It’s Time to Rethink 4 Unique Cancer Terms

 

The words we use in our communication with others, either verbally or in writing, may substantially affect the message being delivered. Of course, what is heard by the receiving party may not necessarily be identical to what we intend to convey. When one is dealing with the topic of cancer, its treatment and consequences, language that clinicians and members of the cancer research community use may have an even greater impact.

 

During 40 years of working in the oncology arena, I have witnessed the effects of certain words and terms commonly employed within the professional establishment whose unclear meaning and implications for patients, their families, and the general public may not have been adequately considered. Further, they may have resulted in unfortunate confusion rather than enlightenment. The following commentary highlights my perspective on several of these terms.

 

PALLIATIVE CARE

To palliate, “to make a disease or symptoms less severe or unpleasant without removing the cause” as defined in one English-language dictionary, is a critical goal of medicine, particularly for clinicians dealing with the manifestations of malignant disease. Critically, there is nothing in this definition that speaks to advanced, progressive, incurable, or end-stage illness. The term simply implies a specific therapeutic focus on directly controlling clinically meaningful symptoms, such as administering effective pain medications, rather than a more indirect effect resulting from the rapid or longer-term successful treatment of cancer. This could include, for example, alleviating abdominal pain from the reduction of peritoneal carcinomatosis in response to cytotoxic drug delivery. Although such strategies have become increasingly relevant in cancer management, the term palliative care or, more specifically, a clinical palliative care service, has become essentially synonymous to many patients and their families with end-of-life care. It is not uncommon for patients with cancer to initially decline the opportunity to benefit from the expertise of a first-class palliative care team simply because they assume that this focus on symptom management is inconsistent with the goal of maximizing efforts to prolong survival. As a result, a strong argument can be made to educate both the public and our own clinical colleagues that, although optimal palliation of symptoms is essential when providing end-of-life care, this specific focus and expertise has the potential to be beneficial to patients throughout their cancer journey.

 

COMPLEMENTARY ALTERNATIVE MEDICINE

It is difficult to identify a clinically related concept that is more inaccurate, distorted, misleading, and potentially dangerous than that of complementary and alternative medicine (CAM). Complementary, or the more appropriate term used today—integrative—clearly implies the use of a wide variety of approaches designed to optimize the quality of life and enhance symptom management during the course of standard antineoplastic therapy. These strategies range from spiritual and behavioural medical support to far less fully understood interventions, such as acupuncture. The critical point here is that there is nothing “alternative” about such interventions because in this model of care they simply do not substitute for known effective anticancer therapeutics. Lumping these completely different concepts together in the expression CAM delivers an inappropriate message regarding the medically legitimate goals of integrative oncology care. Take, for example, one rather bizarre report that appeared in a peer-reviewed journal several years ago. Investigators examined records in the National Cancer Database of 1,901,815 patients treated from January 1, 2004, through December 31, 2013, and identified individuals “who received complementary medicine,” as self-reported by 258 patients, or 0.01% of the total population in this database. The authors concluded that these patients were more likely to refuse conventional cancer treatment and experience inferior survival compared with those who did not list an interest in this approach to cancer care.1 In addition to the profoundly inadequate sample size for drawing any meaningful conclusions, the authors’ decision to consider individuals interested in alternative approaches to conventional therapy as being equivalent to those desiring an integrative strategy focused on enhancing the quality of life while undergoing state-of-the-art oncology care either unintentionally or intentionally distorts facts. The term CAM simply needs to be discarded, never again to be used by cancer specialists, other clinicians, or members of the research community.

 

PRECISION CANCER MEDICINE

As relevant as the term precision cancer medicine has become in describing a focus of modern anti-neoplastic drug delivery, there remains a serious issue with the way in which many in the oncology community are using it. Precision cancer medicine refers to a specific goal of our treatment paradigm: to become ever more precise in favourably impacting cancer-relevant molecular targets, measured by improved objective response rates, time to disease progression, or overall survival. The term does not refer to a specific time or event, such that one can declare treatment has achieved a state of being optimally “precise.” The fact that a particular trial of a theorized relevant drug-target combination has failed to reveal the benefits of that approach does not signify a failure of the process of precision cancer medicine. Rather, this outcome serves as an example of how the process should work, discarding approaches that have not demonstrated meaningful benefit while continuing to examine other novel strategies that will hopefully, following appropriate clinical investigation, achieve the desired goal.

 

CURE

There is probably a no more powerful word in all of oncology, and no potential question associated with more fear following the diagnosis of cancer, than when a patient or family member inquires: “Will I or my loved one be cured?” Of course, as all oncologists know, the answer to this question can be quite complex, depending on the tumour type, disease stage, and other considerations. The point here is that even when “cure” is a realistic—or at least not irrational—goal of therapy, achieving this clinical state, with important exceptions such as non-melanoma skin cancers, is something one only knows with reasonable medical certainty at some point in the future. Depending on the natural history of the specific malignancy in question, this may represent a period of many years into that future. Providing an honest but also encouraging and hopeful response is one of the first important challenges facing treating oncologists as they begin to assist patients through their cancer survivorship journey.

 

Long-term face mask use will not cause lung cancer

The claim: Long-term mask-wearing may cause advanced-stage lung cancer, one study shows

It is well-known by now masks can help prevent the spread of the novel coronavirus. New data from the U.S. Centers for Disease Control and Prevention recommends even better prevention with double masking. But one social media post claims wearing a mask may cause serious harm in the long run.

 

“Long-Term Mask Use May Contribute to Advanced Stage Lung Cancer, Study Finds,” asserts a Jan. 29 article from BlackListed News, an independent news platform known to publish pseudoscience and conspiracy-related content.

 

How exactly this alarming condition arises is through the “inhalation of harmful microbes” into the lung that has been “cultivated through prolonged mask-wearing,” writer Phillip Schneider claims.

 

He also provides quotes from lead author Dr Leopoldo Segal, director of New York University Langone’s Lung Microbiome Program, explaining the scientific basis for these microbes’ destructive effect, and ties the study’s discovery to the larger trend of purported evidence against mask-wearing.

 

BlackListed News did not return USA TODAY’s request for comment.

 

Fact check: Masks encouraged on federal lands if distancing isn’t possible

 

Oral bacteria can lead to poor lung cancer prognosis and progression

The human body is a host to millions of different kinds of microorganisms inhabiting both the skin surface and deep within various organs, such as the gastrointestinal tract. These bacteria, viruses, fungi and other life forms – the microbiome – play a key role in maintaining health and preventing disease. Shifts in the microbiome because of ageing, long-term dieting, stress or pharmaceutical drugs have been linked to conditions like obesity, depression and autoimmune diseases, among many others.

 

They can even contribute to cancer, as some emerging research has found. Segal’s study particularly looked at how the microbiome within the lungs – previously believed a sterile, microorganism-free environment – plays into the development of lung cancer, a disease afflicting over 2 million people worldwide and responsible for nearly 1.8 million deaths in 2018, according to the World Health Organization.

 

Story continues

 

The study analyzed the lung microbiomes of 83 untreated adult patients with lung cancer and found that patients with advanced-stage lung cancer (stage III to IV) “had greater enrichment of oral commensals in the lung than those who had the early-stage disease (stages 1-3a),” stated a November news release on the study from the American Association for Cancer Research. Oral commensals are simply oral bacteria.

 

Some of those bacteria are the same ones typically found in the respiratory tract’s lower airways, such as Prevotella and Veillonella, both of which can cause oral infections and mingle with Streptococcus to form dental plaque (in the case of Veillonella).

 

These oral bacteria were found to be associated with “decreased survival, even after adjusting for tumour stage.” Veillonella, Prevotella and Streptococcus, in particular, were associated with poor prognosis. All three, plus another bacteria making up the mouth’s normal flora, Rothia, were associated with tumour progression.

 

The study did report that one limitation to its findings – aside from the study size being too small to allow for patient stratification into subgroups – was that since lung microbiomes were sampled before patients undergoing their respective cancer treatments, “changes resulting from treatment could not be assessed.”

 

Fact check: Posts use 2012 photo of Magic Johnson to falsely claim he donated blood

 

No correlation of long-term mask-wearing with lung cancer

USA TODAY reviewed the study’s paper published online this month: Nowhere is long-term mask-wearing mentioned or even alluded to.

 

Segal and another author, Dr James Tsay of NYU’s Grossman School of Medicine, told Reuters their study did not involve long-term mask-wearing, and that, “currently there is no scientific evidence to this misinterpretation of our result.”

 

The study’s participants were individuals recruited from NYU’s Lung Cancer Biomarker Center between March 2013 and October 2018, before the pandemic. Tsay stated that “since mask-wearing was not common during our study period, it is highly unlikely it is one of the reasons that contribute to our findings.”

 

“The main source of these bacteria to the lung is the mouth and oropharynx (the part of the pharynx that is behind the mouth) itself,” said Segal, explaining these oral bacteria are in “pretty much every individual” and how much is present depends on oral hygiene and food intake.

 

In an email to USA TODAY, Schneider, the author of the BlackListed News article, acknowledged it was his personal view “this study suggests that prolonged mask-wearing may breed microbes which contribute to advanced-stage lung cancer.” Schneider did not say whether he verified his inference with the study’s authors but did add a clarification to the article on his website. This revision has not been made to the original BlackListed News article.

 

Fact check: Masks encouraged on federal lands if distancing isn’t possible

 

No evidence mask-wearing poses danger to health

Claims regarding whether face masks work against COVID-19, are detrimental to health (causing oxygen reduction or excessive blood carbon dioxide levels) or violate constitutional amendments have been debunked numerous times.

 

The claim in November alleging people were arriving in intensive care units sick with pneumonia from mask-wearing has also been debunked.

 

While bacteria and other microorganisms can collect on the inside of a mask, microbiologist Patrick Grant of Florida Atlantic University told CBS Florida affiliate CBS12 that whatever collects does not have the potential to harm unless it is allowed to build up; borrowing someone else’s mask is also ill-advised.

 

The CDC recommends storing cloth masks properly – either in plastic bags for damp masks, paper bags for dry or clean ones – and washing regularly, making sure to dry thoroughly. Disposable masks should be thrown away after one use.

 

Fact check: Post distorts WHO’s COVID-19 PCR testing guidelines

 

Our rating: False

The claim that long-term mask-wearing was found by one study to contribute to advanced-stage lung cancer is FALSE, based on our research. The study, headed by Dr Leopoldo Segal, director of NYU’s Lung Microbiome Program, found patients with advanced-stage lung cancer had greater amounts of oral bacteria in the lungs compared to early-stage patients. The presence of these bacteria was associated with decreased survival, poor prognosis and tumour progression. Nowhere is the impact of long-term mask-wearing or the relationship with lung cancer mentioned or alluded to. The writer of the article making the claim stated that the relationship was his personal view. There is no evidence to suggest masks, the only effective means to prevent COVID-19 transmission, instead cause disease.

 

Our fact-check sources:

Centres for Disease Control and Prevention, Feb. 10, “Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021”

 

Media Bias/Fact Check, accessed Feb. 16, “Blacklisted News”

 

Nature, Jan. 29, 2020, “The complex relationship between drugs and the microbiome”

 

The New York Times, Sept. 10, 2019, “Seeking an Obesity Cure, Researchers Turn to the Gut Microbiome”

 

Science Magazine, May 7, 2020, “Meet the ‘psychobiotic: the gut bacteria that may alter how you think, feel, and act”

 

Nature, Jan. 29, 2020, “Could a bacteria-stuffed pill cure autoimmune diseases?”

 

Nature, Jan. 29, 2020, “Fighting cancer with microbes”

 

The Journal of Immunology, June 15, 2016, “The Lung Microbiome, Immunity, and the Pathogenesis of Chronic Lung Disease”

 

The World Health Organization, Sept. 12, 2018, “Cancer”

 

American Association for Cancer Research, Nov. 11, 2020, “The Lung Microbiome May Affect Lung Cancer Pathogenesis and Prognosis”

 

American Journal of Respiratory and Critical Care Medicine, June 2, 2011, “Topographical continuity of bacterial populations in the healthy human respiratory tract”

 

Journal of Bacteriology, June 3, 2015, “Interaction between Streptococcus spp. and Veillonella tobetsu ensis in the Early Stages of Oral Biofilm Formation”

 

Journal of Microbiological Methods, Jan. 10, 2017, “Isolation and identification methods of Rothia species in oral cavities”

 

Cancer Discovery, Feb. 1, “Lower Airway Dysbiosis Affects Lung Cancer Progression”

 

Reuters, Feb. 4, “Fact check: No evidence linking masks to oral bacteria and to lung cancer; article refers to the study that did not involve masks”

 

USA TODAY, Jul. 27, 2020, “Fact check: What’s true and what’s false about face masks?”

 

CBS12, Nov. 20, 2020, “Bacteria is growing on your mask”

 

U.S. Centers for Disease Control and Prevention, Oct. 28, 2020, “How to Store and Wash Masks”

 

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or electronic newspaper replica here.

 

Our fact check work is supported in part by a grant from Facebook.

 

This article originally appeared on USA TODAY: Fact check: Long-term face mask-wearing does not cause lung cancer