Targeted radiation therapy safe, effective treatment for elderly with pancreatic cancer

Sep. 24, 2013 — A highly targeted cancer radiation therapy may offer a safe and effective treatment option for elderly pancreatic cancer patients unable to undergo surgery or combined chemotherapy and radiation therapy, according to researchers at Henry Ford Hospital in Detroit.

Called stereotactic body radiotherapy (SBRT), the study finds patients lived, on average, six to seven months longer following treatment with minimal side-effects even when they had other severe comorbidities such as chronic obstructive pulmonary disease (COPD), heart disease and diabetes.

Two of the patients in the study lived nearly two years.

“Elderly individuals, those ages 75 and older, account for approximately 40 percent of patients diagnosed with pancreatic cancer,” says study lead author Raphael Yechieli, M.D., with the Department of Radiation Oncology at Henry Ford Hospital.

“These patients are too ill to receive any other treatment, but with stereotactic body radiotherapy we’re able to deliver a safe and effective treatment in two weeks that can provide them with a substantial quality of life with minimal side effects.”

The study was presented at the 55nd annual American Society for Radiation Oncology (ASTRO) meeting in Atlanta.

In 2013, there will be an estimated 45,220 new cases of pancreatic cancer, and approximately 38,460 will die from the disease, according to the National Cancer Institute. Risk factors for pancreatic cancer include smoking, diabetes, obesity, family history of the disease and pancreatitis. Most people diagnosed with the disease are older than 65.

Surgery is the only known cure for resectable pancreatic cancer, where the cancer is localized to the pancreas and hasn't spread. It is estimated that only 20 percent of pancreatic cancer patients have their tumors present with localized disease amendable to surgical removal.

A select number of those patients, however, are not candidates for surgery due to having other co-morbidities such as COPD, heart disease and diabetes. This leaves only chemotherapy and radiation, or a combination of the two, available for treatment.

But for a large portion of elderly patients with localized pancreatic cancer even chemotherapy and radiation therapy are not options.
The Henry Ford study looked to determine if SBRT – a method of giving radiation that can be highly targeted to the tumor, sparing the normal tissue around it – was a viable option for this group of patients. SBRT provides a higher dose of radiation, meaning patients have fewer treatments. In this case, treatment averaged two weeks.

The study included 20 patients with a median age of 83, all of whom were medically unable to tolerate surgery or combined chemo-radiation therapy. The majority of patients in the study (90 percent) received SBRT treatment at the time of diagnosis.

Seven patients reported side-effects from treatment: nausea, vomiting and fatigue.

Among the patients: 13 had a recurrence of cancer; nine had cancer spread from the original tumor to distant organs or distant lymph nodes.

Median overall survival was 6.7 months, and median recurrence-free survival was 8.1 months. At six months post-treatment, 61 percent of patients were alive; two patients in the study survived nearly two years.

“National trends tell us that very few patients over the age of 75 are getting any treatment at all for pancreatic cancer due to comorbidity risks,” notes Dr. Yechieli. “So we want to push the envelope to give them a treatment option that, while not a cure, is short, effective and safe, and has the potential to give them a good quality of life.”

The next step in this research, Dr. Yechieli says, is to closely follow patients after SBRT and get their direct feedback to measure post-treatment quality of life.

View the original article here

Elderly care needs 'set to treble'

19 September 2013 Last updated at 15:33 ETBy Tulip Mazumdar Global health reporter

Care needs can put huge pressure on families

The number of older people needing care is set to nearly treble globally by 2050, campaigners say.

Currently 101 million people require care, but a report from Alzheimer's Disease International warns the figure will rise to to 277 million.

Many needing care have dementia, and the report warns there will be a "global Alzheimer's epidemic".

The report's author said countries like India and China would be hard hit - and must start planning services now.

Alzheimer's is the most common cause of dementia. Symptoms include loss of memory, mood changes, and problems with communicating and reasoning.

More than 35 million people live with dementia across the world, according to the World Health Organization. More than half are living in low and middle income countries.

The report reveals that as the world population ages, the traditional system of informal care by family, friends and the community will need much greater support.

Just over one in 10 people aged 60 or over needs long-term care, according to the report. This includes daily help with things like washing, eating, dressing and using the toilet.

It can put huge pressure on families. Carers often have to give up work to look after elderly relatives.

'Older people left behind'

Treating and caring for people with dementia currently costs the world more than ￡376bn per year. That includes the cost of health and social care as well as the loss of earnings.

Prof Martin Prince, from King's College London's Institute of Psychiatry, the author of the report, said lower and middle income countries including India and China need to urgently start planning services to deal with the "epidemic".

"The social and economic changes happening in those countries are inevitably going to mean that family carers will be less available.

"Things like the decline in fertility rates mean people are going to have fewer children.

"Women are also better educated so are more likely to join the paid workforce and are going to be less likely to be available to provide care."

And he said an increase in migration between countries, and from rural to urban areas amongst younger people meant there would be a lot of older people "left behind".

The report makes a range of recommendations including giving paid and unpaid carers "appropriate financial rewards" and monitoring the quality of care both in care homes and in the community.

A spokesperson for the Alzheimer's Society in the UK said: "Dementia is the biggest health crisis facing the world today.

"This report is a wake-up call to governments across the world about the immediate need to put in place more care and support.

"The UK government's G8 summit on dementia this year will be a key opportunity to rally support from world leaders to tackle dementia together. We need to see political leadership to avoid a spiralling global crisis," the spokesperson added.

View the original article here