promising deintensification approach," he says.
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Many People Being Treated for Cancer Also Take Herbal Supplements
About 25 percent of all people with cancer taking oral chemotherapy medications also take herbal supplements, according to research from the University of Rhode Island. Assessing the use of over-the-counter herbal supplements is important because some substances may interact with oral chemotherapy agents, the authors say.
The study of 187 people taking oral chemotherapy drugs found that 24 percent were also taking herbal dietary supplements. The most frequently used supplements were melatonin and marijuana or cannabidiol oil. The authors recommend that people taking oral chemotherapy consult with an oncology pharmacist to prevent drug interactions and maximize the effectiveness of oral chemotherapy.
Federal health officials also recommend that people being treated for cancer consult with their healthcare providers before using any complementary health approach, such as using dietary supplements. According to the National Center for Complementary and Integrative Health, only about 15 percent of people being treated for cancer who use herbal supplements discuss their usage with their healthcare providers.
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Immunotherapy Combination Plus Chemotherapy Promising for Lung Cancer
The combination of Opdivo (nivolumab) and Yervoy (ipilimumab) with limited chemotherapy appears to prolong overall survival as a first-line treatment for people with metastatic non-small cell lung cancer (NSCLC). The study suggests that adding limited chemotherapy to the combination of Opdivo and Yervoy may reduce the risk of the disease progressing when it’s in the early stage.
A previous study, CheckMate-227, showed the value of the immunotherapy combination as a first-line treatment for NSCLC. Opdivo is a type of immunotherapy known as a PD-1 inhibitor, while Yervoy is a category of drug known as a CTLA-4 inhibitor.
The new study, called CheckMate-9LA, was designed to assess the value of adding chemotherapy to the combination. The research presented at ASCO is the first release of results from CheckMate-9LA.
The phase 3 trial showed that Opdivo and Yervoy given together with two cycles of chemotherapy reduced the risk of death by 31 percent compared with chemotherapy alone after at least eight months of follow-up. After more than a year of follow-up, the combination plus chemotherapy showed continued improvements in overall survival compared with chemotherapy alone.
“Adding a limited course of chemotherapy may help mitigate the risk of early disease progression,” says Martin Reck, MD, PhD, the study’s lead investigator and an oncologist at the Lung Clinic Grosshansdorf in Germany. “As the data become more mature, I see the potential for an improving survival benefit over time.”
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