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Nursing Home Residents With Metastatic Cancer Are More Likely to Receive Aggressive End-of-Life Care

A new study suggests aggressive care near the end of life is slightly more likely among patients with metastatic cancer who live in nursing homes than among those who live in the community, although the study notes that aggressive care is high in both groups. The study, published online Feb. 22 in JAMA Network Open, used databases that include more than 146,000 older patients with metastatic breast, colorectal, lung, pancreatic or prostate cancer. Researchers found that 63.6% of patients who lived in nursing homes had received aggressive end-of-life care, compared with 58.3% of those who lived in the community. Nursing home residents were also more likely to die in hospitals than those who lived in the community. However, nursing home residents were 43% less likely to receive cancer-directed care in comparison with those living in the community. Those who resided in nursing homes were also less likely to receive hospice care in the last three days of life. Health services researcher Siran M. Koroukian at Case Western Reserve University School of Medicine in Cleveland, the lead study author, commented about the study in an article published on Medscape. “Despite the increased emphasis on reducing aggressive end-of-life care, such care remains highly prevalent among older persons with metastatic cancer and is more common among nursing home residents than their community-dwelling counterparts,” Koroukian said.

Could Immunotherapy Be a Single Treatment for Earlier Stage Cancer?

As immune checkpoint inhibitors are approved to treat a range of cancers, researchers are encouraged by findings from several small clinical trials that suggest this type of immunotherapy alone could one day be effective in treating certain locally advanced cancers. Immune checkpoint inhibitors are a type of immunotherapy that help the body’s own immune system recognize and fight cancer. A post published Feb. 23 in the National Cancer Institute’s Cancer Currents blog encapsulates several promising, but small, studies that suggest this therapy could replace other treatment staples, such as chemotherapy, in malignancies that are limited to the original cancer location and nearby lymph nodes. In one study of just 35 patients, about half of patients received up to six months of immunotherapy prior to surgery for colorectal cancer with more than half showing no evidence of cancer in the removed tissue. Other participants in the same study were treated with an immune checkpoint inhibitor for up to a year and had no further treatment. Within 24 weeks of starting the immune checkpoint inhibitor, all except one participant in this group had a substantial reduction in the size of their tumors, and many had no evidence of cancer at all. Of note, these patients’ tumor tissue tested positive for a biomarker that suggests they will respond to immunotherapy. The findings, when added to results seen in other trials, point to a future where a short course of immunotherapy may be the entire treatment for some people with these locally advanced cancers, said James Gulley, an expert in cancer immunotherapy who is the co-director of the NCI’s Center for Immuno-Oncology. The potential upside is substantial, he noted. “If we can avoid all the potential harms of surgery and other treatments, that could be a game changer for patients.”

Research Compares Stereotactic Body Radiotherapy With Surgery for Localized Prostate Cancer

An analysis presented at the 2023 American Society of Clinical Oncology Genitourinary Cancer Symposium compared the long-term effects of surgery versus stereotactic body radiotherapy (SBRT), a treatment that delivers highly precise doses of radiation to the tumor, in people with localized prostate cancer. The study, which was closed early due to the pandemic, enrolled 123 patients who received either SBRT or laparoscopic or robot-assisted surgery. The results suggest that patients undergoing SBRT for localized prostate cancer have better urinary continence and fewer bothersome sexual side effects, but surgery was associated with fewer bowel problems. The results, reported in an article in OBR Oncology, support previous studies related to localized prostate cancer management. In this study, 46.8% of patients who had surgery required the use of urinary pads at two years compared with 4.5% of those who had SBRT. Scores to measure bowel issues were better with surgery, ranking 97.3 out of a 100-point scale, compared with 88.7 with SBRT. People who had surgery were more bothered by sexual symptoms than those who had SBRT. The article notes that management of localized prostate cancer can range from watchful waiting to surgery or SBRT, but that treatment outcomes of surgery and SBRT have not yet been directly compared.