A PATIENT-FOCUSED ORGANIZATION
COLORECTAL CANCER TREATMENT & CLINICAL RESEARCH UPDATES
Month Ending November 12, 2020
The following colorectal cancer treatment and research updates extend from October 15th to November 12th, 2020, inclusive and are intended for informational purposes only.
This content is not intended to be a substitute for professional medical advice. Always consult your treating physician or guidance of a qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional or delay in seeking it because of something you have read on this website.
CONTENT
- Phase II LEAP Clinical Trial to Treat mCRC
- Health Canada approves VITRAKVI (Larotrectinib), first tumour agnostic cancer treatment for advanced solid tumours harbouring an NTRK gene fusion
- A Phase II, Open-Label, Multicentre, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population
- Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin: Both in Combination with 5FU, Oxaliplatin, and Bevacizumab in Patients with Advanced Colorectal Cancer
- Key Takeaways From ESMO: CRC
- Selecting the Best Treatment Option for Patients With MSI–High mCRC
- More Data Tie Statin Use to Lower CRC Risk
- Anti-KRAS for CRC; Do Heart Meds Boost Cancer Treatment
- Treating CRC with Immunotherapy: Implications for Single versus Combination Therapy
- Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program – Sunnybrook Hospital
- Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases
- Surgical Skill in Colectomy Linked with Long-Term Survival
- Outcomes of Laparoscopic Surgery for CRC in Elderly Aged Over 80 Years Old Versus Non-Elderly
- Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer
- FIT Could Accurately Rule Out CRC in Symptomatic Patients
- Updated CRC Screening Guidelines
- Young Adult Colorectal Cancer Clinic Available at Sunnybrook Hospital
- CADTH Recognizes Outstanding Leaders in HTA
- Can a Healthier Diet Affect Survival in Patients with mCRC?
- COVID-Related Delays to CRC Screening Causing 11.9% Rise in Death Rates
- FDA OKs Remdesivir, First Drug for COVID-19
- Coronavirus Vaccine Produces Immune Response Among Adults
- Regeneron Antibody Cocktail Cuts COVID-19 Viral Load, ‘Medical Visits’
- Toronto cancer surgeon warns Ontario hospitals are at a ‘tipping point’
- Daily Roundup of News on COVID-19
- Fauci, NIAID Look to Past to Inform Future of COVID-19 Therapies
- Researchers Think They May Know Cause of Long-Haul COVID-19
- Frequently Asked Questions for COVID-19
DRUGS / SYSTEMIC THERAPIES
- Phase II LEAP Clinical Trial For mCRC (Mar.01/20)
The purpose of this study is to determine the safety and efficacy of combination therapy with pembrolizumab (MK-3475) and Levantine (E7080/MK-7902) in patients with triple-negative breast cancer (TNBC), ovarian cancer, gastric cancer, colorectal cancer (CRC), glioblastoma (GBM), or biliary tract cancers (BTC). Participants will be enrolled in initial tumor-specific cohorts, which will be expanded if adequate efficacy is determined. The trial is available at the Odette Cancer Centre and at the Princess Margaret Cancer Centre in Toronto as well as the following Centres throughout Canada: Abbotsford, BC; Winnipeg, MB; CHU de Quebec. For information, visit the link below.
- Health Canada Approves VITRAKVI (Larotrectinib), First Tumour Agnostic Cancer Treatment For Advanced Solid Tumours Harbouring an NTRK Gene Fusion (Mar.05/20)
Bayer announced that there is now a treatment in Canada for tyrosine receptor kinase fusion protein-driven childhood and adult cancers. Neurotrophic Tyrosine Receptor Kinase (NTRK) gene fusions can result in the production of TRK fusion proteins that can lead to uncontrolled cell growth and cancer. Health Canada issued a Notice of Compliance with Conditions (NOC/c) for VITRAKVI® (Larotrectinib). VITRAKVI® is approved for the treatment of adult and pediatric patients with solid tumours that have an NTRK gene fusion without a known acquired resistance mutation, are metastatic or where surgical resection is likely to result in severe morbidity and have no satisfactory treatment options. Treatment with VITRAKVI® should be initiated following confirmation of an NTRK gene fusion in a tumour specimen using a validated test.
This is the first time Health Canada has approved a tumour agnostic treatment, such that patients with advanced solid tumours harbouring an NTRK gene fusion may be eligible for treatment with VITRAKVI®, across multiple tumour types and ages. VITRAKVI® is a first-in class oral and highly selective TRK inhibitor that may shrink the tumour or may slow or stop it from growing. In the clinical trials that were the basis for this approval, TRK fusion cancer patients treated with Larotrectinib experienced clinical benefit across numerous tumour types, including lung, thyroid, melanoma, GIST (gastrointestinal stromal tumour), colon, soft tissue sarcoma, salivary gland, and infantile fibrosarcoma. The overall response rate (ORR) was 75% (95% CI, 64%, 85%) with 22% of patients experiencing a complete response (CR) to treatment. The ORR observed was 90% in pediatrics and 69% in adults, and responses were rapid and durable.
What is TRK Fusion Cancer?
TRK fusion cancer is rare and occurs when an NTRK gene fuses with another unrelated gene, producing a TRK fusion protein that becomes constitutively active or overexpressed, triggering a signaling cascade. These TRK fusion proteins act as oncogenic drivers promoting cell growth and survival, leading to TRK fusion cancer, regardless where it originates in the body. TRK fusion cancer is not limited to certain types of tissues and can occur in any part of the body. TRK fusion cancer occurs in various adult and pediatric solid tumours with varying frequency, including lung, thyroid, gastrointestinal cancers (colon, cholangiocarcinoma, pancreatic and appendiceal), sarcoma, CNS cancers (glioma and glioblastoma), salivary gland cancers (mammary analogue secretory carcinoma) and pediatric cancers (infantile fibrosarcoma and soft tissue sarcoma). TRK fusion proteins are rare in common cancers (such as colorectal cancer) and common in rare cancers.
NB: The pan Canadian Oncology Drug Review Expert Committee (pERC) has recently issued a funding recommendation in respect of Larotrectinib. It conditionally recommends the reimbursement of Larotrectinib (Vitrakvi) for the treatment of adult and pediatric patients with locally advanced solid tumors that have an NTRK gene fusion This recommendation pertains only to adult and pediatric patients with salivary gland tumours, adult or pediatric patients with soft tissue sarcoma (STS) and pediatric patients with cellular congenital mesoblastic nephroma or infantile fibrosarcoma, without a known acquired resistance mutation, that are metastatic or where surgical resection is likely to result in severe morbidity and have no satisfactory treatment options, only if the following conditions are met:
- Cost-effectiveness being improved to an acceptable level
- Feasibility of adoption (budget impact and access to testing) is addressed
Stay tuned as the expert committee is currently reviewing feedback submissions from various stakeholders.
Please note: the expert review committee has as of October 31st, 2019 issued a final negative funding recommendation in respect of Larotrectinib. Efforts are currently underway to assemble a massive campaign to address this final recommendation by working to secure a sustainable, long-term funding solution for TRK fusion cancer patients.
Bayer’s Commitment
- Bayer has launched a testing program called FastTRK. As per an information sheet that may be obtained from CCRAN, FastTRK is a clinical testing program for the diagnosis of NTRK gene fusions. Sponsored by Bayer, this is a complimentary service for clinicians to determine whether their patients’ cancer has an NTRK gene fusion. Solid tumour samples from eligible patients (in the form of a solid tumour block or prepared slides) will be tested by immunohistochemistry (IHC) and/or next-generation sequencing (NGS). Currently, Bayer has partnered with Life Labs and the Kingston Health Sciences Centre (KHSC) to provide NTRK gene fusion testing services for Canadians. The FastTRK program will be supported at least until the end of 2021.
- Bayer will continue to offer the therapy to patients who are identified to have TRK fusion cancers and who are responding to the therapy.
- Bayer will provide a TRAKTION Patient Support Program to assist patients while on the therapy.
https://www.bayer.ca/en/media/news/?dt=TmpBPQ==&st=1
- A Phase 2, Open-label, Multicenter, Study of an Immunotherapeutic Treatment for the MSI High Colorectal Cancer Metastatic Population (Oct.01/20)
The purpose of this study is to look at the effectiveness of the vaccine DPX-Survivac in combination with the drugs cyclophosphamide and the immunotherapy Pembrolizumab in patients with solid cancers who are identified to be MSI-High. All patients will receive combination therapy of DPX-Survivac, cyclophosphamide, and pembrolizumab. Patients participating will know which treatment they are receiving. The trial is currently hosted at the Odette Cancer Centre, and a new site is opening at Mt. Sinai Hospital.
- Phase III Study at the Odette Cancer Centre Comparing Arfolitixorin vs. Leucovorin in Combination with 5FU, Oxaliplatin and Bevacizumab in Patients with Advanced Colorectal Cancer (Oct.01/20)
The purpose of this study is to look at the effectiveness of the drug Arfolitixorin in combination with 5-fluorouracil (5FU), oxaliplatin, and bevacizumab in patients with colorectal cancer. Patients with advanced/metastatic colorectal cancer who meet certain criteria may be able to participate. There will be two groups of patients participating in this study;
- one group will receive Arfolitixorin in combination with 5FU), oxaliplatin, and bevacizumab,
- while the other group will receive the drug Leucovorin in combination with 5FU, oxaliplatin, and bevacizumab (standard of care).
The doctor and study staff will not know which group a patient is in. Patients will be randomized to receive one treatment or the other.
About Arfolitixorin:
Arfolitixorin is Isofol’s proprietary drug candidate being developed to increase the efficacy of standard of care chemotherapy for advanced colorectal cancer. The drug candidate is currently being studied in a global Phase 3 clinical trial. As the key active metabolite of the widely used folate-based drugs, arfolitixorin can potentially benefit all patients with advanced colorectal cancer, as it does not require complicated metabolic activation to become effective.
Treating cancer patients with arfolitixorin – The goals:
- When treating colorectal cancer, for example, arfolitixorin is administered in combination with 5-FU to increase cell mortality in circulating cancer cells and in cancerous tumours.
• Arfolitixorin is administered in conjunction with rescue therapy after high-dose treatment with the cytotoxic agent, methotrexate, in order to suppress the cytotoxic effect in surrounding healthy tissue. The treatment is used for certain types of cancer, such as osteosarcoma, a type of bone cancer. This involves administering arfolitixorin separately, 24 hours after the chemotherapy.
https://sunnybrook.ca/trials/item/?i=293&page=49335 and https://clinicaltrials.gov/ct2/show/NCT03750786
(https://isofolmedical.com/arfolitixorin/ )
- Key Takeaways From ESMO: CRC – Immunotherapy (Pembrolizumab) and ideal duration of adjuvant therapy (Oct.14/20)
In a video attached in the link below, Dr. Axel Grothey, MD, Director, GI Cancer Research, West Cancer Center, Germantown, Tennessee, discussed a few practice updates with regard to colorectal cancer (CRC) presented at the ESMO 2020 virtual meeting.
One point he noted was the quality of life analysis of KEYNOTE-177 phase 3 study, testing pembrolizumab versus standard of care in MSI-high/MMR-D CRC patients. He mentioned “patients who received pembrolizumab had improved quality of life (QoL) over time, whereas patients on systemic chemotherapy, QoL from cycle to cycle went down a bit so that the gap between these patients, between pembrolizumab and chemotherapy actually got wider over time in their QoL parameter assessment”. Reassuringly, efficacy endpoint has been met, response rate, progression-free survival higher with pembrolizumab, and QoL endpoint has been met. This has become a new standard of care, which the FDA already acknowledged by approving pembrolizumab in first line, MSI-high/MMR-D CRC.
Another piece he mentioned was an interesting analysis of the Italian TOSCA study, which was part of the IDEA collaboration, investigating the optimum duration of therapy, 3 versus 6 months, of oxaliplatin-based treatment. They looked at an analysis of efficacy and treatment compliance, side effects in elderly patients (over 70) and younger patients. They found that patients who are older were less able to have the same dose intensity of their treatment, there were more frequent interruptions, dose reductions, etc. They also found that the efficacy in terms of outcomes in disease-free survival were mitigated for patients who are older compared to younger patients, meaning over 70, and under 70. When they adjusted for the factors mentioned, treatment interruptions, dose compliance, etc., there was no difference in disease-free survival outcome, meaning patients who were able to have the same dose intensity, treatment compliance, etc., when they were older, had the same outcome as patients who were younger.
Grothey said “[his] approach for patients who are over 70 years of age, where we don’t really even know about whether oxaliplatin actually improves outcomes, improves disease-free survival and overall survival, is that the biologic age is more important than the passport age, that we have to carefully select our patients who are candidates for oxaliplatin-based regimen”. “Having said that, now with the trend toward using shorter duration of treatment, it makes it easier for us to often kind of keep the dose intensity of these agents, even in elderly patients, because it’s easier to keep the dose intensity for three months than for six months,” he added.
He concluded by stating “when patient expectations are different, and I do believe that for the majority of patients who are considered candidates for oxaliplatin-based therapy, when they’re older than 70, three months of CAPOX is the one standard of care in the adjuvant treatment for patients with stage 3 disease”.
https://www.practiceupdate.com/content/key-takeaways-from-esmo-colorectal-cancer/107747
- Selecting the Best Treatment Option for Patients With MSI–High mCRC (Oct.21/20)
The treatment of mismatch repair–deficient (MMR-D) and microsatellite instability–high (MSI-H) metastatic colorectal cancer (mCRC) has changed dramatically in the last 3 years. Due to the high tumor mutational burden and immunogenicity of MMR-D or MSI-H patients, immunotherapy has shown significant efficacy compared with microsatellite-stable mCRC, where the effective response rate to immune checkpoint therapy is 0%. The highly anticipated preliminary results of the KEYNOTE-177 trial presented during the ASCO20 Virtual Scientific Program are practice-changing and have established immunotherapy as the frontline therapy for MMR-D and MSI-H mCRC.
KEYNOTE-177 is a large, randomized phase III study evaluating pembrolizumab against standard-of-care chemotherapy, which was provider’s choice FOLFOX or FOLFIRI with or without cetuximab or bevacizumab. Patients treated with pembrolizumab had a median progression free survival (PFS) of 16.5 months compared with 8.2 months for patients treated with standard chemotherapy. The median duration of response in the pembrolizumab arm not yet reached, compared with 10.6 months for patients receiving chemotherapy. Safety data from the study are also supportive of pembrolizumab, with far fewer grade 3 to 5 adverse events compared with chemotherapy (22% vs. 66%). These results strongly suggest that pembrolizumab should be used in the frontline setting for this patient population. Overall survival (OS) data are yet to be presented for KEYNOTE-177.
The CheckMate-142 trial is an ongoing, phase II, multicohort study evaluating the efficacy and safety of nivolumab with or without a relatively low dose of ipilimumab. The combination of the two, as well as single-agent nivolumab, have both shown efficacy and safety in later lines of treatment of MMR-D and MSI-H mCRC. High response rates have been seen in a small single-arm trial with the combination of nivolumab and ipilimumab, with an overall response rate of 69% and disease control rate of 84%. The combination also appeared to be similarly well tolerated, with the lower dose of ipilimumab seeming to confer less risk of toxicity than typical combination regimens.
Overall, the results of KEYNOTE-177 are practice changing, and patients with dMMR/MSI-H mCRC should be treated with pembrolizumab in the frontline setting because of the improved PFS, response rate, and lower overall toxicity.
https://dailynews.ascopubs.org/do/10.1200/ADN.20.200348/full/
- More Data Tie Statin Use to Lower CRC Risk (Oct.26/20)
Statins conferred an estimated 20% reduction in the risk of colorectal cancer (CRC) with a possibly larger impact in patients with inflammatory bowel disease, according to an analysis presented during ACG 2020 Virtual. In a meta-analysis, the pooled odds ratio (OR) was 0.80 for CRC in the general population without inflammatory bowel disease (IBD). Risk reduction rose to 60% in the high-risk population of IBD patients, but prospective randomized trials are needed to confirm the finding.
What are statins?
Statins are a class of drugs that can lower cholesterol levels in the blood. They work by blocking a substance your body needs to make cholesterol. By lowering the levels, they help prevent heart attacks and stroke. These drugs may also help stabilize the plaques on blood vessel walls and reduce the risk of certain blood clots.
Finding a safe and effective chemopreventive agent may add to the effectiveness of current CRC preventive strategies. Statins are the most prescribed medications worldwide and are generally well-tolerated. Although the study is novel in evaluating the use of statins in reducing CRC, it is hypothesis generating, and statins should not be prescribed specifically for chemoprevention based on this meta-analysis.
Some earlier data from individual studies have suggested that statins offer no benefit and may even be harmful in CRC. A recent population study from Spain found no significant CRC risk reduction with statin use. To revisit this issue, researchers conducted an analysis including 52 studies with a total of 11,459,306 patients, of whom 2,123,293 used statins and 9,336,013 did not. A separate analysis to examine the CRC and statin use in IBD populations included five observational studies comprising 15,342 IBD patients, of whom 1,161 were statin users and 12,145 were not. Again, statin use was associated with a significant risk reduction in IBD patients.
In terms of future cancer prevention, statins might be started in people in their 40s and 50s when the risk of CRC rises. Dose would likely be lower than that for people taking statins to lower cardiovascular risk, and would be determined after assessment by a primary care physician.
https://www.medpagetoday.com/meetingcoverage/acg/89323
https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/statins/art-20045772 https://www.healio.com/news/gastroenterology/20201027/statins-linked-to-20-lower-colorectal-cancer-risk
Image Source: https://www.healthydaes.com/blog/2015/3/15/can-statin-drugs-increase-your-risk-for-diabetes
- Anti-KRAS therapy for mCRC; Do Heart Meds Boost Cancer Tx? (Oct.28/20)
More than 90% of patients with metastatic lung or metastatic colorectal cancer (CRC) benefited from treatment with an investigational KRAS inhibitor (adagrasib). A study showed that 3 of 18 (17%) patients with previously treated advanced CRC responded to adagrasib, and 17 of 18 (94%) derived clinical benefit. Additionally, four of six evaluable patients with other advanced solid tumors had objective responses (confirmed and unconfirmed). The most commonly reported treatment-related adverse events (TRAEs) were diarrhea, nausea, vomiting, fatigue, and elevated liver enzymes (ALT). In some patients with the KRAS G12C mutation, the tumor size decreased, and this shrinkage was durable, with some evaluable patients still on treatment after 11 months.
https://www.medpagetoday.com/oncology/lungcancer/89365
- Treating CRC with Immunotherapy: Implications for Single versus Combination Therapy (Nov.02/20)
One of the promising current interventions for colorectal cancer (CRC) is immunotherapy that relies on harnessing the body’s immune mechanisms to kill the cancer cells. The aim of this review is to highlight the implications of single versus combination immunotherapy and identify the molecular features and mutations that enhance or deter responsiveness. Based on current findings, responsiveness is associated with mismatch repair deficient (MMR-D) genes or presence of microsatellite instability (MSI-high), with high immunoscore and tumor-mutational burden contributing to better efficacy while BRAF mutation conferring no significant effect. Combination immunotherapy demonstrates better efficacy in treating MSI-high CRC compared to single agent immunotherapy or chemotherapy. Given improved responsiveness and overall survival, there is a potential for immunotherapy to change the standard of care for metastatic CRC. Furthermore, stratifying the patients by their molecular features and mutation status is critical for establishing care.
SURGICAL THERAPIES
- Hepatic Artery Infusion Pump (HAIP) Chemotherapy Program — Sunnybrook Odette Cancer Centre (July 16/20)
The HAIP program is a first-in-Canada for individuals where colon or rectal cancer (colorectal cancer) has spread to the liver and cannot be removed with surgery. The program involves a coordinated, multidisciplinary team approach to care, with close collaboration across surgical oncology, medical oncology (chemotherapy), interventional radiology, nuclear medicine, and oncology nursing. The Hepatic Artery Infusion Pump (HAIP) is a small, disc-shaped device that is surgically implanted just below the skin of the patient and is connected via a catheter to the hepatic (main) artery of the liver. About 95 percent of the chemotherapy that is directed through this pump stays in the liver, sparing the rest of the body from side effects. Patients receive HAIP-directed chemotherapy in addition to regular intravenous (IV) chemotherapy (systemic chemotherapy), to reduce the number and size of tumours. Drs. Paul Karanicolas and Yooj Ko are the program leads and happy to see patients eligible for the therapy.
Presently at Sunnybrook Odette Cancer Centre, HAIP is being used in patients with colorectal cancer that has spread to the liver that cannot be removed surgically and has not spread to anywhere else in the body. Patients who have few (1-5) and very small tumors in the lungs may be considered if the lung disease is deemed treatable prior to HAIP. If you believe you may benefit from this therapy and/or would like to learn more about the clinical trial, your medical oncologist or surgeon may fax a referral to 416-480-6179. For more information on the HAIP clinical trial, please click on the link provided below.
http://sunnybrook.ca/content/?page=colorectal-colon-bowel-haip-chemotherapy
- Living Donor Liver Transplantation for Unresectable Colorectal Cancer Liver Metastases (July 12/20)
Approximately half of all colorectal cancer (CRC) patients develop metastases, commonly to the liver and lung. Surgical removal of liver metastases (LM) is the only treatment option, though only 20-40% of patients are candidates for surgical therapy. Surgical therapy adds a significant survival benefit, with 5-year survival after liver resection for LM of 40-50%, compared to 10-20% 5-year survival for chemotherapy alone. Liver transplantation (LT) would remove all evident disease in cases where the colorectal metastases are isolated to the liver but considered unresectable.
Image Source: https://www.slideshare.net/AhmedAdel65/preoperative
While CRC LM is considered a contraindication for LT at most cancer centers, a single center in Oslo, Norway demonstrated a 5-year survival of 56%. A clinical trial sponsored by the University Health Network in Toronto will offer live donor liver transplantation (LDLT) to select patients with unresectable metastases limited to the liver and are non-progressing on standard chemotherapy. Patients will be screened for liver transplant suitability and must also have a healthy living donor come forward for evaluation. Patients who undergo LDLT will be followed for survival, disease-free survival, and quality of life for 5 years and compared to a control group who discontinue the study before transplantation due to reasons other than cancer progression. Despite the trial’s negative outcome, investigation of HIPEC, and other strategies to prevent peritoneal metastasis, should continue, they concluded in Lancet Gastroenterology & Hepatology. “The 21% peritoneal recurrence noted in the overall study population indicates the magnitude of the clinical problem in locally advanced colon cancer, and therapeutic strategies have to be further explored,” they said. “Outcomes of other trials investigating adjuvant HIPEC are eagerly awaited.”
https://clinicaltrials.gov/ct2/show/NCT02864485
- Surgical Skill in Colectomy Linked with Long-Term Survival (Oct.30/20)
Surgeons’ technical skill at performing colectomy for colon cancer was associated with long-term survival outcomes, researchers said. A recent study showed that those surgeons who ranked in the top third of skill level had the highest overall survival (OS) for patients, even after adjustment for patient characteristics. This association persists when excluding early post-operative deaths, suggesting that these findings are not solely attributable to mortality from surgical complications. ”This is an important study that begins to show that cancer surgery is more nuanced than just getting the tumor out — technique matters. In fact, surgical technique impacts the long-term survival of our colon cancer patients”, said Elizabeth Wick, MD, of University of California San Francisco.
In the study, 15 surgeons from 11 hospitals submitted a video of laparoscopic right hemicolectomy. The surgeon skill was reviewed and assessed by 12 or more surgeons, including two experts at video review. Outcomes for participating surgeons were drawn from 609 patients who underwent minimally invasive surgery for stage I to III epithelial-origin colon cancer from the National Cancer Database between 2012 and 2017. The 5-year OS was 79% for those who had surgery performed by high-skill surgeons, 55% for medium-skill surgeons, and 60% for low-skill surgeons. Each 0.1-point skill score increment was associated with higher likelihood of the patient’s survival. When assessing outcomes by cancer stage, the association between surgeon skill and outcomes was most evident among patients with stage II disease.
If surgeons want to continue to improve patient outcomes, Wick said, “We, as a surgical profession, need to come together and develop real mechanisms to evaluate and support a surgeon’s technical skills over the course of a 30-year career.”
https://www.medpagetoday.com/hematologyoncology/coloncancer/89414
Image Source: https://www.mayoclinic.org/tests-procedures/colectomy/multimedia/right-hemicolectomy/img-20007591
- Outcomes of Laparoscopic Surgery for CRC in Elderly Aged Over 80 Years Old Versus Non-Elderly (Nov.04/20)
Recently, colorectal cancer (CRC) has increased in elderly patients worldwide, with laparoscopic colorectal surgery increasing in elderly patients with CRC. This study aimed to verify safety and curability of laparoscopic colorectal surgery in elderly patients ≥80 years old. Patients undergoing curative colorectal surgery from 2006 to 2014 were enrolled and classified into the laparoscopic surgery in elderly patients aged ≥80 years (LAC-E) group, open surgery in elderly patients (OC-E) group, and laparoscopic surgery in non-elderly patients (LAC-NE) group. Short- and long-term outcomes were compared between these groups.
The LAC-E, OC-E, and LAC-NE groups comprised 85, 25, and 358 patients, respectively. Intraoperative blood loss and incidence of postoperative complications were significantly lower in the LAC-E versus OC-E group. Long-term outcomes were not different between these two groups. Operation time was significantly shorter in the LAC-E versus LAC-NE group. Intraoperative blood loss and postoperative complications were similar between the groups. Although the 5-year overall survival rate in the LAC-E group was lower than that in the LAC-NE group, there was no difference in 5-year disease-specific survival between the groups.
Laparoscopic colorectal surgery is safe for CRC in the elderly as well as the non-elderly and can be an optimal procedure for CRC in the elderly.
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01779-2
Image Source: https://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/cancer/laparoscopic_surgery.jpg
RADIATION THERAPIES/INTERVENTIONAL RADIOLOGY
- Study Offered at the Odette Cancer Centre to Treat Recurrent Rectal Cancer (Mar.12/20)
Magnetic resonance-guided focused ultrasound (MRg-FU) is a lessinvasive, outpatient modality being investigated for the thermal treatment of cancer. In MRg-FU, a specially designed transducer is used to focus a beam of low-intensity ultrasound energy into a small volume at a specific target site in the body. MR is used to identify and delineate the tumour, focus the ultrasound beam on the target, and provide a real-time thermal mapping to ensure accurate heating of the designated target with minimal effect to the adjacent healthy tissue. The focused ultrasound beam produces therapeutic hyperthermia (40-42°C) in the target field, causing protein denaturation and cell damage. Currently, there is no prospective clinical data reported on the use of MRg-FU in the setting of recurrent rectal cancer. Recurrent rectal cancer is a vexing clinical problem. Current retreatment protocols have limited efficacy. The addition of hyperthermia to radiation and chemotherapy may enhance the therapeutic response. With recent advances in technology, the investigators hypothesize that MRg-FU is technically feasible and can be safely used in combination with concurrent reirradiation and chemotherapy for the treatment of recurrent rectal cancer without increased side-effects. The study is being offered at the Odette Cancer Centre. Here is the link to the study protocol:
SCREENING
- 15. FIT Could Accurately Rule Out CRC in Symptomatic Patients (Oct.22/20)
Fecal immunochemical testing (FIT) could be used to rule out colorectal cancer (CRC) in patients with suspected symptoms and fast-track those needing urgent care. In an analysis of almost 10,000 patients referred to a specialist for suspected CRC symptoms that met criteria for urgent care, FIT sensitivity was maximized to 97.0% at the lowest fecal hemoglobin concentration cutoff of 2 µg/g (microgram/gram). CRC and other serious bowel diseases are more likely at higher fecal hemoglobin concentrations. A negative FIT result at this cutoff can effectively rule out CRC and a positive FIT result is better than symptoms to select patients for urgent investigations. There was no significant variation found in FIT’s ability to detect CRC by patient or tumor characteristics, including age, sex, ethnicity, income, or iron-deficiency anemia.
The findings follow a recent modeling study from England which concluded that FIT could prioritize symptomatic primary-care patients for colonoscopy and circumvent delays caused by the COVID-19 pandemic. Results suggest a role for FIT in patients with symptoms such as rectal bleeding and anemia that may prompt evaluation for cancer with colonoscopy. While the findings show promise, particularly in the era of COVID-19 when cancer screenings have often been deferred, researchers urged caution in the evaluation of FIT sensitivity and the local prevalence of CRC. In the U.K., the National Institute for Health and Care Excellence (NICE) recommends FIT to guide referral of patients with low-risk bowel symptoms, at a fecal hemoglobin concentration cutoff of 10 μg/g, but it has not recommended it for all symptomatic patients owing to concerns about the quality and power of previous studies.
https://www.medpagetoday.com/gastroenterology/coloncancer/89273
Image Source: http://agaperspectives.gastro.org/colonoscopy-better-choice-fit-opportunistic-crc-screening/#.X6xwrC3My9Y
- Updated CRC Screening Guidelines in the U.S. (Oct.27/20)
The U.S. Preventive Services Task Force (USPSTF) released a new draft colorectal cancer (CRC) screening recommendation, lowering the age for average-risk adults to begin screening from 50 to 45. These changes come in response to scientific studies that show the rates of CRC continue to increase among younger adults. The draft recommendation will undergo further review before it’s finalized, but the lower screening age is consistent with the change the American Cancer Society made to their CRC screening guidelines in 2018.
Black Americans are more likely to be diagnosed with and die from CRC than other ethnicities. While there are many reasons for this, several studies have identified lower screening rates among Black Americans as an important factor. The USPSTF has already recommended that Black Americans start colorectal cancer screening at age 45, a younger age than the general population, in an effort to decrease the disparities seen. Yet, they have now reinforced this recommendation and extended it to everyone.
Portions of younger patients (under 45) with CRC have a hereditary condition or other medical conditions that increase their risk of this disease. So, it’s important to know your family history and understand associated cancer risks. Younger adults should also look out for symptoms that may be consistent with CRC, such as pain, bleeding, altered bowel habits or changes in stool patterns. Finally, maintain a healthy lifestyle to minimize your CRC risk. Healthy lifestyle behaviours include eating a plant-based diet, getting regular exercise, maintaining a healthy weight, and avoiding tobacco use and excessive alcohol consumption.
What should people know about colorectal cancer screening during the COVID-19 pandemic?
First, know that it’s safe to schedule your recommended cancer screenings now. It’s important to understand that getting your screenings on time can help ensure you get a diagnosis earlier, enabling physicians to diagnose cancers or precancerous at the earliest stages, when they are more treatable or curable. Also, learn about the different screening tests that are available. Some stool-based tests can be done at home and do not require an office procedure, but a colonoscopy is the gold standard.
OTHER
- Young Adult Colorectal Cancer Clinic Available at Sunnybrook (Mar.12/20)
A recent study led by the University of Toronto doctors has observed a rise in colorectal cancer rates in patients under the age of 50. The study mirrors findings from the U.S., Australia and Europe. The growing colorectal cancer rates in young people come after decades of declining rates in people over 50, which have occurred most likely due to increased use of colorectal cancer screening (through population-based screening programs) which can identify and remove precancerous polyps. Patients diagnosed under the age of 50 have a unique set of needs, challenges and worries. They are unlike those diagnosed over the age of 50. Dr. Shady Ashamalla (colorectal cancer surgical oncologist), and his team at the Sunnybrook Health Sciences Centre understand the needs of this patient population.
Dr. Ashamalla belongs to a multidisciplinary team of experts in the Young Adult Colorectal Cancer Clinic who will work with young colorectal cancer patients, regardless of disease stage, to create an individualized treatment plan to support each patient through their cancer journey. Their needs and concerns will be addressed as they relate to:
- Fertility concerns and issues
- Young children at home
- Dating/intimacy issues
- Challenges at work
- Concerns about hereditary cancer
- Relationships with family and friends
- Psychological stress due to any or all of the above
The team of experts consists of:
- Oncologists (medical, surgical, radiation)
- Social workers
- Psychologists
- Geneticists
- Nurse navigator
Should a patient wish to be referred to Sunnybrook, they may have their primary care physician, or their specialist refer them to Sunnybrook via the e-referral form, which can be accessed through the link appearing below. Once the referral is received, the Young Adult Colorectal Cancer Clinic will be notified if the patient is under the age of 50. An appointment will then be issued wherein the patient will meet with various members of the team to address their specific set of concerns.
http://sunnybrook.ca/content/?page=young-adult-colorectal-cancer-clinic
- CADTH Recognizes Outstanding Leaders in HTA (Nov.09/20)
Today CADTH (Canadian Agency for Drugs and Technologies in Health) presented Recognition Awards to two scientists to honour their exceptional contributions to the field of health technology assessment (HTA) — one as a pioneer who has pushed the boundaries of economic evaluation in child health and the other as a rising star who is advancing the use of real-world evidence in drug funding decisions in Canada.
Dr. Kelvin Chan received the Dr. Maurice McGregor Award, which honours rising stars early in their careers. Dr. Chan is widely known as a skilled and compassionate medical oncologist at the Sunnybrook Odette Cancer Centre, and a highly accomplished scientist and methodologist. He co-leads the Canadian Centre for Applied Research in Cancer Control (ARCC), a network devoted to health outcomes and economic research, and he launched the Canadian Real-World Evidence for Value of Cancer Drugs collaboration to develop a framework generating and using real-world evidence for cancer drug funding decisions. Dr. Chan is also an Associate Professor at the University of Toronto and an Associate Scientist at the Sunnybrook Research Institute.
NUTRITION/HEALTHY LIFESTYLE
- Can a Healthier Diet Affect Survival in Patients with mCRC? (Oct.30/20)
A prospective study examining links between diet quality and survival of patients with metastatic colorectal cancer (mCRC) found no link between diet at the initiation of first-line treatment and overall survival (OS). Erin Van Blarigan, ScD, of the University of California San Francisco, and colleagues assessed “validated food frequency” questionnaires completed by 1,284 of 2,334 patients (55.0%) with mCRC enrolled in the Cancer and Leukemia Group B (Alliance)/Southwest Oncology Group 80405 trial.
The results found no significant association in OS and any of five dietary patterns:
Alternative Healthy Eating Index (AHEI)
- Scored from 0 to 110
- Based on vegetables (excluding potatoes), fruits, whole grains, nuts and legumes, long-chain n-3 fatty acids, polyunsaturated fatty acids, sweetened beverages and juice, red and processed meat, trans fat, sodium, and alcoholic drinks
Alternative Mediterranean Diet (AMED)
- Scored from 0 to 9
- Based on vegetables, fruits, nuts, whole grains, legumes, fish, ratio of monounsaturated to saturated fat, red and processed meat, and alcohol
Dietary Approaches to Stop Hypertension (DASH) Diet
- Scored from 0 to 45
- Based on fruits, vegetables, nuts and legumes, low-fat dairy, whole grains, sodium, sweetened beverages, red and processed meats, and sweets and desserts
The Western Dietary Pattern
- Characterized by higher intake of dairy, refined grains, condiments, red meat, and sweets and desserts
The Prudent Dietary Pattern
- Characterized by high intake of vegetables, legumes, and fruit
Overall, none of the diet scores or patterns examined were associated with survival in mCRC, the investigators reported. “We observed an inverse association between the AMED score and risk of death, but point estimates were not statistically significant. Additionally, the Western diet pattern was associated with longer survival in individuals with KRAS variant tumors but not those with wild-type tumors,” the team noted. Cindy Kin, MD, MS, of Stanford University School of Medicine in California, pointed out that although a Western diet, high in red meat and saturated fats, has been linked to the development of CRC, the new study addresses the less well-studied area of diet quality and outcomes in CRC, particularly for those with metastatic disease. More studies are necessary for understanding the associations of diet with outcomes during and after treatment.
https://www.medpagetoday.com/hematologyoncology/coloncancer/89408
COVID-19 UPDATES
- COVID-Related Delays to CRC Screening Causing 11.9% Rise in Death Rates (Oct.12/20)
New research presented at UEG Week Virtual 2020 has shown that delays in colorectal cancer (CRC) screening caused by COVID-19 has resulted in significantly increased death rates.
Researchers at the University of Bologna found that moderate (7-12 months) and large (>12 months) delays in screening caused a 3% and 7% increase in advanced stage CRC respectively. Based on survival rates at five years for stage III-IV CRC, the results showed an 11.9% increase in deaths when comparing a zero-to three-month delay to a >12 month delay.
Lead author of the study, Professor Luigi Ricciardiello, says, “Around the globe, healthcare systems are facing serious difficulties while dealing with COVID-19 and it is imperative that support is given to the public and patients throughout the crisis, including for high-impact diseases such as colorectal cancer. Healthcare authorities need to act urgently on how they reorganize activities during COVID-19, without compromising the diagnosis of other high-impact diseases like this research shows.”
Screening aids the early detection of CRC, and since the rollout of screening programs across Europe there has been a steady decline in mortality rates. However, since the start of the pandemic, screening programs have been suspended in many areas across Europe. “Early-stage diagnosis of colorectal cancer is crucial—it’s far easier to treat and enhances optimal patient outcomes,” adds Professor Ricciardiello. “It is therefore essential that vital diagnosis tools, like screening programs, continue and help to prevent mortality rates from rising even further.”
https://medicalxpress.com/news/2020-10-covid-related-colorectal-cancer-screening-death.html
- FDA OKs Remdesivir, First Drug for COVID-19 (Oct.22/20)
The FDA approved remdesivir (Veklury) on Thursday for treating hospitalized COVID-19 patients. Remdesivir, an antiviral that works by limiting SARS-CoV-2 replication, is indicated for hospitalized patients age 12 and up (and at least 88.2 lbs). Remdesivir should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care.
Approval was based on three randomized trials, including the National Institutes of Health-led ACTT-1 trial, a phase III trial that showed that patients with mild, moderate, and severe disease who were treated with up to 10 days of remdesivir recovered a median 5 days quicker than those on placebo, and a median 7 days quicker in those requiring oxygen at baseline. Fewer patients on oxygen at baseline progressed to mechanical ventilation with remdesivir, and a trend toward lower day-29 mortality was observed with the drug. Other trials that supported approval showed that a 5-day course of the drug was roughly equivalent to a 10-day course, and that some clinical benefit was also seen in patients hospitalized with moderate illness.
Remdesivir should not be used in those allergic to the drug or any of its components. Adverse events that were more common with the drug versus placebo included nausea and increased liver enzymes, but FDA listed other possible side effects that included allergic reactions, low blood oxygen level, fever, shortness of breath, wheezing, swelling, rash, nausea, sweating, and shivering.
Therefore, the availability of a rigorously tested treatment that can significantly speed recovery and offers other benefits (i.e. lower rates of progression to mechanical ventilation) provides hospitalized patients as well as their families important hope and offers healthcare providers a critical tool as they care for patients in need.
https://www.medpagetoday.com/infectiousdisease/covid19/89281
- Coronavirus Vaccine Produces Immune Response Among Adults (Oct.26/20)
The COVID-19 vaccine being developed by the University of Oxford produces a similar immune response in both older and younger adults, and adverse responses were lower among the elderly. Immunogenicity blood tests carried out on a subset of older participants echo data released in July, which showed the vaccine generated “robust immune responses” in a group of healthy adults aged between 18 and 55. Such news that older people get an immune response from the vaccine is positive because the immune system weakens with age and older people are those most at risk of dying from the virus. The Financial Times reported earlier that the vaccine, being developed by Oxford and AstraZeneca, triggers protective antibodies and T-cells in older age groups. This Oxford/AstraZeneca vaccine is expected to be one of the first from Big Pharma to secure regulatory approval. The London hospital, receiving the first batches of the vaccine, was told to prepare from the “week commencing the 2 November.”
https://globalnews.ca/news/7421863/coronavirus-vaccine-astrazeneca-immune-response/amp/
- Regeneron Antibody Cocktail Cuts COVID-19 Viral Load, ‘Medical Visits’ (Oct.29/20)
Regeneron’s REGN-COV2 antibody combination met its primary endpoint and a key secondary endpoint in a phase II/III trial involving high-risk patients with mild to moderate COVID-19. In patients randomized to combined doses of REGN-COV2, the average daily decrease in viral load through day 7 for patients with a high viral load was 0.68 log10 copies/mL greater than in patients randomized to placebo. Viral load refers to the amount of virus in an infected person’s blood. Moreover, the two-antibody combination significantly reduced COVID-19-related “medical visits” by 57% through day 29, defined as hospitalizations, emergency room or urgent care visits, or physician office or telemedicine visits. 2.8% of patients in combined REGN-COV2 dosing groups and 6.5% of patients in placebo reported a medical visit. Regeneron also said REGN-COV2 treatment led to 72% fewer COVID-19-related medical visits among patients with more than one risk factor (such as older than age 50, cardiovascular, metabolic, lung, liver or kidney disease).
The company released descriptive data on 275 patients a month ago; the new data cover an additional 524 patients. Similar to the earlier descriptive analysis, Regeneron noted patients with a higher viral load and/or no detectable antibodies at baseline derived greater benefit from the intervention, though there was no significant virological or clinical difference with the high-dose (8 grams) group and the low dose (2.4 grams) group. They also found a higher proportion of serious adverse events in the placebo group (2.3% placebo, 1.6% low dose, 0.8% high-dose). Not surprisingly, infusion reactions were more common in the high-dose group (1.5%) versus low dose (0%) and placebo (0.4%). Regeneron said the phase III trial is continuing in non-hospitalized patients.
https://www.medpagetoday.com/infectiousdisease/covid19/89386
- Toronto cancer surgeon warns Ontario hospitals are at a ‘tipping point’ (Nov.09/20)
An Ontario cancer surgeon is sounding the alarm over hospital capacity, warning that the province’s record high COVID-19 case count has placed the healthcare system at a “tipping point” and relaxed provincial restrictions could once again lead to overwhelmed emergency rooms.
Dr. Shady Ashamalla, head of general surgery at Sunnybrook Health Sciences Centre, told CTV News Toronto that hospitals are currently in a “sweet spot” where critical surgeries are being performed, while space for COVID-19 patients is still being maintained. Ashamalla warns that the growth of cases during the pandemic’s second wave has led to anxiety among his patients, who recall the cancellation of surgeries during the first wave. “Our phone is ringing off the hook with people very anxious to have their surgery done immediately because they’re terrified that two, three, four weeks from now they won’t be able to get their operation,” he said. Already, the William Osler Health System — which encompasses hospitals in Etobicoke and Brampton — are at capacity and have begun transferring patients to other regional hospitals, which have also approached capacity.
There are currently 374 novel-coronavirus patients in the province’s hospitals, far below the 1,043 patients who were hospitalized during the peak of the first wave. Over the weekend, the Ford government implemented a new colour-coded COVID-19 chart, which loosened restrictions on hotspot regions such as Peel Region, York Region and Ottawa. Under the new framework, the most stringent measures would still allow for indoor dining, the usage of gyms and the re-opening of casinos — albeit with strict capacity limits. The framework has been heavily criticized for it’s pandemic benchmarks which some infectious disease specialists and public health experts have argued will allow the virus to spread uncontrollably before triggering public health measures. Ashamalla says while the government’s drive to avoid a full lockdown is the “right idea” he also believes some of the benchmarks — including the requirement that a region should carry a 10 per cent positivity rate before being designated a “red zone” — are too high.
As a cancer surgeon, Dr. Ashamalla wants to avoid the postponement of surgeries and said the government should clamp down on indoor activities where patrons are allowed to remove their masks. “When someone has cancer, if you don’t take it out with surgery that has a hundred per cent mortality,” Ashamalla said. “It’s very difficult to tell people we are prioritizing indoor dining over taking out their cancers.”
- Daily Roundup of News on COVID-19 (Nov.09/20)
Pfizer and BioNTech said their COVID-19 vaccine achieved “more than 90%” efficacy in an interim analysis, after 94 infections were recorded — but with few other details.
The U.S. is the first country to pass 10 million cases for COVID-19 cases by some counts; Texas alone accounts for 1 million of them. Johns Hopkins’ unofficial U.S. tally stood at 9,973,563 as of 8:00 a.m. on Monday, with 237,584 dead. Daily averages over the past week reached 109,000 new cases and 940 deaths.
Neutralizing antibodies against the common cold found in some adults and many children also neutralized the new coronavirus in vitro.
FDA authorized the first blood test for SARS-CoV-2 neutralizing antibodies, GenScript USA’s cPass kit.
The RECOVERY trial is adding an arm to test aspirin for hospitalized COVID-19 cases.
For more information related to the COVID-19 updates mentioned above, follow the link below to access a specific article for each.
https://www.medpagetoday.com/infectiousdisease/covid19/89550
- Fauci, NIAID Look to Past to Inform Future of COVID-19 Therapies (Nov.06/20)
In developing therapeutic agents for COVID-19, researchers learned from the lessons of past viruses, from HIV to Ebola to even flu. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), discussed prior experience in studying the replication cycle for the HIV virus. He added that discovering “all vulnerable points of intervention” eventually led to a host of antiretroviral drugs against the disease, including nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors.
While acknowledging that chronic HIV infection was different from acute infection with SARS-CoV-2, he said the replication cycle was comparable and each virus can “provide vulnerable targets in the replication cycle” for which to develop drugs. Fauci also reviewed the “windows of opportunity” to treat SARS-CoV-2, noting that treatment appears most effective during a patient’s pre-symptomatic period.
“A lot of emphasis has been put on monoclonal antibodies, which are in various levels of clinical trials,” he said. Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight off harmful antigens such as viruses. NIH researchers gave an overview of SARS-CoV-2 antibody trials currently in progress, noting that both the cocktails from Eli Lilly and Regeneron have shown effectiveness in treating viral load and symptoms in non-hospitalized patients. While Regeneron’s product trended towards reducing medical visits, Eli Lilly’s product was unlikely to help hospitalized COVID-19 patients recover from this advanced stage of their disease. Eli Lilly recently announced that its monoclonal antibody trial was on hold.
Hilary Marston, MD, also of NIAID, also noted the importance of generating data in clinical trials during outbreaks, noting that researchers have made “significant strides in this area.” She explained that at the beginning of outbreaks, researchers generally start with non-specific treatments like interferon, “but as we go on, we have things far more targeted.” “It’s helpful to have adaptive designs into which we can feed additional agents as the outbreak goes on,” she said, adding that it “gives us the most interpretable evidence about safety and efficacy of drugs in order to benefit patients of the future.”
https://www.medpagetoday.com/infectiousdisease/covid19/89543
- Researchers Think They May Know Cause of Long-Haul COVID-19 (Nov.09/20)
In one study, researchers at the University of Trieste in Italy and King’s College London looked at the lungs of 41 people who died from COVID-19 between February and April. The researchers found that all the lungs showed extensive lung damage, while 36 of those also had massive abnormal blood clotting in lung arteries and veins.
Dr. Mauro Giacca, professor of cardiovascular sciences at King’s College London, explained that COVID-19 is a “unique disease” in terms of its symptoms, and that he conducted this research because “it was important to understand whether the virus was really present in these organs.” What Giacca and team found was “persistent and extensive” lung damage in most cases, which could help doctors better understand what causes long-haul COVID-19. “Long COVID” describes the long-term symptoms people may experience after recovering from COVID-19. According to the University of California, Davis, symptoms include fatigue, coughing, shortness of breath, and “brain fog.”
“I remember that when the pathologist (Dr. Rossana Bussani, professor and first author of the study) first looked at the samples,” Giacca said, “[and] immediately commented that she had never seen such pathological pictures before.” Giacca said among the surprising findings was the amount of blood clots in the lungs and signs of the virus being present even 30 to 40 days after initial infection. He concluded that such extensive, virus-caused damage in the lungs “might not permit lung regeneration,” and this could explain the respiratory problems seen in long-haul COVID-19.
- Frequently Asked Questions for COVID-19
Q: What is COVID-19 (or novel Coronavirus Disease – 19)?
A: Coronaviruses are a large family of viruses that can cause illnesses in humans and animals. Coronaviruses can cause illnesses that range in severity from the common cold, to more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and most recently, COVID-19. COVID-19 or novel coronavirus originated from an outbreak in Wuhan, China in December 2019. The most common symptoms associated with COVID-19 can include fever, fatigue, and a dry cough. Though additional symptoms have now been linked with the disease, which may include aches and pains, nasal congestion, runny nose, sore throat, diarrhea, skin rash and vomiting. It is also possible to become infected with COVID-19 and not experience any symptoms or feeling ill. The spread of COVID-19 is mainly through the transmission of droplets from the nose or mouth when a person coughs, exhales or sneezes. These droplets land on surfaces around a nearby person. COVID-19 can be transmitted to that nearby person who may end up touching the surface contaminated with COVID-19 and then end up touching their nose, mouth, or eyes. A person can also contract COVID-19 through inhaling these droplets from someone with COVID-19. Although research is still ongoing, it is important to note that older populations (over the age of 65), those with a compromised immune system and those with pre-existing conditions including heart disease, high blood pressure, lung disease, diabetes or cancer may be at a higher risk of severe illness due to COVID-19.
https://www.who.int/news-room/q-a-detail/q-acoronaviruses)
Q: What can I do to avoid getting Coronavirus?
A: There are various ways in which we can reduce our risk of contracting COVID-19. Below are some measures suggested by the World Health Organization
- Keep at least 2 metres (or 6 feet) between yourself and other people. This will reduce the risk of inhaling droplets from those infected with COVID-19.
- Regularly clean your hands for at least 20 seconds with warm water and soap, or an alcohol-based hand rub. This will kill any viruses on your hands.
- Avoid touching your eyes, nose and mouth. If the virus is on your hands, it can enter the body through these areas.
- Follow good respiratory hygiene by covering your mouth and nose with a tissue or elbow when you cough and sneeze. This prevents the droplets from settling on surfaces or being released into the air around you.
- Stay home as much as possible, especially if you are feeling unwell. If you think you may have the Coronavirus, please see “What should I do if I think I have Coronavirus?” section.
- Please wear a face covering or mask in public when physical distancing is not possible.
https://www.who.int/news-room/q-adetail/q-a-coronaviruses
Q: Are there any treatments available for Coronavirus?
A: People with cancer are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
There are currently no treatments available for COVID-19 but trials are underway to determine how to best treat and manage those afflicted with the virus. Vaccine candidates are being vigorously tested in a number of countries around the world, Canada included. The US government is funding 3 major phase 3 trials on potential COVID-19 vaccines and all 3 trials are being conducted by 3 different pharmaceutical companies looking at different vaccine candidates. The hope is to have a vaccine by the end of the year!
Source: https://www.who.int/news-room/q-a-detail/q-acoronaviruses
Q: Are there special precautions that people with cancer can take?
A: People with cancer (and other chronic ailments such as heart disease, diabetes, high blood pressure and lung disease) are at a higher risk of severe illness due to COVID-19 as cancer is considered a pre-existing health issue. Some cancer treatments including chemotherapy, radiation and surgery can weaken the immune system, making it harder for the body to fight infections and viruses, such as Coronavirus. It is important to diligently follow the World Health Organization’s recommendations above to reduce the risk of contracting COVID-19. If you have any concerns about your risk, it is best to contact your doctor or healthcare team.
Will anything change with regards to my cancer related medical visits? As each patient and treatment plan is unique, it is always best to contact your health care provider for updated information about your treatment plan. In some cases, it is safe to delay cancer treatment until after the pandemic risk has decreased. In other cases, it may be safe to attend a clinic that is separate from where COVID-19 patients are being treated. Oral treatment options could be prescribed by your care provider virtually, without the need to attend the clinic. Finally, some follow-up appointments or discussions could be held virtually (via skype or zoom for example) or over the phone to minimize your risk. As we know, conditions and protocols are changing daily due to the nature of the COVID-19 outbreak, and vary based on location, therefore, the best first step is to reach out to your care provider for guidance.
https://www.cancer.gov/contact/emergencypreparedness/coronavirus
Should you wish to contact your local public health agency, please see below.
Alberta
COVID-19 info for Albertans
Social media: Instagram @albertahealthservices, Facebook @albertahealthservices, Twitter @GoAHealth
Phone number: 811
British Columbia
British Columbia COVID-19
Social media: Facebook @ImmunizeBC, Twitter @CDCofBC
Phone number: 811
Manitoba
Manitoba COVID-19
Social media: Facebook @manitobagovernment, Twitter @mbgov
Phone number: 1-888-315-9257
New Brunswick
New Brunswick Coronavirus
Social media: Facebook @GovNB, Twitter @Gov_NB, Instagram @gnbca
Phone number: 811
Newfoundland and Labrador
Newfoundland and Labrador COVID-19 information
Social media: Facebook @GovNL, Twitter @GovNL, Instagram @govnlsocial
Phone number: 811 or 1-888-709-2929
Northwest Territories
Northwest Territories coronavirus disease (COVID-19)
Social media: Facebook @NTHSSA
Phone number: 811
Nova Scotia
Nova Scotia novel coronavirus (COVID-19)
Social media: Facebook @NovaScotiaHealthAuthority , Twitter @healthns, Instagram @novascotiahealthauthority
Phone number: 811
Nunavut
Nunavut COVID-19 (novel coronavirus)
Social media: Facebook @GovofNunavut , Twitter @GovofNunavut, Instagram @governmentofnunavut
Phone number: 1-888-975-8601
Ontario
Ontario: The 2019 Novel Coronavirus (COVID-19)
Social media: Facebook @ONThealth, Twitter @ONThealth , Instagram @ongov
Phone number: 1-866-797-0000
Prince Edward Island
Prince Edward Island COVID-19
Social media: Facebook @GovPe, Twitter @InfoPEI,
Quebec
Coronavirus disease (COVID-19) in Québec
Social media: Facebook @GouvQc, Twitter @sante_qc
Phone number: 1-877-644-4545
Saskatchewan
Saskatchewan COVID-19
Social media: Facebook @SKGov, Twitter @SKGov
Phone number: 811
Yukon
Yukon: Find information about coronavirus (COVID-19)
Social media: Facebook @yukonhss, Twitter @hssyukon
Phone number: 811
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