FOR PATIENTS, SURVIVORS AND FRIENDS
Cancer Patients in Appalachia Face Difficulty Accessing Radiation Therapy
A review of studies on Appalachian patients with lymphoma and cancers of the lung, colon, cervix, prostate, head, neck, breast and
esophagus identified common difficulties accessing radiation therapy. Barriers to treatment included not having private insurance and the
inability to pay for treatment. The researchers said these problems were compounded by lack of access to high-quality radiation centers.
The median household income in Appalachia is 82 percent of the U.S. median income.
LEARN MORE IN THE OC TOBER-DECEMBER 2018 ADVANCES IN RADIATION ONCOLOGY.
Check the safety and effectiveness of more
than 50 popular herbs on the National Institutes
of Health’s new HerbList app. The app provides
research-based information about the herbsʼ
usefulness, side effects and known herb-drug
interactions, and can be used when you talk to
your health care provider about herbs you take or
may want to try.
Listen to meditations tailored to the specific
needs of cancer patients and survivors on the
CancerCare Meditation app, for iPhones only.
Choose from a menu of hundreds of guided
meditations on topics such as reducing stress,
preparing for surgery, relieving anxiety and
pain, improving sleep, and managing depression.
Relaxing music and CancerCare’s expert talks are
available as well.
meditation/id1373888072?ls= 1&mt= 8
Look for financial assistance to help manage
the cost of cancer treatments on the National
Comprehensive Cancer Network’s Reimbursement
Resource app. You can search for support
options by cancer type or treatment, drug name
(brand or generic), or pharmaceutical company
Q: In what ways did older patients
respond differently to Keytruda?
A: What we saw was that older patients
did better in terms of their disease
stabilizing and not progressing. Both
younger and older patients had the
same levels of complete response—
where their tumor disappeared. No one
is saying younger patients shouldn’t
try these therapies, because the chance
they will respond is still very good.
But younger patients might do better
on a combination therapy, rather than
Q: You studied the patients and then
you studied old and young mice. Why
study the mice too?
A: In the patients, we saw the different
responses. But we didn’t know why.
To model this, we had to go to mice
and say: What is changing inside the
tumor in terms of the immune cells?
When we did that, we saw that there
were fewer regulatory T cells—called
Tregs—inside the tumors in the older
mice. [Tregs help regulate other cells
in the immune system.] Then we went
back to the patients to see if the Tregs
were different inside the tumors of
older and younger patients. And they
were. So, this is bedside to bench [and]
back to bedside again research.
Q: Why are Tregs important?
A: Having fewer Tregs and more
CD8 T cells—which are the good cells
that go in and kill the tumors—created
an environment around the tumor that
led to a better response to immunotherapy in the older patients.
Q: Might there be a way to make the
microenvironment in younger patients
more similar to that of older patients?
A: That is actually one of the things
we did in the mice. We changed the
microenvironment by depleting the
Tregs in the young mice, and we showed
that they then responded as well as the
old mice to the immunotherapy.
Q: What are your thoughts on studies
that have found gender differences in
responses to immunotherapy?
A: In melanoma there are big
male/female differences in responses
to targeted therapy. If we had a
larger sample size, we may have
seen that too. Also, I want to point
out that in our study, we had data
from the United Kingdom, Australia
and Germany and throughout the
United States. I think this speaks to
the nature of the type of science we
have to do. It needs to be collaborative and it really needs to be global.
When you collect data from multiple
institutions, you are likely to get
more robust findings.
Q: Should researchers be paying more
attention to how the age of patients in
clinical trials could affect findings?
A: Yes. This is also true for studies
done in labs. Most labs do studies in
6- to 8-week-old mice, which represent 19- to 20-year-old humans. If
everyone is just using young mice,
you are not really considering the
impact of age, which we are showing
more and more has a huge impact on
Q: Are you starting to see this change?
A: We are really sort of at the tip of
the iceberg here. There is a glimmer
of more people doing aging in cancer
research. I wish it was more than just
a glimmer. Our new director of the
National Cancer Institute [Norman
“Ned” Sharpless] is one of the pioneers
in this field, so I’m hoping that will also
spur more interest. —SUE ROCHMAN