Engagement Is Survival: My Take on ASCO 2017
Don Dizon, MD
The American Society of Clinical Oncology (ASCO) Annual Meeting wrapped up early in June, and what a meeting it was.
In addition to important clinical trial outcomes that evaluated novel strategies across tumor types, there were impressive studies aiming to help our patients live with cancer as well — regardless of where they are in their own disease trajectory.
I found the spotlight on the psychosocial and quality of life issues illuminating and refreshing. They also represented an important challenge to those of us who practice oncology: do not accept distress as a normal part of the cancer journey.
This was aptly demonstrated by 3 studies, all of which were part of the Press Program for the annual meeting, and all of which I provided comment for as an ASCO expert.
For patients with a new diagnosis, Viviane Hess and colleagues studied the impact of a web-based intervention to improve access to psychological support.1 In their trial, almost 130 patients who initiated treatment within 12 weeks were randomly assigned to the online intervention (called STREAM) or to a control group (all of whom were offered the web-based program subsequently).
Enrollment in STREAM at baseline was associated with significant improvement in quality of life compared with the control group; this was coupled with a significant reduction in distress. For those who completed treatment, we learned that over 50% had at least a moderate fear of cancer recurrence.
Even more importantly, Jane McNeil Beith and colleagues showed that we can do something about it.2 In the “Conquer Fear” randomized trial, over 200 patients in follow-up after curative intent treatment were randomly assigned to a psychological intervention or to relaxation exercises. Conquer Fear was set up as therapist-directed, individualized, face-to-face sessions over 10 weeks, and while patients derived a reduction in their fear of recurrence with both arms, Conquer Fear was significantly more effective.
For those living with advanced or metastatic cancer, Gary Rodin and colleagues reported the results of the CALM intervention (Managing Cancer and Living Meaningfully) vs usual care, which enrolled over 300 patients.3 The CALM intervention consisted of 3 sessions attended face-to-face by trained professionals of varying specialization, including social workers, oncologists, and palliative care clinicians.
Compared with usual care, those who participated in the CALM intervention experienced significantly less depressive symptoms at both 3 and 6 month time points. Other significant findings associated with the CALM intervention included greater preparation about end of life, less fear of the future, and a greater ability to manage and express feelings.
Studies like this emphasize what is possible, and what, even in the era of precision therapy, remains an important aspect of care.
Cancer is much more than just biology. It is a social disease, with an impact on the psychosocial health and well being of our patients and those that love them. As oncologists, we cannot accept distress as a normal reaction to cancer. I am hopeful that with this trio of studies we can understand that it affects patients from the point of diagnosis.
Addressing it early can mean tangible improvements in coping and, indeed, in living with cancer.
- Hess V, et al. Web-based stress management for newly diagnosed cancer patients (STREAM): A randomized, wait-list controlled intervention study. J Clin Oncol. 2017;35(suppl; abstr LBA10002).
- Beith JM, et al. Long-term results of a phase II randomized controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence in breast, colorectal, and melanoma cancer survivors. J Clin Oncol. 2017;35(suppl; abstr LBA10000).
- Rodin G, et al. Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. J Clin Oncol. 2017;35(suppl; abstr LBA10001).