Value Propositions

Jayson Slotnik, JD, MPH

March 2014, Vol 5, No 2 - Value Propositions

New Evidence Confirms Value of Yoga for Women with Breast Cancer
A new study from M.D. Anderson has shown that patients with breast cancer who participated in yoga exercises that incorporated controlled breathing, meditation, and relaxation techniques into their treatment plan had significant improvement in their ability to manage their daily activities and had better regulation of the stress hormone cortisol. The patients who practiced yoga had the steepest reduction in their cortisol levels throughout the day. Increased levels of the stress hormone during the day (ie, blunted cortisol circadian rhythm) have been linked to worse outcomes in patients with breast cancer.

“Combining mind and body practices that are part of yoga clearly have tremendous potential to help patients manage the psychosocial and physical difficulties associated with treatment and life after cancer, beyond the benefits of simple stretching,” said Lorenzo Cohen, PhD, Director of the Integrative Medicine Program at M.D. Anderson, and lead author of the study that included 191 women with breast cancer (stage 0-III) that was recently published in the Journal of Clinical Oncology.

In addition, after completing radiation treatment, only the women in the yoga and stretching groups reported a reduction in fatigue. At 1, 3, and 6 months after radiation therapy, women who practiced yoga during treatment reported greater benefits to physical functioning and general health. “The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less difficult,” said Dr Cohen. M.D. Anderson News Release; March 3, 2014

Immunotherapy an Expanded Focus of the University of Pennsylvania–Novartis Cancer Research Program
Increasing evidence suggests that the human immune system plays a role in fighting cancer. Various research and development companies are increasing their investment in incorporating immunotherapy research into their drug development programs with the goal of creating new targeted anticancer therapies that will stimulate the patient’s immune response to such therapies to maximize outcomes.

Novartis is collaborating with the University of Pennsylvania on the investigative chimeric antigen receptor (CAR) technology to develop

effective targeted immunotherapies. Novartis has announced its recent acquisition of CoStim Pharmaceuticals, a Cambridge, MA–based biotechnology company focused on harnessing the immune system to eliminate immune-blocking signals from cancer. This new acquisition will enhance the CAR program and expand the scope of its focus on immunotherapies directed at several targets, including the PD-1. The goal of this program is to develop medicines that will use the body’s immune system to prevent the patient’s cancer from developing drug resistance to therapeutic anticancer medicines.

“Therapy for many types of cancers is expected to increasingly rely upon rational combinations of agents,” said Mark C. Fishman, MD, President, Novartis Institutes for BioMedical Research. “Immunotherapy agents provide additional arrows in our quiver for such combinations. They com­plement our extensive portfolio of drugs that hit genetically defined

cancer-causing pathways, and also may be relevant to expansion of CAR therapies.” Novartis Press Release; February 17, 2014

Rates of New Lung Cancer Cases Drop in the United States, CDC Reports
A new report from the Centers for Disease Control and Prevention (CDC) indicates that new cases of lung cancer were going down and had been decreasing between 2005 and 2009 for men and for women in the United States (see Figure on page 17). Lung cancer is the leading cause of cancer death in the United States and the second most often diagnosed cancer among US men and women. The majority of the cases are attributable to cigarette smoking and secondhand smoke.

Based on this report, the incidence rates were reduced from 87 to 78 cases per 100,000 men, an annual reduction of 2.6%, and from 57 to 54 cases per 100,000 women, an annual decrease of 1.1%. The fastest reductions were seen in people aged 35 to 44 years, decreasing by 6.5% annually for men and 5.8% for women. Overall, lung cancer incidence rates decreased faster in men than in women.

“These dramatic declines in the number of young adults with lung cancer show that tobacco prevention and control programs work—when they are applied,” said CDC Director Tom Frieden, MD, MPH. “While it is encouraging that lung cancer incidence rates are dropping in the United States, one preventable cancer is one too many,” Dr Frieden said. “Implementation of tobacco control strategies is needed to reduce smoking prevalence and the lung cancer it causes among men and women.”

The incidence of lung cancer decreased among men in all geographic regions in the United States, as well as in 23 states; among women, the incidence decreased in the South and West, as well as in 7 states. Lung cancer rates were stable in all other states. These declines reflect the successes of past tobacco prevention and control efforts, according to the CDC.

The study indicates that continued attention to local, state, and national population-based tobacco prevention and control strategies are needed to achieve further reductions in smoking prevalence among both men and women of all ages to reduce subsequent lung cancer in the United States.

Millions of Americans are living with a smoking-related disease, and each day more than 2100 youth and young adults become daily smokers. For assistance with stopping to smoke, call 1-800-QUIT-NOW (1-800-784-8669) or visit For information on quitting and on preventing children from using tobacco, visit CDC; January 9, 2014

ASCO Is Asking Oncologists to Help Their Patients to Quit Smoking
After the report from the Centers for Disease Control and Prevention (CDC) about the reduction in the new cases of lung cancer in the United States, the American Society of Clinical Oncology (ASCO) issued a statement emphasizing that it has a role in educating patients with cancer on the need to stop smoking in an effort to control lung cancer. “Eliminating tobacco use is the most important thing we can do to prevent lung and other cancers, as well as the many other diseases its use causes,” said ASCO President Clifford A. Hudis, MD, FACP. “This new CDC report shows how far we’ve come in the United States as we approach the 50th anniversaries of both the Surgeon General’s first report on tobacco and ASCO’s founding. Having shown that we can make substantial progress, we must continue to do everything possible to expand tobacco control programs in the United States and especially overseas, where tobacco use is taking an even greater toll.”

Suggesting that oncologists have a responsibility as “cancer doctors” to help their patients quit smoking and oppose tobacco use in any form, Dr Hudis noted that ASCO officials are “deeply committed to proactive tobacco control globally and have set an aggressive agenda for slashing tobacco use, deploying every public health, policy and legal approach available.” ASCO News Alert; January 9, 2014