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Less chemotherapy better for older or frail patients with advanced stomach and oesophageal cancers

Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced..

Less chemotherapy is as effective at controlling disease for elderly or frail patients with advanced cancer of the stomach or oesophagus (food pipe), and leads to fewer side effects such as diarrhoea and lethargy. These are the results of a Cancer Research UK funded study, presented prior to the ASCO conference today (Wednesday).

“Increasingly were realising its not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role.” Dr Peter Hall, Cancer Research UK Edinburgh Centre[contfnewc]

Results from the GO2 trial could change the standard of care for patients who cant have full dose chemotherapy due to their age, frailty or medical fitness.

The study, which ran at hospitals all over the UK, coordinated from the University of Leeds, involved 514 people with stomach or oesophageal cancer. Their average age was 76 and the oldest was 96 years old. All were either frail, elderly or medically unfit, and for those reasons would be unlikely to tolerate full-strength treatment, which involves three chemotherapy drugs.

Patients went through a careful medical assessment, then went onto chemotherapy with just two drugs* and were allocated at random to receive them at either full-strength, medium-dose or low-dose. They were then carefully monitored to see how well the cancer was controlled, whether they had symptoms and side-effects, whether they felt their treatment was worthwhile, and what overall effect it had on their quality of life.

The researchers reported that the medium and lower doses of chemotherapy were as effective as the full-strength dose for controlling the cancer. But when the researchers looked at the overall effect of treatment, including quality of life, they reported that it was the lowest dose treatment that came out best.**

Around 15,800 people in the UK are diagnosed with stomach and oesophageal cancers every year***. Almost half (45%) of these people are 75 and over****. By 2035, this proportion is projected to rise to 55%*****, because of the UKs ageing population. This study, is one of few phase III trials in the country that seek to address how to best care for and treat this increasing population of elderly or frail cancer patients.

These findings also open up the possibility of more older and frail patients being able to take part in clinical trials.

Professor Charles Swanton, Cancer Research UKs chief clinician, said: “These valuable results reduce fears that giving a lower dose chemotherapy regimen is inferior and could make a huge difference for patients with stomach or oesophageal cancer who cant tolerate intensive courses of treatment.

“Older or frail patients are often not considered for new drug trials or standard of care therapy as theyre less able to tolerate combination chemotherapy. These trials are critical to provide much needed evidence on the effectiveness of new therapies and combination approaches, helping us develop new treatments for this growing group of patients.”

The researchers also assessed whether there were differences for the patients in the study who were under 75, or less frail, who might be expected to benefit from stronger treatment; but will be reporting that the lowest dose treatment gave the best results for them as well.

Professor Matt Seymour, co-chief investigator at the University of Leeds and Leeds Teaching Hospitals NHS Trust said: “When were treating people who are elderly or frail, we are especially conscious that treatment can have harmful as well as beneficial effects. Doctors often prescribe reduced doses of drugs, or sometimes no chemotherapy at all, based on their clinical experience, but until now there has been little hard evidence to help them in those decisions. Our results provide that evidence, so doctors can confidently give people a lower dose of chemotherapy, sparing them side effects without worrying that its compromising their chance of survival.

“We hope this approach can be applied in other disease types so that more work can be done to improve both survival and quality of life for elderly and frail patients.”

Liz Chipchase, from Cambridge, was diagnosed with oesophageal cancer in 2017 at 69 years old. She had two non-invasive surgeries under sedation to remove the cancerous cells and didnt require any additional treatment.

She said: “When I was diagnosed with oesophageal cancer, I was lucky that it was caught early enough that I didnt need chemotherapy. I was offered the choice between two different surgeries, giving me the opportunity to select the treatment I thought was best for me.

“Trials like this are important to empower people with choices that give them control over how theyre treated – something I was fortunate to have. Any research that can help improve the quality of life for other patients is essential, so its great to see results like these doing exactly that.”

Dr Peter Hall, co-chief investigator from the Cancer Research UK Edinburgh Centre, said: “Increasingly were realising its not just age that affects how well someone can tolerate their treatment and we need to do more work to understand how other conditions or aspects of frailty might play a role.

“We should now look beyond chemotherapies, at some of the newer targeted therapies or immunotherapies to understand how we can tailor different treatments to patients based on their individual circumstance.”

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References

* The chemotherapy drugs used in this study were oxaliplatin (an intravenous infusion given at the hospital once every three weeks) and capecitabine (tablets, taken at home twice daily)

**The study assessed the effects of treatment on quality of life, as well as survival using a measure called Overall Treatment Utility (OTU). This measure was developed by the researchers as part of a previous Cancer Research UK-funded trial, and takes into account: clinical response, toxicity, adverse events, quality of life and the patients own reported acceptability of the treatment.

***Based on the average number of new cases of oesophageal (C15) and stomach (C16) cancer diagnosed in the UK in 2014-2016.

****Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016.

*****One-year age standardised net cancer survival by stage at diagnosis for oesophageal (IC10 C15) and stomach (ICD10 C16) cancer in adults (15-99 years), diagnosed in England between 2012-2016 and followed up to 2017.

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World Bank and WHO Statement on Partnership & Deployment of Financing to WHO for Ebola Response in DRC

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the G..

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the Government and other key partners, are working in close partnership on the Ebola Crisis Response in the Democratic Republic of the Congo (DRC). Central to this partnership is the assessment of the financing needs, and deployment of resources, with the goal to put an end to the current deadly outbreak.

The World Bank is today announcing that US$50 million in funding is to be released to WHO for its lifesaving operational work on the frontlines of the outbreak. The WHO is announcing that this US$50 million in funds will close the financing gap for its emergency health response in DRC through to the end of September 2019, and is calling on other partners to mirror this generous support in order to fund the response through to December.

The funding comprises US$30 million from the Pandemic Emergency Financing Facility (PEF) and US$20 million from the World Bank. The US$50 million in grant funding is part of the larger financial package of approximately US$300 million that the World Bank announced last month to support the fourth Strategic Response Plan for the DRC Ebola outbreak.

“WHO is very grateful for the World Banks support, which fills a critical gap in our immediate needs for Ebola response efforts in DRC, and will enable the heroic workers on the frontlines of this fight to continue their lifesaving work,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “We keenly await further funding from other partners to sustain the response through to the end of the year.”

The DRC government, working in collaboration with the World Bank, WHO, and other key partners, has finalized the Fourth Strategic Response Plan (SRP4), which outlines the total resources needed for the DRC Ebola Crisis Response from July to December 2019. The financing announced today is part of the World Banks previously announced financial package of up to US$300 million and covers over half of SRP4s needs, with the remainder requiring additional funding from other donors and partners.

“The World Bank is working closely with WHO, the Government of DRC, and all partners to do everything we can to put an end to the latest Ebola outbreak,” said Annette Dixon, Vice President, Human Development at the World Bank. “The partnership between our organizations and the Government is critical for responding to the emergency as well as rebuilding systems for delivery of basic services and to restoring the trust of communities.”

The Government of DRC requested US$30 million from the PEF Cash Window to be paid directly to WHO. The PEF Steering Body approved the request bringing the PEFs total contribution to fighting Ebola in DRC to US$61.4 million. The PEF is a financing mechanism housed at the World Bank; its Steering Body is co-chaired by the World Bank and WHO, and comprises donor country members from Japan, Germany and Australia. The quick and flexible financing it provides saves lives, by enabling governments and international responders to concentrate on fighting Ebola—not fundraising.

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Borno State launches first Malaria Operational Plan, reawakens fight against malaria

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nige..

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nigeria, the Malaria Annual Operational Plan (MAOP) was developed and launched on 08 August 2019 with technical support from the World Health Organization (WHO) and partners. Aligned to the National Malaria Strategic Plan (2014 -2020), MAOP was developed through a broad-based stakeholders workshop involving malaria stakeholders, reviewed on different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary, Borno State Ministry of Health.

Speaking during the launch, the Borno state Malaria Programme Manager, Mr Mala Waziri described the MAOP as the first to be endorsed and disseminated in Borno State. “WHO has made us proud by supporting the first ever Malaria Operational Plan right from development, review, printing to dissemination.”

Dr Ibrahim Kida, the Ministerial Secretary Borno State Ministry of Health and Incident Manager of the state, described the launch as “an historic event as stakeholders across the health sector made commitments to use the document as an implementation guide for all malaria programs”. The plan was also described as an advocacy tool for planning domestic funds mobilization.

The MAOP has seven objectives among which are: provide at least 50% of targeted population with appropriate preventive measures by 2020; ensure that all persons with suspected malaria who seek care are tested with Rapid Diagnostic Test (RDT) or microscopy by 2020 and all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020.

The MAOP will further ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020, ensuring timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020.

In addition, it seeks to ensure that all health facilities report on key malaria indicators routinely by 2020 and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an A rating by 2020 on a standardized scorecard. These strategic objectives have specific targets and the MAOP takes into account the humanitarian response.

“Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden,” says Dr Nglass Ini Abasi, WHO Malaria Consultant for the North East.

“Furthermore, 81,640 deaths are recorded annually (9 deaths every hour), which accounts for 19% of global malaria deaths (1 in 5 global malaria deaths) and 45% malaria deaths in West Africa. The Nigeria Malaria Strategic Plan (NMSP) 2014-2020 has a goal to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero and WHO is working assiduously with Government to ensure the burden is reduced accordingly.”

Results from WHO’s Early Warning, Alert and Response System (EWARS) week 30 report from 223 sites, (including 32 IDP camps) show that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported deaths. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1million people are in dire need of healthcare and 6.2million are targeted for immediate attention.

Despite recent improvements, insecurity remains a challenge limiting access to the functional health facilities. Easily preventable and treatable diseases such as malaria, acute respiratory infection and diarrheal diseases account for the greatest proportion of morbidity and mortality among the vulnerable population. Furthermore, Malaria is endemic in North East Nigeria and the transmission is perennial with a marked seasonal peak from July to November every year. (more…)

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Nearly half of all dengue deaths in the Philippines are children under nine years old

Manila, August 16 – At least 300 children aged 5-9 have died in the recent Dengue outbreak in the Ph..

Manila, August 16 – At least 300 children aged 5-9 have died in the recent Dengue outbreak in the Philippines, Save the Children said today, amid fears the epidemic could claim many more lives before its brought under control. In the first seven months of 2019, some 170,000 people were infected with the disease, killing 720 people – 42 percent were children between 5 and 9 years old. Compared to the same period in 2018, this years dengue caseload is 97 per cent higher. The virus is disproportionately affecting children and young people with a staggering 73 per cent of recorded cases under the age of 19.

Albert Muyot, ceo of Save the Children in the Philippines, said: “Hundreds of children have sadly already died, we expect the numbers to rise. The rainy season started late and will continue this month, creating the perfect breeding ground for dengue mosquitoes.

“Children are particularly a vulnerable to the disease because their immune systems are weaker than adults and they tend to play outside where theres less protection against the mosquitos. Schools in particular are a hotbed of dengue because many have open windows and lack mosquito repellents.

“It is extremely important that health authorities step up their information campaigns in schools, communities and other places where people come together, so people know what to do if they suspect dengue. Also, the government must step up their fumigation campaign to kill adult dengue mosquitoes in densely populated areas.

“In the Philippines, we are working with schools and communities to improve awareness on how to prevent infection. To save lives, children need extra protection. Wearing long sleeves and trousers is one of the simple measures to protect against being bitten. Early diagnosis is critical and we are raising awareness of those symptoms, like fever and body pain, and encouraging all parents to take their children to hospital immediately if they have concerns.

“Save the Children is referring child dengue cases to health centers in vulnerable communities in Navotas, Caloocan and Malabon as well as in conflict-affected provinces in Bangsamoro Automous Region in Muslim Mindanao (BARMM).”

Notes to editors:

  • Dengue causes flu-like illness, including a sudden high fever coming in separate waves, pain behind the eyes, muscle, joint and bone pain, severe headache, and a skin rash with red spots. People with symptoms get ill between 4 to 7 days after a bite from an infected Aedes mosquito.
  • The illness can become the fatal Severe Dengue, characterised by severe abdominal pain, vomiting, diarrhoea, convulsions, bruising, uncontrolled bleeding, and high fever which can last from 2 to 7 days.
  • Complications can lead to circulatory system failure, shock, and death.
  • There were 167,607 dengue cases between January-July 2019, up from 85,011 in the same period in 2018.
  • Of the 167,607 recorded cases of dengue between January and July 2019, 121,942 were under the age of 19.
  • On August 6th, the government declared a national dengue epidemic.
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