The Not-Quite Annual ASCO Round-Up - 2018 edition

by Drew Rosielle

The American Society of Clinical Oncology annual meeting, besides being a feast for the pharmaceutical business news pages (google 'ASCO' and most of the hits will be about how announcement X affected drug company Y's stock), is also one of the premiere platforms for publishing original palliative-oncology research. So every year I try to at least scan the abstracts to see what's happening, and I figure I might as well blog about it. It's tough to analyze abstracts, so I'll mostly just be summarizing ones that I think will be of interest to hospice and palliative care folks. I imagine I've missed some good ones, please leave a link in the comments if I have! My major observations on this year's abstracts is that there was very little about symptom management compared to years past, except for neuropathies.

(Past ASCO reviews here - 2008, 2017 - Ed.)

Fatigue/Nutrition

• A negative phase 2 study of a walking intervention for fatigue in patients with breast cancer
• A look at 10-year trends in TPN use in cancer patients (use is slightly declining, as are costs, and involvement of palliative care is increasing)
• Parenteral nutrition once again fails to show any benefit over oral feeding for cancer cachexia (and in fact suggested harm)
• A nice study looking at the determinants of long-term fatigue in patients with treated ovarian cancer
• Perhaps the microbiome influences cancer-related fatigue?

• Code status, race, and palliative care involvement at a single institution in Texas
• A small study that showed that training oncologists in communication skills (it's implied that it's with Vitaltalk methods, although that's not exactly clear from the abstract) does increase the use of those skills in real life, but did not increase the amount of goals of care conversations, etc. 
• A project to disseminate palliative care knowledge in multiple Sub-Saharan African countries
• A fascinating prospective study looking at dis-/concordance between patient and oncologist perception of care goals over time. Another abstract from this study showed that concordance did seem to matter at least for patients with 'aggressive' goals (they got what they wanted if the oncologist understood that goal). I hope they write this up for full-publication, as I want to know more. 

• Apparently palliative celiac plexus radiosurgery is a thing
• More frustratingly inconclusive data about the 'Scrambler' device for chemo neuropathy (it was randomized against TENS, unclear if anyone was blinded, results were barely positive for Scrambler). Perhaps I'm just totally ignorant, but I don't understand why no one can do a double-blinded sham-controlled study of the technology. Actually at this point I'm just assuming because it's not effective and that's why, but I don't really know. [Late edit - hey, I guessed right, a sham-controlled study showed Scrambler probably doesn't help, and you can sense the disbelief and desperation in this curiously-written abstract.]
• Omega-6 fatty acids reduced pain more than O-3 fatty acids in breast cancer survivors in a randomized & blinded (but no placebo-arm) study. Interesting, but I just can't imagine that we are ready to study this without a placebo arm yet!
• An uncontrolled mindfulness study on chronic cancer pain shows promise
• A look at the natural history of chronic pain in survivors of childhood cancers
• Low-quality, retrospective look at cannabis and QOL/symptoms in patients with cancer
• Investigations into cryotherapy to prevent chemo neuropathy stumble along
• RCT of a novel superoxide dismutase mimetic to prevent radiation mucositis in Head and Neck cancer patients with promising results

• Claims and SEER database study suggesting that earlier palliative care involvement in pancreatic cancer reduces some costs. 
• Patients in Medicare managed care organizations use hospice a little more than fee for service Medicare patients 
• Barriers to palliative care involvement in patients receiving stem cell transplants, including this data point, which is something I've personally wondered about a lot: "Higher sense of ownership over patients’ PC issues (β = -0.36, P < 0.001) was associated with a more negative attitude towards PC [by hematologists]."  
• EOL spending was higher in ACO patients vs non-ACO patients.  
• A retrospective study which compares many outcomes in patients who receive early palliative care inpatient vs not. The title abstract highlights survival (which was a bit longer in the palliative group). Please do not quote this abstract however to claim that PC prolongs survival in patients with cancer: this is messy retrospective data, and it's not even clear from the abstract whether the survival difference was in univariate or multivariate analysis (PC patients, eg, were younger, more likely to be discharged home, etc.). Similarly, a Canadian study looked at early palliative care consultation in pancreatic cancer (retrospectively) and apparently showed that late but not early palliative consultation was associated with longer survival. The same study also showed that having metastatic disease at the time of diagnosis was also associated with longer survival, so I'm not going to make much of any of this.

Drew Rosielle, MD is a palliative care physician at the University of Minnesota Health in Minnesota. He founded Pallimed in 2005. You can occasionally find him on Twitter at @drosielle. For more Pallimed posts by Drew click here.