Bankruptcy rates among cancer patients increase along with survival time, study finds

ScienceDaily (June 6, 2011) — An analysis linking federal bankruptcy court records to cancer registry data from nearly 232,000 adult cancer cases in western Washington during a 14-year period has found a hidden cost to survival: Insolvency rates increase along with the length of survival.

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"Patients diagnosed with cancer may face significant financial stress due to income loss and out-of-pocket costs associated with their treatment," said Scott Ramsey, M.D., Ph.D., a health care economist and internist at Fred Hutchinson Cancer Research Center who led the study. "On average, bankruptcy rates increased fourfold within five years of diagnosis." Ramsey presented the findings June 6 at the 2011 annual meeting of the American Society of Clinical Oncology in Chicago.

The study found that compared to the general population, bankruptcy rates were nearly twice as high among cancer patients one year after diagnosis, and that the median time to bankruptcy was two and a half years after diagnosis.

"The risk of bankruptcy for cancer patients is not well known, and previous studies have relied on individual self-reports about medically related reasons for bankruptcy filing," said Ramsey, a member of the Hutchinson Center's Public Health Sciences Division. "By linking two irrefutable government records of cancer and bankruptcy, we are able to determine how financial insolvency risk varies by cancer type, treatment and other factors," he said.

For the study, Ramsey and colleagues linked Washington state cancer registry data with federal bankruptcy court records in 13 western Washington counties. They measured the rate of bankruptcy after a first cancer diagnosis and identified factors that increased bankruptcy risk among people with common cancers.

They found that bankruptcy risk varies widely across cancer types. The risk is highest for lung, thyroid and leukemia/lymphoma cancer patients. In contrast, patients over 65, who are typically on Medicare, have a much lower risk of bankruptcy than younger patients. The researchers also found that bankruptcy rates among cancer patients have increased significantly since the U.S. financial crisis.

Ramsey and colleagues in the Hutchinson Center's Public Health Sciences Division, along with researchers at the University of Washington, conducted the study in collaboration with the U.S. Bankruptcy Court, Western District of Washington, Seattle.

The National Cancer Institute funded the research.

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C-reactive protein levels predict breast cancer survival rates, study finds

ScienceDaily (June 1, 2011) — Levels of C-reactive protein (CRP) are increased in response to acute inflammation, infection and tissue damage. There are also reports that CRP levels are elevated because of cancer. New research published in BioMed Central's open access journal Breast Cancer Research shows that elevated CRP levels are predictive of a poor prognosis for breast cancer sufferers.

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C-reactive protein is produced by the liver, in response to infection or injury, when stimulated by the cytokine IL-6. Tumor sites are often associated with inflammation and this inflammation contributes to tumor growth, invasion and metastasis. While elevated CRP has been found associated with a poor outcome for many solid tumors, including endometrial, cervical, prostate and colorectal cancer, there has been some discussion about whether this is true for breast cancer.

Researchers from Denmark looked at data from over 2000 breast cancer patients and followed their progress for up to seven years from diagnosis (average follow up was three years). The researchers found that regardless of lifestyle, menopause status and presence of cardiovascular disease, increasing levels of CRP resulted in increasingly poor prognosis. The five-year survival decreased from 90% for low CRP to 74% for high levels of CRP, disease-free survival reduced from 87% to 74%, and deaths from breast cancer increased from 11% to 20%.

Dr Kristine Allin, from Herlev Hospital, said, "Elevated CRP at time of diagnosis remained predictive of overall survival rates regardless of patient's age, tumor size, lymph node status, or presence of metastasis, and whether or not the patient was estrogen receptor positive. It was still true even when we excluded patients which we believed to have bacterial infections because of their very high CRP levels."

Dr Allin continued, "While measuring CRP levels gives a general indication of health and longevity, measuring CRP levels for breast cancer patients seems to be an easy way to predict the severity of the patient's disease. This may allow clinicians to alter their treatment tactics and improve cancer survival rates."

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Vaccine extends recurrent glioblastoma survival rates by 2 to 3 times, study finds

ScienceDaily (June 3, 2011) — In data presented at The American Society of Clinical Oncology (ASCO) Annual Meeting, cancer researchers found that the brain tumor vaccine HSPPC-96 for treating recurrent glioblastoma (GBM) has a favorable safety profile and extends survival by two to three times more than the current median survival rate.

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Patients in the study, conducted at University Hospitals Case Medical Center, University of California, San Francisco and Columbia University, were found to have a median survival of 11 months compared to current three to five month survival.

"The findings are very favorable for patients with this deadly form of brain cancer," said Andrew Sloan, MD, one of the authors of the study presented at ASCO and Director of the Brain Tumor and Neuro-Oncology Center at University Hospitals Case Medical Center. "The vaccine is one of the few immune therapies designed specifically for patients who are not newly diagnosed, and these encouraging results make this a promising therapy for a more extensive Phase 3 trial."

HSPPC-96 isolates the heat shock protein, which is part of the immune system. The protein from the patient's tumor is then reinjected into the skin with an adjuvant, or an agent added to a drug to increase its effect.

The vaccine was developed by Andrew Parsa, MD, PhD, principal investigator of the Brain Tumor Research Center at the University of California, San Francisco. He is collaborating with the Lexington, Massachusetts biotech company called Agenus. Columbia University also is part of the ongoing Phase 2 study designed to evaluate overall survival and immunologic response with HSPPC-96 in patients with first or subsequent recurrence of GBM.

All patients underwent surgery prior to vaccine therapy. However, since the vaccine is made from the patient's own tumor, the surgery had to be performed at one of the participating sites. The vaccine therapy begins within 5 weeks after surgery and consists of four weekly injections, followed by bi-weekly injections for up to 52 weeks.

"The vaccine is made from a patient's own cells, so it takes into account what is unique about the patient's particular tumor -- it's the ultimate in 'personalized medicine'," said Dr. Sloan who also is the Peter D. Cristal Chair in Neurosurgery and an Associate Professor of Neurological Surgery at Case Western Reserve University School of Medicine.

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Advanced-stage prostate cancer patients experience 20-year survival rates with surgery, study suggests

ScienceDaily (May 15, 2011) — Long-term survival rates for patients with advanced prostate cancer suggest they can be good candidates for surgery, Mayo Clinic researchers have found. Their study found a 20-year survival rate for 80 percent of patients diagnosed with cancer that has potentially spread beyond the prostate, known as cT3 prostate cancer, and treated with radical prostatectomy, or surgery to remove the prostate gland. Previously, patients found to have cT3 prostate cancer were offered radiation or hormone treatment, but not radical prostatectomy.

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The researchers presented their findings during the American Urological Association Annual Meeting in Washington.

"We are doing a much better job of identifying and expanding candidates for surgery, which results in better, longer outcomes for so many of our patients," says R. Jeffrey Karnes, M.D., of Mayo Clinic's Department of Urology. "We have confirmed that patients diagnosed with locally advanced prostate cancer can enjoy a long, cancer-free interval."

The 80 percent survival rate for cT3 diagnoses at 20 years compares to 90 percent for cT2, or cancer confined to the prostate. This long-term follow-up of patients who underwent surgery between 1987 and 1997 is an important advance in understanding the quality outcomes for cT3 patients. The study sample included patients diagnosed and operated on between 1987 and 1997. Ongoing research will examine contemporary data.

Other study investigators include Christopher Mitchell, M.D., Eric Umbreit, M.D., Rachel Carlson and Laureano Rangel, all of Mayo Clinic.

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