Prevention: Major Highlights
Annual Report - 2005-2006
The Weighty Truth
While one’s scale can forecast an increase in pant size, it may also predict a much weightier truth — the silent progression of cancer.
In a groundbreaking study, the first of its kind analyzing the role of weight on prostate cancer progression, Sara Strom, Ph.D., has unveiled some remarkable trends.
She and her team reported in the journal Cancer that obesity is an independent predictor of whether localized prostate cancer will progress following radiation therapy.
They found that moderately and severely obese patients had a 99% greater risk of developing “biochemical failure,” which is a rising prostate specific antigen level that can indicate advancing cancer. Researchers also found that obese patients had a 66% increased risk of tumor recurrence or metastasis than did non-obese patients.
These findings mirror results from a parallel study reported in the journal Clinical Cancer Research. M. D. Anderson researchers found a history of weight gain or obesity at the time of diagnosis played an important role in how aggressive prostate cancer became after surgery.
Biochemical failure occurred more quickly in patients registering increases in their body mass index, which is a statistical measure of an individual’s weight scaled according to their height. These men also experienced a higher rate of cancer recurrence.
“Together, these studies confirm that a man’s body mass index can be a significant factor in how well he fares after standard treatments for prostate cancer,” says Strom, lead researcher on both studies and associate professor in the Department of Epidemiology. “The fact that the same association was found among patients with different risk profiles, who were treated with different therapies, would suggest that poorer outcomes are related not as much to differences in treatment as to differences in tumor behavior between obese and non-obese men.”
According to Strom, further study may reveal that a man’s history of body weight should be a factor oncologists consider when designing a treatment and follow-up plan for newly diagnosed patients with prostate cancer.
“Understanding the mechanisms by which weight gain contributes to prostate cancer progression is an important first step in the development of rational, preventive strategies,” Strom says.
Not Just the Air You Breathe
Cigarettes aside, genes and diet also play a role in whether a person — even a non-smoker — develops lung cancer or not.
In one of the largest studies ever conducted, M. D. Anderson researchers found that first-degree relatives of lung cancer patients who never smoked had a 25% increased risk of developing any cancer compared to the control group. Additionally, their risk of developing lung cancer before age 50 was six times higher.
According to study principal investigator Margaret Spitz, M.D., chair of the Department of Epidemiology, and Olga Gorlova, Ph.D., assistant professor, the average age of diagnosis was approximately 61 years among non-smoking relatives of lung cancer patients, as compared to 74 years for non-smoking relatives in the control group.
The study included 2,465 first-degree relatives (parents, children and siblings) of 316 lung cancer patients who had never smoked, compared with a control group of 2,441 first-degree relatives of 318 people who did not have lung cancer and also had never smoked.
“It has long been observed that cancer aggregates in some families, and with the help of this unique group of lung cancer patients and their relatives, we can begin to study the underlying genetic factors,” Spitz says.
In a second case-controlled study, Spitz and Matthew Schabath, Ph.D., epidemiology postdoctoral fellow, note that a diet rich in plant-derived compounds that possess weak estrogen-like activity may reduce the risk of developing lung cancer.
Among the more than 3,500 participants, they found that those who ate the highest amount of foods rich in dietary phytoestrogens had a 46% reduced risk of lung cancer, compared to those who ate the lowest quantity. These results build upon the team’s previously published findings that hormone replacement therapy was associated with a reduced risk of lung cancer.
“While the best cancer prevention advice continues to be to stop smoking, these findings showing that specific dietary patterns resulted in lower lung cancer risk are tantalizing,” Spitz says.
On Your Side
While modern medicine continually opens new doors to cancer care, a few significant populations repeatedly find these entrances locked.
M. D. Anderson’s Center for Research on Minority Health, however, hopes to remove the barriers many minorities, those of lower socioeconomic status and the medically underserved face in accessing health care services.
“With a little extra assistance, we believe these individuals can overcome many of the obstacles they encounter and receive appropriate screenings and treatment,” says Lovell A. Jones, Ph.D., the center’s director and professor in the Department of Health Disparities Research.
Through a $5 million grant from the Centers for Medicare and Medicaid Services, Jones and his colleagues have begun recruiting Hispanics into the Facilitated Assistance, Research and Outreach for Seniors Study. Project FAROS, which means “beacon of light” in Spanish, was initiated to assess the effectiveness of individual counselors in facilitating patients’ health care experiences.
Researchers hope to apply innovative, evidence-based intervention models to reduce risk factors, as well as to increase screening rates, use of treatment and survival among patients with breast, cervical, colon, lung and prostate cancer in underserved populations. Eligible participants will receive personal “navigators” to help them receive timely, effective medical treatment and obtain appropriate follow-up care.
Individuals will be randomly divided into an intervention group, which will receive navigation services, and a non-intervention group, which will receive information about local resources that can provide health care assistance.
Navigators will assist patients by coordinating doctor appointments, identifying barriers to care and making referrals to other health care professionals.
Cancer screenings will include a Pap test for cervical cancer; prostate specific antigen blood test and digital rectal exam for prostate cancer; fecal occult blood testing, with or without colonoscopy or sigmoidoscopy, for colorectal cancer; and mammography for breast cancer.
Navigating the health care system can be difficult for any patient, but real barriers place some individuals at a significant disadvantage. M. D. Anderson aims to meet underserved patients where they are and provide much-needed facilitators to improve cancer prevention and treatment.
When East Meets West
At the same time that M. D. Anderson is dedicated to pursuing the latest technology to improve the overall health of cancer patients, its researchers also are exploring the benefits of combining Western medicine with 5,000-year-old “energy-based” Eastern practices.
The National Cancer Institute recently awarded M. D. Anderson a $2.4 million grant to study the effects of Tibetan yoga in women with breast cancer who are undergoing chemotherapy.
With this grant support, Lorenzo Cohen, Ph.D., and his team will conduct a large randomized trial comparing Tibetan yoga versus simple stretching or usual breast cancer care.
The award is the largest ever made to study Tibetan yoga in cancer patients, says Cohen, whose team published a 2004 study in the journal Cancer that found the practice led to significant sleep improvements in patients with lymphoma.
The study will assess the physical and psychological benefits of the yoga program and examine such patient lifestyle factors as fatigue, sleep, mental health and distress.
“Cancer and its treatment are associated with considerable distress, impaired quality of life, poor mental health and reduced physical function,” says Cohen, study principal investigator and director of M. D. Anderson’s Integrative Medicine Program. “This is particularly true for women with breast cancer who receive multi-modality treatment over an extended period of time.
“For thousands of years,” he adds, “Tibetans have been employing a form of yoga that we think could help improve the treatment-related morbidity that accumulates over time in cancer patients.”
In addition to the yoga study, NCI also awarded M. D. Anderson and Fudan University Cancer Hospital in Shanghai, China, a $2.9 million grant to expand ongoing studies of traditional Chinese medicine in the treatment of cancer.
The two institutions will expand their laboratory and clinical studies of herbal and natural-based products as sources for new therapies, acupuncture for relieving disease- and treatment-related side effects and mind-body practices such as qigong for relaxation among breast cancer patients receiving radiation therapy.
“Traditional Chinese medicine has a remarkable history,” notes Cohen, “and by applying Western research standards to traditional Chinese medicine, we can better understand possible new applications.”