Just as electronic health records revolutionized the healthcare industry for nurses and doctors, patient portals are giving patients new ways to access their healthcare information and communicate with members of their healthcare team.

And while many practices and hospitals across the country offer patient portals to all their patients, those with chronic diseases, such as cancer, seem to benefit the most from the portal.

“Our patients might have a greater need [for the portal] simply because of the nature of their illness,” explained Sheila Ferrall, RN, Director of Nursing Practice, Education and Clinical Effectiveness at Moffitt Cancer Center in Tampa, Florida. “I think it’s very empowering for patients to go in and look at their results."

Patient portals give patients the opportunity to see test results, read their doctor’s notes, access educational information about their disease, and even communicate electronically to manage appointments or ask their healthcare team questions.

And patients with cancer seem to like having their medical information at their fingertips.

A recent study conducted by David Gerber, MD, an associate professor of internal medicine at UT Southwestern Medical Center in Dallas, found a sharp increase in the number of cancer patients using MyChart, the patient portal that the hospital uses.

The results found that over a 6-year period, the number of patients actively using MyChart each year increased fivefold, while the number of total log-ins each year increased more than tenfold.

Patients most commonly used the portal to view test results (37%), view and respond to clinical messages (29%), and send medical advice requests (6.4%).

Patient portals are fed information from electronic medical records (EMRs). In 2009, the American Recovery and Reinvestment Act provided financial incentives for providers to adopt electronic health record technology and meet meaningful use objectives, but some providers were using EMRs before that.

“Electronic medical records…are a widely implemented and accepted component of patient care and the portal is a key part of that,” Gerber said.

Extending Care Between Patients and Practices

By providing patients with secure 24-hour access to information specific to their health, patients have the time to become more educated about their condition and get more involved in their care.

In fact, the study that examined the use of MyChart at UT Southwestern Medical Center found that 37% of all log-ins and 31% of all medical advice requests occurred outside of clinic hours.

“It’s really about being more engaged,” said Jennifer Trageser, the associate director of portal technology product management at McKesson Specialty Health. “Empowering the patient in their day-to-day decisions, increasing health literacy…is really important in the oncology space.”

McKesson Specialty Health’s patient portal, My Care Plus, was rolled out in 2012 and now reaches and impacts nearly 218,000 oncology patients across the nation.

My Care Plus syncs up with McKesson Specialty Health’s iKnowMed or iKnowMed Generation 2 EHR platforms so patients can access their vital signs from their visits, see lab results and view summaries of their visits and assigned care plans that were recorded in the EHR.

Trageser explained that although the EHR and patient portals are synced, patients can only see the “common data set,” which consists of demographic data, conditions, vitals, lab results, visit summaries and care plans.

“There is a variety in the patient portal market—some portals limit the data being provided to the common dataset, and other portals expand beyond that dataset to include imaging reports, physician notes, and more,” she said.

By expanding information to the patient, you’re also expanding information to their caregiver, Trageser noted.

“Patients are able to provide access or share their health information with caregivers who may not be able to make every doctor’s appointment,” she said.

Pros, Cons, and the Future of Patient Portals

The idea of providing patients instant and constant access to all their healthcare information, as well as a line of communication to healthcare providers, allows practices to continue to improve healthcare treatment.

Because patient portals allow specific information to be sent to each patient, a triage nurse can send messages to patients reminding them to take their Day 1 oral medication, or an infusion nurse could follow up with a patient about the potential side effects that might occur after their treatment, continued Trageser.

“And this creates a highly personal engagement with that patient…it’s not waiting for the phone call—it’s building a relationship with an electronic way that can shared at any point in time by patients or their caregivers.”

But there are also some potential problems with patient portals.

“I think there are opportunities and I think there are also areas that we need to approach cautiously,” Gerber said.

For example, if patients are given access to test results prior to an appointment with their doctor, they might misinterpret the findings.

“I think it’s very important that we think about how patients are interpreting this information,” Gerber said.

And while the idea of being able to send a message to the healthcare provider might seem like a quick and easy way to get an answer, Gerber cautioned that might not be the case.

He noted that in this day and age, society has a growing expectation that text messages and emails are instant. But when it comes to using the portal to communicate with healthcare providers, messages are not guaranteed to be answered immediately. “To what extent can we ask patients to have the medical knowledge to triage their own questions and symptoms?”

Some of these concerns with patient portals are just extensions of issues in current practice, Gerber explained.

“We’re still not perfect in person or on the phone. All aspects of clinical care in oncology are entities that we are always trying to improve,” he said. “I think as electronic patient portals are used by more and more patients and used more intensively and frequently by those patients, I think we will all grow with this experience to try to optimize this technology.“

Nurses have always been at the center of patient interaction. So it’s no surprise that they have a key role when it comes to patient portals.

“Gerber said that at his practice, it is primarily clinic nurses who manage MyChart. This includes sending messages regarding appointments and prescriptions, as well as responding to and triaging incoming questions from patients.”

Ferrall said at Moffitt, EMRs were put into place about 3 years ago, and new features were slowly introduced. And while the patient portals are fairly new, the nurses seem to enjoy having the patient portals because they help empower and educate their patients.

“It gives the patient access to information that they often want, and it allows the nurse not to have to be the middle in terms of providing that information,” she said. “Patients can go directly to the portal to access information.”

Articles

Patient portals are giving patients new ways to access their healthcare information and communicate with members of their healthcare team.

For Patients With Cancer, Web-Based Portals Can Inform and Empower

Jacquelyn Lauria said she never thought she’d become an oncology nurse, but looking back, it’s easy to see the writing on the wall.

A candy striper in high school, the family’s health advocate, a biology minor in college…But it took Lauria 15 years of working at a risk-management company, specializing in pharmaceuticals, to realize she was on the wrong path.

“I wasn’t passionate about it,” Lauria said of her senior vice president position at Marsh & McLennan. “I had my job, but there was something that was pulling me toward [nursing].”

“I really wanted to do something with this…[nursing] is something that I could really make a difference in,” she added.

After taking a few years to think about a plan to go back to school and brushing up on her science credits, Lauria traded her full-time job for a part-time one and enrolled in Columbia University’s “Entry To Practice program,” designed for students selecting nursing as a second career.

And while it took Lauria a long time to make the switch to nursing, it didn’t take long for her to pick oncology as a specialty.

Her sister Barbara had been diagnosed with Hodgkin’s disease at the age of 26 and Lauria’s husband Don had developed prostate cancer. And while both were doing fine with their disease, her brother Michael developed a recurrent brain tumor right before Lauria started school.

“Because of my family experiences in dealing with cancer, I was drawn to oncology,” Lauria said.

She had her clinical rotations at Memorial Sloan Kettering Cancer Center and the New York Hospital before working part time for 2 years at the oncology department at Robert Wood Johnson University Hospital while finishing up her master’s degree.

“I really loved it. I enjoyed it,” Lauria said of her time at Robert Wood Johnson.

And when her schooling was just about done, all Lauria had to do to find a job was look across the street.

“I looked out the window and saw ‘cancer institute’ across the street,” she said. “I was really fortunate that there was a wonderful APN here who was willing to take me on for the last semester before I graduated.”

At the end of the semester, her mentor asked her if she would like to work full time at the Rutgers Cancer Institute of New Jersey.

“I said ‘I would love to, but I don’t know if I’m experienced enough … I’m a new nurse. I’m not young, but I’m a new nurse!’” Lauria said.

Twelve years later, Lauria is an advanced practice nurse at the Stacy Goldstein Breast Cancer Center at Rutgers Cancer Institute where she meets with patients at high risk of developing breast cancer, those with breast cancer,and those who have finished treatment.

“I love it,” she said. “This is what I’m supposed to be doing. It took me a long time to find my passion, but I realize what a difference it makes to have a career that’s part of who I am, not just what I do.”

Lauria said she spent 2 years planning her career change to make sure it made sense.

Since she had a lot of friends in nursing, Lauria said she was able to get advice about the job market.

“I had a teenage son … I couldn’t quit my job for a year plus and then get done with school and not have a job,” she said. “It was a big change after working so many years in the corporate world and then just stopping. I had to think about finances and make sure that I had my ducks in line before I could do that.”

While she was still working, Lauria went to community college to get the credits she needed to enroll in school and to brush up on her science. “I went back to school at night, three times a week.

“My old credits were pretty rusty,” Lauria joked.

The program that Lauria ended up applying to took 3 years to complete, and during that time, she earned both her bachelor’s and her master’s degrees.

Lauria said that at first, her coworkers were confused by her decisions to switch careers.

“They really shook their heads … they didn’t understand it,” she said. “I had a very good job; I knew I was going to make significantly less money in nursing.”

Lauria also recognized that she would have to start at the bottom and move up the ranks and that there were nurses her age leaving nursing because they were burned out. Because of her confidence in her decision, Lauria said she wasn’t rattled by the naysayers.

“This was something I was more excited about,” she said.

It didn’t take long for Lauria to put her new nursing skills to use.

While she was in school, Michael was set up at a long-term care facility after having a stroke during one of his neurosurgeries, and his condition was worsening.

“I found myself navigating the palliative care and hospice route, which is something I was unfamiliar with but was learning about,” she said. “I was just barely a nurse, and he was in a facility where they weren’t familiar with hospice.”

Lauria used her new nursing knowledge to call a meeting with the staff. After multiple meetings, the facility had someone come in to help deliver hospice care for Michael before he passed away.

But for Lauria, the biggest accomplishment was what happened after Michael received hospice care.

“It actually turned this facility around, and they all of a sudden were advocates of hospice care,” she said. “I felt like I made a difference and it wasn’t just for my brother.”

Lauria said her experience with cancer in her personal life helps her relate to her patients.

“It’s something that changes your life that you don’t have control over,” she said.

But Lauria also sees the parallels in her patients’ journeys and her journey to become a nurse.

“They’re similar journeys. It’s about changing expectations and marshaling your resources and that’s what we need our patients to do,” she said.

Lauria also said her previous experience with cancer and her career change helped her get a new perspective on life, one that she shares with her patients.

“Don’t waste time, because none of us have an unlimited amount of time. And when you’re in a second career, your timeframe and perspective are different, just like our patients are kind of on a second journey,” she said. “I think I appreciate what they are going through with that.”

Although her husband’s stage IV prostate cancer is under control, Lauria said they don’t put off the things they want to do.

“I wouldn’t have thought that way 15 years ago and I wouldn’t have thought that way if I didn’t have family members with cancer.”

Lauria said she plans on staying in nursing as long as she can while continuing to make a difference in the lives of her patients.

She said she knows that she’ll never work as long as some other nurses, but her love of oncology nursing and her enthusiasm to learn will keep her working for as long as she can.

“I’m ready to roll. I’m fresh,” she said. “This is what I want to do.”

Jacquelyn Lauria said she never thought she'd become an oncology nurse, but looking back, it's easy to see the writing on the wall.

Changing Careers to Become an Oncology Nurse

Breast density, which is associated with breast cancer risk, is higher in black/African-American women than in white women, according to research presented at the AACR Annual Meeting.

The study enrolled 1589 black women and 1256 white women who underwent screening mammography at the University of Pennsylvania from 2010 to 2011. The researchers found that black women in the study had a significantly higher absolute area density of 40.1 cm

 in white women. The study also showed that black women had a significantly higher volumetric density of 187.2 cm

“Since breast density is associated with breast cancer risk, a better understanding of racial differences in breast density levels could help us identify women at the highest risk for breast cancer and target prevention strategies to those women,” Anne Marie McCarthy, PhD, a research fellow at Massachusetts General Hospital and lead author of the study, said in a statement.

Breast density refers to the amount of fibroglandular tissue in the breast when observed on a mammogram. Since the fibroglandular tissue appears as white on the mammogram, it makes it difficult to visually detect breast cancers.

Research has shown that women who have the highest breast density have a 4 to 6 times greater risk for breast cancer compared with women with lower breast density.

Although several studies have previously shown that black women have lower breast density than white women on average, the authors of this study suggest the reason behind that may be partly due to racial differences in BMI, which is inversely associated with density.

Usually, radiologists examine mammograms and assign patients a breast density level, but that assignment can be subjective, McCarthy explained. For this study, which was funded by the National Institutes of Health, the researchers used fully automated, computer algorithms to produce both the conventional two-dimensional breast density measurement and a three-dimensional volumetric estimate of breast density.

“Our findings are using a new, quantitative and, perhaps, more reliable way to measure breast density,” McCarthy said.

The mean age of the patients was 57. The results showed that black women had higher mean BMI and higher absolute area and volume density than white women but lower area and volume percent density.

When adjusting for age, BMI, and breast cancer risk factors, black women had higher breast density across all measures. The results also showed that the interaction between race and BMI was significant for area percent and volume percent density and was near significant for volume density; however, for all three measures, BMI was more strongly associated with density among white women than black women.

The researchers concluded that the significantly higher breast density in black women was not explained by BMI or recognized breast cancer risk. Therefore, racial differences in breast density may have implications for disease risk and prevention strategies.

Follow-up ultrasound screening for women with dense breasts continues to garner interest among advocates and researchers, with 22 states enacting breast density reporting laws and legislation pending in the US Congress. A study presented at the 2014 San Antonio Breast Cancer Symposium drawing on data from radiology practices in Connecticut (the first state to enact legislation mandating breast density reporting) showed that during 4 years of ultrasound screening of mammographically normal but dense breasts, the follow-up screening did detect a significant number of breast cancers not discovered by mammogram.

“Our next step will be to see how quantitative density measures and other imaging biomarkers are associated with cancer risk, cancer subtype, and stage of diagnosis by race,” McCarthy said.

		McCarthy AM, Keller B, Synnestvedt, et al. Racial differences in quantitative measures of area and volumetric breast density. Presented at: AACR Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA. Abstract 6580.

		Weigert JM. The Connecticut experiment: 4 years of screening women with dense breasts with bilateral ultrasound. Presented at: San Antonio Breast Cancer Symposium; December 9-13, 2014; San Antonio, TX. Abstract S5-01.

Understanding Why Black Women Have Denser Breasts May Help Target Those With Highest Cancer Risk

New research reported at the AACR Annual Meeting has found that decreasing the number of hours spent eating each day and increasing the number of hours spent fasting overnight may reduce a woman’s risk of developing breast cancer.

Previous preclinical studies have suggested these steps may improve metabolic parameters and reduce the risk of developing a number of chronic diseases, including cancer; however, no human studies had explored the potential impact of this type of fasting schedule on cancer risk factors such as hyperglycemia, which is a possible facilitator of neoplastic proliferation.

“We found that women who fasted for longer periods of time overnight had significantly better control over blood glucose concentrations, and these effects were independent of how much they ate,” lead author Catherine Marinac, doctoral candidate in public health at the University of California, San Diego, said in a statement.

“This finding is relevant to cancer research because people who have poor glucose control are more likely to develop certain types of cancer, and it is hypothesized that high concentrations of circulating glucose may fuel cancer growth and progression.”

For the study, researchers looked at possible associations between the duration of nighttime fasting and glycemic control biomarkers associated with increased breast cancer risk in a population-based sample of women in the 2009-2010 US National Health and Nutrition Examination Survey.

Women included in the study were a median age of 47 years. Data on HbA1c levels over the previous 2 to 3 months were available for 2212 women, and data on 2-hour postprandial blood sugar were available for 1066 women. The women fasted for approximately 12.4 hours per night.

The results showed that for each 3-hour increase in nighttime fasting, women had a 4% lower 2-hour postprandial blood sugar measurement and a nonsignificant 0.4 unit decrease in HbA1c.

Each 3-hour increase in nighttime fasting was also associated with about 20% reduced odds of having elevated HbA1c and nonsignificantly reduced odds of an evaluated 2-hour postprandial blood sugar measurement.

“Our group is hoping to gain funding for a large-scale trial to confirm these findings,” Marinac said. “If these findings are reproduced, it would mean that increasing the duration of overnight fasting could be a novel strategy to reduce the risk for developing breast cancer.”

“This is a simple dietary change that we believe most women can understand and adopt, and it may have a big impact on public health.” 

Marinac CR, Natarajan L, Sears DD, et al. Prolonged nightly fasting and breast cancer risk: findings from NHANES (2009-2010). Presented at: AACR Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA. Abstract 1234.

New research reported at the AACR Annual Meeting has found that decreasing the number of hours spent eating each day and increasing the number of hours spent fasting overnight may reduce a woman's risk of developing breast cancer.

Nighttime Fasting May Help Reduce Breast Cancer Risk

A new study has shown that vaccinating adolescent boys may be cost-effective for preventing oropharyngeal cancer, a disease that’s projected to become the most common HPV-related cancer by 2020.

The results of the study, published early online in 

, estimated a savings between $8 million to $28 million Canadian dollars [$6.5M-$22.5M USD] over the course of a 12-year-old’s lifetime.

HPV vaccination has proven effective against HPV-related disease in both sexes. While policymakers in many countries, including the United States, Canada, Austria, and Australia, have recommended HPV vaccination in boys, it is excluded from national immunization programs in many countries worldwide, noted study leader Lillian Siu, MD, FRCPC, of the Princess Margaret Cancer Centre, University Health Network.

“We hope that results from this study would raise awareness and lead to further assessment of this important public health issue,” Siu said in a statement.

For the study, the investigators applied a statistical model to a population of 192,940 Canadian boys who were 12 years old in 2012. Assuming 99% vaccine efficacy and 70% update, the study found .05 more quality-adjusted life-years (QALYs) and a savings of $145 Canadian dollars [$118 USD] per individual compared with those who received no vaccine.

When adjusting for 50% vaccine efficacy and 50% uptake, there were .023 more QALYs and a savings of $43 Canadian dollars [$34 USD].

Potential factors that could impact the cost savings of HPV vaccination in boys include vaccine cost, vaccine effectiveness, cost of cancer treatment, and survival of patients with HPV-related oropharyngeal cancers.

“We believe this study is important because HPV-related oropharyngeal cancer has increased significantly in incidence, especially in developing countries,” coauthor Donna Graham, MD, BCh, MRCPUK, also from the Princess Margaret Cancer Centre, said in a statement. “It is projected that by 2020, HPV-related oropharyngeal cancer will become the most common HPV-related cancer in the United States, surpassing cervical cancer.”

A new study has shown that vaccinating adolescent boys may be cost-effective for preventing oropharyngeal cancer, a disease that's projected to become the most common HPV-related cancer by 2020.

HPV Vaccination in Boys Found Cost-Effective in Preventing Oropharyngeal Cancer

A new study has found that obesity is associated with an increased risk for prostate cancer in African American men, a risk that grows by nearly four times as an individual’s body-mass index (BMI) increases.

It is known that African American men have the highest incidence of prostate cancer of any other racial or ethnic group in the United States as well as the highest rates of aggressive disease and prostate cancer death. While those risks likely arise from both social and biological factors, the associations of obesity with prostate cancer risk in this population are complex.

 researchers analyzed data from 3398 African American men and 22,673 non-Hispanic white men participating in the SELECT [Selenium and Vitamin E Cancer Prevention] Trial, carried out between 2001-2011. During a median follow-up of 5.6 years, results showed that of the 1732 men that developed prostate cancer; 270 of them were African American whereas 1453 were non-Hispanic white males.

Obesity was not associated with the risk of prostate cancer overall among non-Hispanic white men; however, there was a significant association between obesity and the total risk for both low- and high-grade prostate cancer in African American men.

Results showed that being African American increased the risk for prostate cancer across BMI categories, jumping from 28% among African American men with a BMI less than 25 [normal and underweight] to 103% among African American men with a BMI of at least 35 [obese].

For low-grade prostate cancer, obesity was inversely associated with prostate cancer risk among non-Hispanic white men. Those with a BMI of at least 35 had a 20% reduced risk compared with non-Hispanic white men with a BMI of less than 25. However, the results showed that obesity was positively associated with the risk of high-grade prostate cancer among non-Hispanic white men.

While the reasons for these findings are unknown, the authors speculate that one explanation may be that the biological effects of obesity differ in African American and non-Hispanic white men.

“This study reinforces the importance of obesity prevention and treatment among African American men, for whom the health benefits may be comparatively large,” the authors concluded. “Although obesity is linked to poor health outcomes in all populations, clinicians might consider the unique contribution of obesity prevention and treatment to the health of their African American patients. Such targeted efforts may contribute to reductions in prostate cancer disparities.”

In an editor’s note, Charles R. Thomas Jr, MD, deputy editor of 

, noted, “Despite the limitations inherent in the methodology utilized for the analysis and the inability to define a clear mechanism behind the association between BMI and risk, the findings do provide a further rationale for weight reduction and a target BMI for clinicians to aim for in care of African American men.” 

A new study has found that obesity is associated with an increased risk for prostate cancer in African American men, a risk that grows by nearly four times as an individual's body-mass index (BMI) increases.

Risk of Prostate Cancer Linked to Higher BMI in African American Men

A new telephone-based intervention for breast cancer survivors is showing promise, and it involves them becoming more actively engaged in goal setting and problem solving with an eye toward accelerating their recovery by engaging in health-promoting activities such as exercise, stress management, and healthy eating.

	Many breast cancer survivors experience difficulty after treatment when trying to resume previous levels of work, leisure, physical, and social activities. This is particularly true in younger women and those in middle adulthood. For them, cancer diagnosis comes at a time of high demands for peak performance at work and home, and correspondingly less flexibility in time and schedule.

	"Most breast cancer survivors bounce back well after treatment, but anywhere from a quarter to a third of them might benefit from rehabilitation interventions that help them accelerate recovery by finding and applying ways to engage in productive and health-promoting activities," first-author Kathleen D. Lyons, ScD, said in a statement. Lyons is an assistant professor of psychiatry at Dartmouth’s Geisel School of Medicine.

	The pilot study, published online in the 

, was conducted by a team from Dartmouth's Norris Cotton Cancer Center who tested their goal-setting telephone intervention with 31 breast cancer survivors. They found that the participants found it highly satisfying and primarily used the program to set weekly goals regarding exercise, work, better nutrition, taking care of themselves and their homes, managing stress, and social activities.

	Participants met 71% of their weekly goals and showed improvements in quality of life, active coping, planning, and reframing. It also resulted in less self-blame among the women receiving the intervention.

	Lyons and colleagues plan to continue to study the program with a larger sample. They also plan to work with nurse practitioners at the cancer center to determine the feasibility of integrating the problem-solving and action-planning structure into survivorship care.

Telephone Intervention Helps Breast Cancer Survivors Set-and Meet-Lifestyle Goals

A new study has found that patients with lower vitamin D levels prior to treatment for follicular lymphoma are more likely to die or relapse from the disease earlier than patients with adequate vitamin D levels in their blood.

, is believed to be the first report to find that a lack of vitamin D is a potentially modifiable risk factor for this type of cancer.

“Our data, replicated internationally, support other published observations linking vitamin D deficiency with inferior cancer outcomes,” said Jonathan W. Friedberg, MD, co-leader of the study, in a statement. Friedberg is director of the Wilmot Cancer Institute at the University of Rochester Medical Center.

Prior studies have shown a survival benefit among patients with higher vitamin D levels for diffuse large B-cell lymphoma and chronic lymphocytic leukemia. It has also been found that low levels of vitamin D among women with breast cancer correlated with more aggressive tumors and poorer prognosis, and that a vitamin D deficiency among African Americans may help to explain higher death rates from colorectal cancer.

For the study, researchers observed a total of 423 patients with follicular lymphoma in two independent cohorts: SWOG, part of the NCI’s National Clinical Trials Network, and the Lymphoma Study Association (LYSA) based in France. Researchers measured the patients’ baseline vitamin D blood levels before cancer treatment began and then tracked and analyzed cancer survival data for each group over a minimum median follow-up of 5.5 years.

The researchers found that the adjusted progression-free survival (PFS) hazard ratio [HR] for the 15% of patients in the SWOG cohort who were 

, defined as <20 ng/mL, was 1.97 (95% CI, 1.10-3.53). The overall survival (OS) HR for the vitamin D—deficient patients in the SWOG cohort was 4.16 (95% CI, 1.66-10.44).

For patients in the LYSA cohort who were vitamin D deficient (<10 ng/mL; 25% of cohort), the adjusted HR for PFS was 1.50 (85% CI, 0.93-2.42); the adjusted HR for OS among these patients was 1.92 (95% CI, 0.72-5.13).

“Although statistical significance was not reached in the LYSA cohort, the consistent estimates of association between low vitamin D levels and follicular lymphoma outcomes in two independent cohorts suggest the serum vitamin D might be the first potentially modifiable factor to be associated with follicular lymphoma survival,” the authors wrote.

Large differences in vitamin D levels among the patients in the two cohorts prevented scientists from being able to recommend an optimal level of vitamin D for follicular lymphoma patients, but future research might support prescribing vitamin D supplements for patients at the earliest point of follicular lymphoma treatment, when patients are typically monitored closely but have not begun active therapy. It has also been theorized that vitamin D may represent a proxy or biomarker for better health going into cancer treatment.

“However, the mechanisms of this link are likely complex and require further study,” Friedberg said.

Follicular lymphoma is generally incurable, although it is slow-growing, and many people live for years with the disease. While treatments have improved, a subset of patients can have an aggressive form of the disease for which therapy is not as effective.

Better ways to predict the course of the disease are needed, and this is where vitamin D levels might provide a previously unidentified but modifiable factor associated with prognosis, Friedberg said.

Kelly JL, Salles G, Goldman B, et al. Low serum vitamin D levels are associated with inferior survival in follicular lymphoma: a prospective evaluation in SWOG and LYSA studies [published online March 30, 2015]. 

Low Vitamin D Levels Linked to Worse Outcomes in Follicular Lymphoma

Many women who are diagnosed with breast cancer are concerned about the genetic risk of developing other cancers themselves or of a loved one developing cancer. However, a large amount of those concerns are not being addressed, according to a new study.

The study, published early online in the 

, found that 35% of breast cancer patients expressed a strong desire for genetic testing, but 43% of those women did not have a relevant discussion with a healthcare provider. 

“Our findings suggest a marked unmet need for discussion about genetic risk,” study author Reshma Jagsi, MD, DPhil, associate professor of radiation oncology at the University of Michigan Medical School, said in a statement.

Approximately 5% to 10% of patients with breast cancer have an inherited genetic mutation that drives their cancer. In addition, many women who reported interest in genetic testing were at low risk of having a mutation, and thus, doctors would not have typically discussed genetic risk with them.

“With recent judicial opinions, direct-to-consumer marketing, and celebrity reports, the public has become much more aware that genetic testing is available,” Jagsi said. “But genetic risk is complex. Even patients unlikely to have elevated genetic risk may still benefit from a discussion.”

For the study, researchers surveyed 1536 women who had been treated for breast cancer identified through the SEER databases from Detroit and Los Angeles.

The results showed that 35% of these women expressed a strong desire for genetic testing, 28% reported discussing testing with a healthcare professional, and only 19% reported undergoing genetic testing.

Younger women, Spanish-speaking Latinas, and those with a family history of cancer expressed the strongest desire for genetic counseling.

Minority patients were also significantly more likely to have an “unmet need for discussion” concerning genetic counseling, with results showing Spanish-speaking Latinas being nearly five times more likely to experience this unmet need compared with white, non-Spanish speaking patients.

The results also found that the patients who had a strong desire for testing reported being worried that other members of their family might get breast cancer in the future.

This worry was highest among Latinas who spoke only Spanish, with 83% reporting this concern. These women were also more likely to report worry about their own risks when evaluated in long-term follow-up as survivors.

Nearly half of those who had an unmet need for discussion about genetic testing were worried about breast cancer, and only a quarter of those who did not have an unmet need reported this worry.

 podcast, Jennifer E. Axilbund, MS, CGC, a genetic counselor at the Johns Hopkins Breast Center, pointed out that this study “highlights the discrepancy between perceived risk and actual risk.”

“As the participants were identified through SEER registries, one would assume that the majority of respondents were not appropriate for genetic testing,” Axilbund continued. “Yet, depending on race and ethnicity, up to 60% of respondents had a strong desire for genetic testing, whereas only around 10% would be expected to actually meet indications for testing.”

Axilbund mostly attributed this trend to the lack of understanding of breast cancer genetics and the fact that only a small percentage of breast cancers can be connected to known genetic mutations. 

The study authors also attributed the desire for genetic testing to ongoing media coverage of breast cancer genetic testing.

“Much of this coverage focuses on sensational issues, such as prophylactic mastectomy in young, healthy women, rather than the limited utility of current genetic testing to truly define risk,” Axilbund said.

Therefore, all patients may benefit from a discussion of genetic risk, even if the patient is perceived to be at low risk, as this may increase education on the subject and also reduce worry, the authors concluded.

“By addressing genetic risks with patients, we can better inform them of their true risk of cancer returning or of developing a new cancer,” Jagsi said. “This could potentially alleviate worry and reduce confusion about cancer risk.” 

An Unmet Need-Discussing Genetic Risk May Benefit All Patients With Breast Cancer 

The link between diabetes and late-stage breast cancer is strong, according to a new study.

, found that breast cancer patients with diabetes were significantly more likely to be diagnosed with advanced-stage breast cancer than those without diabetes.

“Our findings suggest that women with diabetes may be predisposed to more advanced-stage breast cancer, which may be a contributor to their higher cancer mortality,” Lorraine Lipscombe, MD, MSc, FRCPC, a scientist at the Institute for Clinical Evaluative Sciences and Women’s College Research Institute in Toronto said in a statement.

Although women with diabetes have higher breast cancer incidence and mortality, the link between diabetes and breast cancer stage at diagnosis has not been examined.

The study examined the stage at diagnosis among more than 38,000 Canadian women aged 20-105 years who were newly diagnosed with invasive breast cancer between 2007 and 2012. Of those women, 15.9% had diabetes.

The study found that women with diabetes were 14% more likely to be diagnosed with stage II breast cancer, 21% more likely to have stage III disease, and 16% more likely to have stage IV breast cancer, than to present with stage I.

Researchers also found that women with diabetes had a higher risk of lymph node metastases and tumors larger than 2 centimeters.

“In addition, the risk of advanced-stage breast cancer was greatest in younger women and those with longer standing diabetes,” Lipscombe said.

The later stage diagnosis translated into a 15% decrease in 5-year survival for diabetes patients at the time of cancer diagnosis. 

According to researchers, diabetes was associated with more advanced-stage breast cancer even after accounting for differences in screening mammogram use and other factors.

Therefore, the results show that diabetes may predispose individuals to more aggressive breast cancer, which may be a contributor to their higher cancer mortality.

Lipscombe LL, Fischer HD, Austin PC, et al. The association between diabetes and breast cancer stage at diagnosis: a population-based study. 

Christina Izzo