The quality of life of cancer patients will take center stage at the upcoming American Society for Radiation Oncology (ASTRO) 55th Annual Meeting. All 4 of the plenary-session presentations will directly or indirectly address this issue.

The meeting will be held in Atlanta from September 22 to 25.

Historically, oncologists have been so focused on extending survival that the concern about the quality of that longer life has lagged, said Colleen Lawton, MD, president of ASTRO's board of directors and professor of radiation oncology at the Medical College of Wisconsin in Milwaukee.

"We are now understanding that quality of life is exceedingly important," she told Medscape Medical News in an interview. "And the only way to learn about it is to ask the patient."

Quality of life and related measures are typically secondary end points in cancer research, Dr. Lawton pointed out. But that is not the case in the Radiation Therapy Oncology Group (RTOG) 0933 clinical trial, which is a study of patients with brain metastases who receive a modified form of whole-brain radiotherapy (WBRT).

The ground-breaking study has a primary cognitive end point, and seeks to understand whether radiation that conformally avoids the hippocampus can preserve memory function (abstract LBA1).

Loss of memory, especially short-term memory, is a significant potential toxicity with WBRT, Dr. Lawton explained.

The researchers will compare their results on cognitive function with that in historic control subjects treated with standard WBRT in this phase 2 study, which will be presented during the plenary session.

"It's never been systematically studied," said Dr. Lawton about the strategy of sparing the hippocampus, the section of the brain associated with cognition, to preserve memory.

"Many of these patients will now live years beyond a diagnosis of brain metastases and, therefore, quality of life is critical," she added.

Another plenary-session presentation is a quality-of-life analysis (abstract 2) from a major lung cancer trial. Survival results, reported earlier this year by Medscape Medical News, were unexpected and perplexing.

The RTOG 0617 investigators had hypothesized that a radiation dose higher than the standard would improve survival in patients with advanced lung cancer; surprisingly, outcomes were significantly worse.

Now, the investigators are back with patient-reported outcomes from the study and what they call "the rest of the story," said Dr. Lawton.

More Quality of Life at the Plenary

Dr. Lawton believes that all cancer patients should receive mental-health screening. But in lieu of that, screening for depression would be a boon to patients and their treating clinicians, she said. "If you are depressed, your quality of life is lousy."

A new study (abstract 3), also part of the plenary session, looks at a "short and sweet" approach to screening for depression in cancer patients receiving radiotherapy, Dr. Lawton reported.

The fourth presentation at the plenary will compare disease-specific survival in men with intermediate-risk prostate cancer who receive 8 or 28 weeks of androgen suppression prior to radiotherapy plus concurrent androgen suppression (abstract 1).

Although the primary outcome is one of efficacy, the researchers will also report on the rates of adverse effects for the different periods of androgen suppression. These adverse effects are well known, and potentially include muscle loss, sexual dysfunction, hot flashes, bone loss, weight gain, and fatigue.

"This is technically a quantity-of-life study and potentially has major quality-of-life implications," said Dr. Lawton.

The study will add to the literature on prostate cancer treated with radiotherapy and hormone therapy in men with intermediate-risk disease. Previous research has indicated that high-risk patients benefit from a longer period of hormone therapy.

5 Radiotherapy Practices That Should Stop

At the annual meeting, ASTRO will unveil a list of its first set of radiation oncology clinical practices that are not supported by evidence and should not be routinely used.

The issuance is part of the Choosing Wisely campaign, an initiative of the American Board of Internal Medicine Foundation.

Some of the recommendations will result in less revenue for a practice.

The campaign dates from 2010, when a prominent primary care clinician challenged each medical specialty to take a critical look at its field and identify practices that are commonly performed despite a lack of evidence (N Engl J Med. 2010;362:283-285).

The content of the Choosing Wisely lists is intended to reduce waste and overuse in the American healthcare system.

The new recommendations from ASTRO have some teeth in them, Dr. Lawton noted. "Some of the recommendations will result in less revenue for a practice."

Proton Therapy

No major radiation oncology meeting would be complete without research on its most controversial modality — proton-beam therapy.

The ASTRO meeting will prominently feature 2 presentations on the use of proton therapy in children, which has not been controversial, compared with its use in adults, especially those with prostate cancer.

One study compares the cost-effectiveness of proton therapy with that of photon therapy in the management of pediatric medulloblastoma (abstract 10). In the other, researchers will report on survival and cognitive and endocrine outcomes for children with intracranial ependymoma (abstract 2188).

"Proton therapy has been proven to be exceedingly important in certain pediatric malignancies," said Dr. Lawton.

"We have to further study proton therapy in other tumors to learn more about efficacy and cost-effectiveness," she noted.

Dr. Lawton reports receiving honoraria from Elsevier, the publishing company.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.