tag:theconversation.com,2011:/id/topics/brain-tumour-3158/articlesBrain tumour – The Conversation2023-10-30T01:37:44Ztag:theconversation.com,2011:article/2165342023-10-30T01:37:44Z2023-10-30T01:37:44ZBrain tumours can bring long-term disability – but some diagnosed are being refused NDIS support<figure><img src="https://images.theconversation.com/files/556271/original/file-20231027-27-bv58zn.jpg?ixlib=rb-1.1.0&rect=56%2C113%2C9432%2C6203&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-patient-ready-do-magnetic-1949322067">Shutterstock</a></span></figcaption></figure><p>The ABC <a href="https://www.abc.net.au/news/2023-10-29/palliative-care-terminal-illness-ndis/102934026">is reporting</a> how terminally ill patients are being left in limbo as the states and the National Disability Insurance Scheme (NDIS) argue over disability supports. The reports share the experiences of Australians with brain tumours and highlight the distress of getting a diagnosis, as well as the lack of support <a href="https://www.abc.net.au/news/2023-09-12/ndis-battle-for-family-of-cancer-patient-spencer-barton/102843554">people can experience</a>.</p>
<p>Those living with what is at once a serious illness, disability and a potentially life-limiting condition can be caught <a href="https://theconversation.com/the-ndis-promises-lifelong-support-but-what-about-end-of-life-support-for-people-with-disability-199990">between</a> the NDIS, the health system and palliative care. A <a href="https://www.ndisreview.gov.au/">review of the NDIS</a> is due to be released soon, following a year of investigations into eligibility, sustainability and how costs and supports should be split between the NDIS and the states.</p>
<p>How can we support people better and make sure they don’t fall between the gaps? </p>
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Read more:
<a href="https://theconversation.com/the-ndis-promises-lifelong-support-but-what-about-end-of-life-support-for-people-with-disability-199990">The NDIS promises lifelong support – but what about end-of-life support for people with disability?</a>
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<h2>Brain tumours may not be a death knell</h2>
<p>About <a href="https://www.canceraustralia.gov.au/cancer-types/brain-cancer/statistics#:%7E:text=3%2C392-,New%20cases,1%2C173%20males%20and%20744%20females">1,900 Australians</a> are diagnosed with brain tumours each year. </p>
<p>Around <a href="https://curebraincancer.org.au/about-us/facts-and-stats">22% of those diagnosed survive beyond five years</a>. And some <a href="https://www.aihw.gov.au/getmedia/ea870f59-a9e4-4772-8fa8-e1206b56a552/cancer-data-in-australia.pdf?v=20210607152619&inline=true">68% of people</a> aged 20 to 39 have at least a five-year relative survival rate after a brain cancer diagnosis. </p>
<p>Brain tumours and their treatments can cause <a href="https://pubmed.ncbi.nlm.nih.gov/23584801/">substantial disability</a>. This may include paralysis (often hemiplegia, which is when one side of the body is affected), cognitive and sensory changes, seizures and mental health conditions. </p>
<p>People may therefore need substantial support to communicate, travel outside of the home, socialise and interact with others, or take care of their daily needs. </p>
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Read more:
<a href="https://theconversation.com/brain-tumors-are-cognitive-parasites-how-brain-cancer-hijacks-neural-circuits-and-causes-cognitive-decline-205901">Brain tumors are cognitive parasites – how brain cancer hijacks neural circuits and causes cognitive decline</a>
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<h2>Brain tumours and the NDIS</h2>
<p>The NDIS is meant to <a href="http://www5.austlii.edu.au/au/legis/cth/consol_act/ndisa2013341/s30.html">support people with disability</a> up to the age of 65 and beyond if they are already participants of the scheme. But some Australians diagnosed with brain tumours say they are being denied <a href="https://www.abc.net.au/news/2023-09-12/ndis-battle-for-family-of-cancer-patient-spencer-barton/102843554">access to the scheme</a>. Others report having their <a href="https://www.abc.net.au/news/2023-10-09/jim-mills-chose-voluntary-assisted-dying-palliative-care-ndis/102928986">NDIS funding cut</a>. </p>
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<figcaption><span class="caption">People with brain tumours have had their requests for support denied. In some cases, the decisions have been overturned on appeal.</span></figcaption>
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<p>To meet the disability requirements of the <a href="http://www5.austlii.edu.au/au/legis/cth/consol_act/ndisa2013341/s24.html">NDIS Act</a> a person must have an impairment that is likely permanent and requires lifelong support. The National Disability Insurance Agency (NDIA), which administers the scheme, uses the <a href="https://www.dss.gov.au/sites/default/files/documents/09_2021/ndis-principles-determine-responsibilities-ndis-and-other-service-1.pdf">Applied Principles and Tables of Support</a> to assess eligibility under the scheme or whether another government department should be responsible.</p>
<p>These decisions can cause considerable frustration and distress for patients, families, advocacy groups, palliative care clinicians and NDIS providers. The <a href="https://ourguidelines.ndis.gov.au/home/becoming-participant/applying-ndis/do-you-meet-disability-requirements">NDIS Operational Guidelines</a> state:</p>
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<p>It doesn’t matter what caused your impairment, for example if you’ve had it from birth, or acquired it from an injury, accident or health condition.</p>
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<p>But without clear guidelines to spell out what functional supports are provided by each system, it is difficult to determine how the NDIA makes access and planning decisions.</p>
<p>Brain tumours are often life-limiting, but other life-limiting conditions that impact a person’s function are listed as likely to meet the disability requirements. These conditions <a href="https://ourguidelines.ndis.gov.au/home/becoming-participant/applying-ndis/list-conditions-are-likely-meet-disability-requirements">include</a> <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/trisomy-disorders">Patau syndrome</a>, <a href="https://www.ninds.nih.gov/health-information/disorders/leigh-syndrome#:%7E:text=Leigh%20syndrome%20is%20a%20rare,Poor%20sucking%20ability">Leigh syndrome</a> and <a href="https://www.ninds.nih.gov/health-information/disorders/canavan-disease#:%7E:text=Canavan%20disease%20is%20a%20neurological,makes%20an%20enzyme%20called%20aspartoacylase.">Canavan disease</a>, <a href="https://ourguidelines.ndis.gov.au/home/becoming-participant/applying-ndis/list-b-conditions-are-likely-result-permanent-impairment">motor neurone disease</a> and Parkinson’s disease. </p>
<h2>What functional supports can health systems or palliative care provide?</h2>
<p>Many people <a href="https://theconversation.com/what-actually-is-palliative-care-and-how-is-it-different-to-end-of-life-care-205488">confuse</a> palliative care with end-of-life care. When people are referred to palliative care or their medical practitioners adopt a palliative approach to care, they often feel it means they are at the end of their lives. Although palliative care means there will be no further curative treatment for a condition, patients may live for months or years after referral.</p>
<p>The kinds of support Australians receive from palliative care vary widely across the country, particularly in rural and remote areas. Services can help manage clinical symptoms of illnesses such as pain, breathlessness or fatigue. They can also provide some mental health support. </p>
<p>Functional supports such as personal care, domestic assistance, respite, food services or equipment, are usually only provided by palliative care services and some charities as end-of-life care. </p>
<p>People over 65 might be able to access functional support via the aged-care system. If a person under 65 can’t access the NDIS, they may find little or no functional support available until their final weeks of life.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-actually-is-palliative-care-and-how-is-it-different-to-end-of-life-care-205488">What actually is palliative care? And how is it different to end-of-life care?</a>
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<h2>A call for clarity and guidance</h2>
<p>People with life-limiting illnesses, including those featured in the <a href="https://www.abc.net.au/news/2023-10-29/palliative-care-terminal-illness-ndis/102934026">ABC reports</a>, are calling for increased clarity and guidance. Which public health systems are responsible for helping with functional supports? How can they get the support they need to avoid admission to hospital, hospice or residential aged care? </p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/ajag.12843">high costs associated</a> with prolonged hospital stays mean the economic case for helping people to stay at home for as long as possible is strong. But these costs don’t consider the emotional toll that disjointed and chaotic processes can have on patients and families impacted by brain tumours or other life-limiting conditions.</p><img src="https://counter.theconversation.com/content/216534/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Boschen was formerly a senior compliance officer for the NDIS Quality and Safeguards Commission, an advisor for the NDIA Administrative Appeals Tribunal Team, and an NDIA subject matter expert on mental heath access.</span></em></p><p class="fine-print"><em><span>Caroline Phelan receives funding from Australian federal and state governments. </span></em></p>Over 20% of people diagnosed with brain cancer survive longer than five years. But the NDIS may not recognise their need for support to live, work, learn and play.Kathy Boschen, Research Associate, Casual Academic, PhD Candidate, Flinders UniversityCaroline Phelan, Lecturer, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059012023-06-07T12:26:29Z2023-06-07T12:26:29ZBrain tumors are cognitive parasites – how brain cancer hijacks neural circuits and causes cognitive decline<figure><img src="https://images.theconversation.com/files/529651/original/file-20230601-23-o9ysdf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gliomas can form connections with distant areas of the brain, exploiting them for their own spread and growth.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/neuron-system-royalty-free-image/1421511892">Andriy Onufriyenko/Moment via Getty Images</a></span></figcaption></figure><p>Researchers have long known that brain tumors, specifically a type of tumor <a href="https://www.ncbi.nlm.nih.gov/books/NBK441874/">called a glioma</a>, can affect a person’s cognitive and physical function. Patients with <a href="https://rarediseases.info.nih.gov/diseases/2491/glioblastoma">glioblastoma, the most fatal type of brain tumor</a> in adults, experience an especially drastic decline in quality of life. Glioblastomas are thought to impair normal brain functions <a href="https://mayfieldclinic.com/pe-braintumor.htm">by compressing</a> and causing healthy tissue to swell, or competing with them for blood supply. </p>
<p>What exactly causes cognitive decline in brain tumor patients is still unknown. In our recently published research, we found that tumors can not only remodel neural circuits, but that <a href="https://doi.org/10.1038/s41586-023-06036-1">brain activity itself can fuel tumor growth</a>.</p>
<p>We are a <a href="https://scholar.google.com/citations?user=ouLmr_AAAAAJ&hl=en">neuroscientist</a> and <a href="https://scholar.google.com/citations?user=LVHlXIUAAAAJ&hl=en">neurosurgeon</a> team at the <a href="https://herveyjumperlab.ucsf.edu">University of California, San Francisco</a>. Our work focuses on understanding how brain tumors remodel neuronal circuits and how these changes affect language, motor and cognitive function. We discovered a <a href="https://doi.org/10.1038/s41586-023-06036-1">previously unknown mechanism</a> brain tumors use to hijack and modify brain circuitry that causes cognitive decline in patients with glioma.</p>
<h2>Brain tumors in dialogue with surrounding cells</h2>
<p>When we started this study, scientists had recently found that a <a href="https://doi.org/10.1093/neuonc/noaa158">self-perpetuating positive feedback loop</a> powers brain tumors. The cycle begins when cancer cells produce substances that can act as neurotransmitters, proteins that help neurons communicate with each other. This surplus of neurotransmitters triggers neurons to become hyperactive and secrete chemicals that stimulate and accelerate the proliferation and growth of the cancer cells. </p>
<p>We wondered how this feedback loop affects the behavior and cognition of people with brain cancer. To study how glioblastomas engage with neuronal circuits in the human brain, we recorded the real-time brain activity of patients with gliomas as they were shown pictures of common objects or animals and asked to name what they depicted <a href="https://braintumorcenter.ucsf.edu/treatments/surgery/awake-brain-mapping-faq">while they were undergoing brain surgery</a> to remove the tumor. </p>
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<figcaption><span class="caption">Awake brain surgery involves mapping out the function of the areas of the brain around a tumor.</span></figcaption>
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<p>While the patients engaged in these tasks, the language networks in their brains were activated as expected. However, we found that the brain regions the tumors had infiltrated quite remote from known language zones of the brain were also activated during these tasks. This unexpected finding shows that tumors can <a href="https://doi.org/10.1038/s41586-023-06036-1">hijack and restructure connections</a> in the brain tissue surrounding them and increase their activity. </p>
<p>This may account for the cognitive decline frequently associated with the progression of gliomas. However, by directly recording the electrical activity of the brain using <a href="https://doi.org/10.1093/med/9780190228484.003.0030">electrocorticography</a>, we showed that despite being hyperactive, these remote brain regions had significantly reduced computational power. This was especially the case for processing more complex, less commonly used words, such as “rooster,” in comparison with simple, more commonly used words, such as “car.” This meant that brain cells entangled in the tumor are so compromised that they <a href="https://doi.org/10.1038/s41586-023-06036-1">need to recruit additional cells</a> to carry out tasks previously controlled by a smaller defined area.</p>
<p>We make an analogy to an orchestra. The musicians need to play in synchrony for the music to work. When you lose the cellos and the woodwinds, the remaining musicians can’t deliver the piece as effectively as when all players are present. Similarly, when brain tumors hijack the areas surrounding it, the brain is less able to effectively function.</p>
<h2>Gabapentin as a promising drug for glioblastoma</h2>
<p>Now we understood that tumors can impair cognition by affecting neural connections. Next, we further examined their connections with each other and with healthy neurons using mouse models and <a href="https://theconversation.com/brain-organoids-help-neuroscientists-understand-brain-development-but-arent-perfect-matches-for-real-brains-130178">brain organoids</a>, which are clusters of brain cells grown in a Petri dish.</p>
<p>These experiments, led by one of us, <a href="https://scholar.google.com/citations?user=ouLmr_AAAAAJ&hl=en">Saritha Krishna</a>, found that tumor cells secrete a <a href="https://doi.org/10.1038/s41586-023-06036-1">protein called thrombospondin-1</a> that plays a key role in promoting the hyperactivity of brain cells. We wondered whether blocking this protein, which normally helps neurons form synapses, would halt tumor growth and extend the survival of mice with glioblastoma.</p>
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<a href="https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1447&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopy image of glioma cells" src="https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1447&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529647/original/file-20230601-22-crdeom.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Glioma cells could potentially be treated by repurposing the anti-seizure drug gabapentin.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/RrbmvV">Castro Lab, Michigan Medicine/NIH via Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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<p>To test this hypothesis, we treated mice with a common <a href="https://www.ncbi.nlm.nih.gov/books/NBK493228/">anti-seizure drug called gabapentin</a> that blocks thrombospondin-1. We found that gabapentin was able to keep the brain tumors from expanding for several months. These findings highlight the potential of repurposing this existing drug to control brain tumor growth.</p>
<p>Our study suggests that targeting the communication between healthy brain cells and cancer cells could offer another way to treat brain cancer. Combining gabapentin with other conventional therapies could complement existing treatments, helping mitigate cognitive decline and potentially improving survival. We are now exploring new ways to take advantage of this drug’s potential to halt tumor growth. Our goal is to ultimately translate the findings of our study to clinical trials in people.</p><img src="https://counter.theconversation.com/content/205901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shawn Hervey-Jumper receives funding from the National Cancer Institute (NCI), National Institute Neurological and Stroke Disorders (NINDS), Robert wood Johnson Foundation, OligoNation, LoGlio.</span></em></p><p class="fine-print"><em><span>Saritha Krishna does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Glioblastoma is the most aggressive type of brain cancer, causing significant decline in cognitive function. New research suggests a common anti-seizure drug could help control tumor growth.Saritha Krishna, Postdoctoral Fellow in Neurological Surgery, University of California, San FranciscoShawn Hervey-Jumper, Associate Professor of Neurological Surgery, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/814922017-08-23T15:44:55Z2017-08-23T15:44:55ZHow poverty is killing Kenya’s children with cancer<figure><img src="https://images.theconversation.com/files/181148/original/file-20170807-16792-vfvgq4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most common childhood cancers are leukemia and Hodgkin lymphoma.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In the last decade, the <a href="http://onlinelibrary.wiley.com/doi/10.3322/caac.21219/full">survival rates</a> for most types of cancer in children have improved in developed countries. Up to <a href="https://www.sandoz.com/news/media-releases/sandoz-expands-partnership-world-child-cancer-help-children-access-treatment">80% of the patients survive</a>, thanks to early diagnosis, timely treatment and advances in medicine.</p>
<p>But most children who have cancer live in the developing world where their survival rate is <a href="https://www.healio.com/hematology-oncology/palliative-care/news/print/hemonc-today/%7B73828ce7-bd54-4570-9ef9-aa35c9389ce9%7D/a-global-challenge-treating-children-with-cancer-in-developing-countries">less than 25%</a>.</p>
<p>A study in Kenya sought to understand why. </p>
<p>At the <a href="http://www.mtrh.or.ke/">Moi Teaching and Referral Hospital</a> in Western Kenya, the survival rate for all childhood cancers is about <a href="https://www.ncbi.nlm.nih.gov/pubmed/24347434">19%</a>. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/24681695">study</a> found that awareness of cancer in children under 18 was low, the country’s health care resources were inadequate for diagnosis and treatment, and poor families could not afford medical insurance or transport to hospital. </p>
<h2>Childhood cancer around the world</h2>
<p>Cancer is <a href="http://www.who.int/cancer/media/news/Childhood_cancer_day/en/">rare</a> in children under 18. It represents between <a href="http://www.who.int/cancer/media/news/Childhood_cancer_day/en/"> 0.5% and 4.6% </a> of all cancers globally. </p>
<p>Cancer of the <a href="https://www.cancer.gov/types/leukemia/patient/child-all-treatment-pdq">white blood cells</a>and brain tumours are the leading childhood cancers globally. In sub-Saharan Africa, the commonest types are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207091/">non-Hodgkins lymphoma</a> which starts in the immune system , kidney cancer and cancer of the bone marrow.</p>
<p>In <a href="http://canceratlas.cancer.org/the-burden/cancer-in-children/">developing countries</a> the reported rate of childhood cancer is low because it is undiagnosed. Awareness of cancer is low in less educated populations, and
health budgets are too small to provide enough diagnostic equipment and specialised health workers. In some African countries, only <a href="http://www.who.int/dg/speeches/2010/iaea_forum_20100921/en/">20% of patients survive cancers</a>.</p>
<p>Kenya does not have a national childhood cancer registry. It relies on a <a href="http://afcrn.org/membership/members/101-eldoret">hospital based registries</a>. About 2,500 children in Kenya develop cancer every year out of about 20 million children, as calculated from the global estimate in this <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461370/">study</a>.</p>
<h2>The Kenyan study</h2>
<p>Between January 2007 and January 2009, 222 children were newly diagnosed with cancer at the Moi Teaching and Referral Hospital in Eldoret, Western Kenya. Of these, 180 began treatment but 98 (54%) stopped. From December 2011 until August 2012, 53 (54%) of the 98 families were contacted to discuss reasons for discontinuation. The respondents thus represent 24% of the children diagnosed.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/24681695">study</a> investigated the reasons for discontinuation of treatment by childhood cancer patients. The most common reasons given were financial difficulties (46% of respondents), lack of health insurance (27%) and transport difficulties (23%). These are all related to poverty.</p>
<p>The referral hospital is located in an urban area with a population of about 18 million people. Being a public referral health facility, the patients travel long distances to get services that are not available at the satellite health facilities so transport costs are unaffordable to most of them.</p>
<p>Treatment abandonment is the failure to return to hospital for more than <a href="https://books.google.co.ke/books?id=2_O8BAAAQBAJ&pg=PA232&lpg=PA232&dq=abandonment+of+treatment+definition+and+four+weeks&source=bl&ots=4zphmt782c&sig=lyqVU7qPw4e2gL4f6PY6ORyWw4U&hl=en&sa=X&redir_esc=y#v=onepage&q&f=false">four weeks</a> for scheduled appointments.</p>
<p>About four out of every five children who stopped treatment had died by the time of the survey. The survival rate when we did the study was 20%. About 66% of those alive but untreated were very sick. Their families were discouraged by the cost of cancer treatment and the cost of transport to the hospital.</p>
<h2>Reasons for discontinuing treatment</h2>
<p>The reasons given for stopping treatment include: </p>
<ul>
<li><p>Financial constraints: almost half of the families interviewed said they did not have money to pay for cancer treatment. About three out of every ten families had an average monthly income of about 44 dollars per household. About 85% of the patients’ families said cancer treatment had adversely affected other family costs like education and food.</p></li>
<li><p>Lack of health insurance: some families were not members of the <a href="http://www.nhif.or.ke/healthinsurance/">national health insurance fund</a>. The fund is owned by the government and members without formal employment are expected to pay a minimum of five dollars a month in premiums. At the beginning of the study, only 22% of families surveyed had this health insurance. An additional 26% subsequently registered but 52% did not have insurance because they did not apply for it.</p></li>
<li><p>Access to health services: about half of the families interviewed lived more than 100 kilometres from the treatment centre and could not afford the fare for public transport. Most of the patients’ families are unemployed, are farmers and live on less than a dollar a day for their household expenses. Transport expenses can be estimated at about three dollars per hospital visit. These are estimates however the actual figures depend on the type of cancer and the frequency of travel to the hospital.</p></li>
<li><p>Other reasons: the patients families were discouraged by families and communities with negative attitudes on the poor cancer survival rates hence they did not take their children to hospital. The long delays in hospital queues and <a href="https://vector.childrenshospital.org/2011/07/treatment-abandonment-in-childhood-cancer-are-we-willing-to-face-this-challenge/">mistrust</a> of the health care system also kept the patients away from going for treatment. Some also expressed fear of the side effects of treatments like chemotherapy and surgery which could worsen the disease.</p></li>
</ul>
<h2>Way forward</h2>
<p>In countries with universal health, the government pays for most of the hospital costs while in other the health insurance does. However the individual families still have to cater for transport costs. </p>
<p>There is a need for a more cohesive multi-sectoral approach to set up effective and affordable childhood cancer treatment programmes for screening, early diagnosis, treatment and palliative care for childhood cancers.</p>
<p>The government should enrol more Kenyans on the <a href="http://www.nation.co.ke/health/Health-insurance-Why-you-should-get-an-NHIF-cover/3476990-3893140-3yqsxj/index.html">health insurance</a> so that all children diagnosed with cancer can seek treatment in public health facilities. Currently some of the benefits members receive include payment of chemotherapy and radiotherapy sessions especially needy patients.</p>
<p>Kenya should increase <a href="http://www.nation.co.ke/lifestyle/DN2/957860-2769356-w8ne3z/index.html">public health awareness </a> campaigns to provide information on screening for childhood cancers and give information on the available treatment options. These campaigns have worked for other non communicable diseases like <a href="http://www.nation.co.ke/health/Watch-out-you-are-likely-to-contract-TB-in-these-places/3476990-3988036-12c5ahhz/index.html">Tuberculosis</a>, <a href="http://www.nation.co.ke/oped/Opinion/Child-s-HIV-victory-offers-great-hope/440808-4038844-qklhndz/index.html">HIV</a> and some forms of cancers like <a href="http://www.nation.co.ke/lifestyle/family/No-woman-needs-to-go-home-without-a-breast/1954198-4044402-460rucz/index.html">breast cancer</a>.</p><img src="https://counter.theconversation.com/content/81492/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Festus Njuguna does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most children who have cancer live in the developing world where their survival rate is less than 25%. In Kenya awareness about childhood cancer is low and treatment isn’t always readily available.Festus Njuguna, Department of Child Health and Paediatrics, consultant Paediatrician, Moi University Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/600612017-05-10T03:50:19Z2017-05-10T03:50:19ZExplainer: what is cancer radiotherapy and why do we need proton beam therapy?<figure><img src="https://images.theconversation.com/files/140413/original/image-20161005-20235-zqbkxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Radiotherapy treats cancer by directing beams of high energy x-rays at the tumour. </span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>In last night’s federal budget, the <a href="http://budget.gov.au/2017-18/content/bp3/download/bp3_03_part_2b.pdf">government dedicated up to A$68 million</a> to help set up Australia’s first proton beam therapy facility in South Australia. The <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2017-hunt45.htm">government says</a> this will help Australian researchers develop the next generation of cancer treatments, including for complex children’s cancers. </p>
<p>Proton beam therapy is radiation therapy that uses heavier particles (protons) instead of the X-rays used in conventional radiotherapy. These particles can more accurately target tumours closer to vital organs, which can be especially beneficial to patients suffering from brain cancer and children whose organs are still developing and are more vulnerable to damage.</p>
<p>So, the facility will also be an alternative to conventional radiotherapy for treating certain cancer. But what is traditional radiotherapy, and how will access to proton beam therapy improve how we manage cancer?</p>
<h2>What is radiotherapy?</h2>
<p>Radiotherapy, together with surgery, chemotherapy and palliative care, are the cornerstones of cancer treatment. Radiotherapy is recommended for <a href="https://www.ncbi.nlm.nih.gov/pubmed/24833561">half of cancer patients</a>. </p>
<p>It is mostly used when the cancer is localised to one or more areas. Depending on the cancer site and stage, radiotherapy can be used alone or in combination with surgery and chemotherapy. It can be used before or after other treatments to make them more effective by, for example, shrinking the tumour before chemotherapy or treating cancer that remains after surgery.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=556&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=556&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=556&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=699&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=699&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150859/original/image-20161220-26710-1ayj6h4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=699&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A drawing of the X-ray machine used by Wilhelm Röntgen to produce images of the hand.</span>
<span class="attribution"><span class="source">Golan Levin/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Most <a href="http://www.cancervic.org.au/about-cancer/types-treatments-trials/radiotherapy">radiotherapy treats cancer</a> by directing beams of high energy X-rays at the tumour (although other radiation beams, such as gamma rays, electron beams or proton/heavy particle beams can also be used). </p>
<p>The X-rays interact with tumour cells, damaging their DNA and restricting their ability to reproduce. But because X-rays don’t differentiate between cancerous and healthy cells, normal tissues can be damaged. Damaged healthy tissue can lead to minor symptoms such as fatigue, or, in rare cases, more serious outcomes such as hospitalisation and death. </p>
<p>Getting the right amount of radiation is a fine balance between therapy and harm. A common way to improve the benefit-to-cure ratio is to fire multiple beams at the tumour from different directions. If they overlap, they can maximise the damage to the tumour while minimising damage to healthy tissue.</p>
<h2>How it works</h2>
<p>Wilhelm Röntgen <a href="http://www.bl.uk/learning/cult/bodies/xray/roentgen.html">discovered X-rays</a> in 1895 and within a year, the link between exposure to too much radiation and skin burns led scientists and doctors to pursue radiation in cancer treatment.</p>
<p>There are three key stages in the radiotherapy process. The patient is first imaged – using such machines as computer tomography (CT) or magnetic resonance imaging (MRI). This estimates the extent of the tumour and helps to understand where it is with respect to healthy tissues and other critical structures. </p>
<p>In the second stage, the doctor and treatment team will use these images and the patient’s case history to plan where the radiation beams should be placed – to maximise the damage to the tumour while minimising it to healthy tissues. Complex computer simulations model the interactions of the radiation beams with the patient to give a best estimate of what will happen during treatment.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150862/original/image-20161220-26759-1as1d7n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A single radiotherapy treatment takes 15 to 30 minutes.</span>
<span class="attribution"><span class="source">IAEA Imagebank/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>During the third, treatment-delivery stage, the patient lies still while the treatment beam rotates, delivering radiation from multiple angles.</p>
<p>Each treatment generally takes 15 to 30 minutes. Depending on the cancer and stage, there are between one and 40 individual treatments, typically one treatment a day. The patient cannot feel the radiation being delivered.</p>
<h2>Benefits and side effects</h2>
<p>Radiotherapy’s targeting technology has made a significant difference to many cancers, in particular early-stage lung and prostate cancers. It is now possible to have effective, low toxicity treatments for these with one to five radiotherapy sessions.</p>
<p>For early-stage lung cancer <a href="https://www.ncbi.nlm.nih.gov/pubmed/25981812">studies estimate</a> with radiotherapy, survival three years after diagnosis is at 95%. For prostate cancer, one study <a href="https://www.ncbi.nlm.nih.gov/pubmed/24060175">estimates survival</a> at the five year mark is about 93%. </p>
<p>Side effects for radiotherapy vary markedly between treatment sites, cancer stages and individual patients. They are typically moderate but can be severe. A general side effect of radiotherapy is fatigue. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/150843/original/image-20161219-24303-13q1xsj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Radiotherapy is often used to treat brain tumours.</span>
<span class="attribution"><span class="source">Eric Lewis/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Other side effects include diarrhoea, appetite loss, dry mouth and difficulty swallowing for head and neck cancer radiotherapy, as well as incontinence and reduction in sexual function for pelvic radiotherapy. </p>
<p>Long-term effects of radiotherapy are a concern, particularly for children. For instance, radiation to treat childhood brain tumours can have <a href="https://theconversation.com/many-survivors-of-childhood-brain-cancer-have-cognitive-difficulties-but-these-can-be-treated-57566">long-lasting cognitive effects</a> that can affect relationships and academic achievement. </p>
<p>Again doctors will need to weigh up the risks and benefits of treatment for individual patients. Proton beam therapy is arguably most beneficial in these cases.</p>
<h2>Other radiotherapy challenges</h2>
<p>There are several challenges to current radiotherapy. It is often difficult to differentiate the tumour from healthy tissue, and even experts do not always agree on where exactly the tumour is.</p>
<p>Radiotherapy can’t easily adapt to the <a href="http://www.sciencedirect.com/science/article/pii/S0360301611036042">complex changes in patients’ anatomy</a> when a patient moves – for instance, when they breathe, swallow, their heart beats or as they digest food. As a result, radiation beams can be off-target, missing the tumour and striking healthy tissue.</p>
<p>Also, we currently treat all parts of the tumour equally, despite knowing <a href="http://link.springer.com/article/10.1007/s10555-007-9056-0">some of the tumour’s regions</a> are more aggressive, resistant to radiation and likely to spread to other parts of the body.</p>
<p>The tumour itself also changes in response to the treatment, further confounding the problem. An ideal radiotherapy solution would image and adapt the treatment continuously based on these changes.</p>
<p>Improvements in technology, including in imaging systems that can better find the tumour, can help overcome these challenges.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MS590Xtq9M4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Proton therapy requires large accelerators to give protons enough energy to penetrate deep into patients.</span></figcaption>
</figure>
<h2>Proton beam therapy and other innovations</h2>
<p>Proton beam therapy will help maximise benefits for many patients, including those with cancers near the spinal cord and pelvis. It requires large accelerators to give protons enough energy to penetrate deep into patients. The energetic protons are transported into the treatment room using complex steering magnets and directed to the tumour inside the patient.</p>
<p>Protons slow down and lose energy inside the patient, with most of the energy loss planned to occur in the tumour. This reduces energy loss in healthy tissues and reduces side effects. </p>
<p>The problems of changing patient anatomy and physiology in other forms of radiotherapy are also challenges for proton beam therapy. </p>
<p>Australia has a <a href="http://sydney.edu.au/medicine/radiation-physics/research-projects/nano-x.php">number of research teams</a> tackling such challenges, including developing <a href="http://sydney.edu.au/medicine/radiation-physics/research-projects/MRI-linac-program.php">new radiation treatment devices</a>, breathing aids for cancer patients, radiation measurement devices, shorter and more convenient treatment schedules and the optimal combination of radiotherapy with other treatments, such as chemotherapy and immunotherapy.</p><img src="https://counter.theconversation.com/content/60061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Keall is an NHMRC Professorial Research Fellow at the University of Sydney. He is a director and shareholder of three start-up companies. He receives research funding from government and industry sources. </span></em></p>Getting the right amount of radiation is a fine balance between therapy and harm. A common way to improve the benefit-to-cure ratio is to fire multiple beams at the tumour from different directions.Paul Keall, Professor and NHMRC Australian Fellow, Medicine, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/764722017-05-04T14:34:47Z2017-05-04T14:34:47ZCould taking vitamins in huge doses produce a health miracle after all?<figure><img src="https://images.theconversation.com/files/166628/original/file-20170425-27254-154fvs3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Back in business?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/human-raised-hands-mercy-right-trust-324636710?src=O9QKs31qre_88fzIbXgY1Q-1-8">CHOATphotographer</a></span></figcaption></figure><p>For decades, some people have embraced the idea that there might be major health benefits from taking vitamins in quantities well beyond the <a href="http://www.nhs.uk/Conditions/vitamins-minerals/Pages/vitamins-minerals.aspx">recommended</a> daily requirement. The concept was very popular for a while <a href="http://content.time.com/time/covers/0,16641,19920406,00.html">in the media</a>, but research findings to the contrary gradually made it virtually untouchable for scientists. </p>
<p>Yet it is now making a sort of comeback, thanks partly to <a href="http://www.cell.com/cancer-cell/fulltext/S1535-6108(17)30062-4">new findings</a> demonstrating that high doses of vitamin C can treat cancer. As we shall see, however, there are some important caveats here – as well as obstacles to unlocking different potential health benefits from other vitamin treatments. This is a cautionary tale of the dangers of black and white thinking, and how things are rarely as simple as they can be made to appear. </p>
<p>It is about a hundred years since vitamins first came to prominence. <a href="http://www.rsc.org/Education/Teachers/Resources/Contemporary/student/pop_casimir.html">Described</a> in the early days as “vital-amines”, important for “vitality” (life), the public’s knowledge was originally based on solid science. But <a href="http://www.alternet.org/personal-health/how-vitamin-industry-tricks-people-shelling-out-millions-bunk-products">from the 1940s</a>, the information <a href="https://www.quackwatch.org/01QuackeryRelatedTopics/spotquack.html">became conflicted</a> as food manufacturers and later the dietary supplements industry took over much of the education on nutrition. </p>
<p>One example of this advice that has endured to the present day is the idea that we need to bolster our diets with extra vitamins and minerals. This has been phenomenally profitable for everyone in this business, from producers of breakfast cereals to vitamin pills. The dietary supplements sector <a href="https://www.mordorintelligence.com/industry-reports/global-nutraceuticals-market-industry">was worth</a> US$205 billion (£160 billion) last year and <a href="https://globenewswire.com/news-release/2016/07/18/856668/0/en/Dietary-Supplements-Market-Size-Is-Projected-To-Reach-278-02-Billion-By-2024-Demand-In-Food-Beverage-Sector-Grand-View-Research-Inc.html">is predicted</a> to rise to nearly US$280 billion by 2024. </p>
<h2>The rollercoaster remedy</h2>
<p>The idea of miraculous healing properties from taking vitamins in much larger quantities has long been part of this line of thinking – largely thanks to a leading American scientist named Linus Pauling. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167362/original/file-20170501-17316-112xzlt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Linus Pauling in 1962.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Linus_Pauling_1962.jpg#/media/File:Linus_Pauling_1962.jpg">Wikimedia</a></span>
</figcaption>
</figure>
<p>I have written <a href="https://theconversation.com/taking-high-doses-of-vitamins-can-do-more-harm-than-good-15388">previously</a> in The Conversation about how Pauling, a double Nobel prize winner in chemistry and peace, became singularly committed in the 1960s and 1970s <a href="https://www.quackwatch.com/01QuackeryRelatedTopics/pauling.html">to the idea</a> that megadoses of vitamin C could treat diseases from the common cold to cancer. Pauling pushed these claims through a combination of exaggeration and selecting only studies showing positive effects – with a helping hand from the manufacturers. The story is described very well <a href="https://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/">here</a>. </p>
<p>Other scientists <a href="http://www.nejm.org/doi/full/10.1056/NEJM197909273011303">began debunking</a> these claims as far back as the late 1970s, <a href="https://www.theatlantic.com/health/archive/2013/07/the-vitamin-myth-why-we-think-we-need-supplements/277947/">demonstrating</a> not only that Pauling was wrong but also that taking oral vitamin or mineral supplements can often do more harm than good – including in the treatment of <a href="https://www.ncbi.nlm.nih.gov/pubmed/24266867">certain cancers</a>. It soon reached the point that any idea of benefits from vitamin megadoses was considered dubious within the research community. </p>
<p>Some of this was <a href="https://theconversation.com/why-eat-your-vitamins-when-you-can-now-shoot-them-up-16298">absolutely right</a>, yet perhaps the backlash went too far. It overlooked <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273429/pdf/1475-2891-11-7.pdf">some careful science</a> that had hinted, in selected cases, that megadoses of vitamins may treat certain diseases after all.</p>
<p>This is borne out by the new study I mentioned earlier, which <a href="http://www.cell.com/cancer-cell/fulltext/S1535-6108(17)30062-4">has shown that</a> taking high doses of vitamin C may help treat lung cancer and <a href="https://www.thebraintumourcharity.org/understanding-brain-tumours/types-of-brain-tumour-adult/glioblastoma/">certain brain tumours</a>. This follows on from <a href="http://stm.sciencemag.org/content/6/222/222ra18.full">previous work</a> proposing to test the use of vitamin C in the treatment of ovarian cancer. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/166629/original/file-20170425-12629-1jwuts1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">C for cure?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stethoscope-red-love-medical-conceptual-text-555960676?src=BkejedQWbZBT1LzIl8KxJQ-1-82">Mawardi Bahar</a></span>
</figcaption>
</figure>
<p>The new findings come from <a href="http://www.cell.com/cancer-cell/fulltext/S1535-6108(17)30062-4">research</a> led by Dr Joshua Schoenfeld of the University of Iowa. The paper was published last month in the journal Cancer Cell, and showed that vitamin C does not fight cancer directly as a drug, but by rendering radiotherapy and certain chemotherapy treatments more effective. </p>
<p>But where Pauling and his followers extolled supplements, Schoenfeld et al are proposing to directly infuse vitamin C into the patient’s bloodstream. It builds on previous findings that <a href="http://annals.org/aim/article/717329/vitamin-c-pharmacokinetics-implications-oral-intravenous-use">showed that</a> tablets taken orally will not deliver enough vitamin C into the body to be effective. </p>
<p>The research has completed a first phase that found the treatment improving survival prospects in mice, and that the vitamin C is safe and tolerable in patients having radio-chemotherapy. But to stress, if there is a successful final outcome to these trials, any treatment would never involve vitamin C pills from the local pharmacy. It would require a well controlled intravenous infusion. </p>
<h2>The way forward</h2>
<p>This research is an example of meticulous science dissecting vitamin fact from fiction. I am optimistic that new discoveries using megadoses will be made in the future. High doses of vitamin C may also be used to treat the pain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125947/">from postherpetic neuralgia</a>, a nerve-related condition linked to shingles; while preliminary results suggest it may also help treat <a href="http://www.sciencedirect.com/science/article/pii/S0012369216625643">blood poisoning</a> (sepsis). </p>
<p>Megadoses of other water-soluble vitamins have also been proposed, including administering vitamin B3 as a treatment for damaged nerve endings (peripheral neuropathies) after a <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Nicotinamide+riboside%2C+a+form+of+vitamin+B3+and+NAD%2B+precursor%2C+relieves+the+nociceptive+and+aversive+dimensions+of+paclitaxel-induced+peripheral+neuropathy+in+female+rats.">promising study</a> on rats. </p>
<p>There is probably also undiscovered potential among the fat-soluble vitamins – A, D, E and K – but megadoses of them can be dangerous. Too much vitamin A <a href="http://www.healthline.com/health/hypervitaminosis-a">can damage</a> the liver, for instance; while too much vitamin D <a href="http://www.healthline.com/health/hypervitaminosis-d#overview1">can cause</a> everything from fatigue and tinnitus to heart arrhythmias from too much calcium in the blood. </p>
<p>In such cases, the answer might be to design molecules that provide the equivalent of a hyperdose of vitamins but in a very targeted way to reduce the side effects. That is what I have been working on with colleagues at the universities of Aberdeen and Durham, as explained in <a href="https://www.youtube.com/watch?v=8-jiMpNCScM&feature=youtu.be">the clip</a> below. </p>
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<p>We are designing new compounds that activate only one part of the vitamin A response via the retinoic acid receptor, without triggering other receptors. It should be possible to achieve similar results for other vitamins with receptors, most obviously vitamin D. </p>
<p>In conclusion, it certainly looks as though the pendulum swung too far in the other direction in reaction to Pauling. Schoenfeld et al have shown how very precise and careful science can extract the benefits from vitamin supplementation. It’s certainly not a new argument for taking oral supplements, but it is worth watching this space to see what emerges next.</p><img src="https://counter.theconversation.com/content/76472/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter McCaffery receives funding from the BBSRC.</span></em></p>Something exciting is going on – no thanks to the supplements industry.Peter McCaffery, Professor of Biochemistry, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673462016-10-24T15:02:41Z2016-10-24T15:02:41ZHow an old antidepressant could provide the next brain cancer breakthrough<figure><img src="https://images.theconversation.com/files/142909/original/image-20161024-28382-6t8lqg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In 1998, I received an intriguing handwritten note. It came from David Wilkie, emeritus professor at University College London, and asked if I thought the antidepressant drug clomipramine could affect brain tumours. I had been investigating how brain cancer spreads and Wilkie wondered if his own work on how clomipramine could kill cells might be of relevance.</p>
<p>This sparked a series of investigations over the last 18 years into how this old drug that was once commonly used as an antidepressant might find a new purpose in cancer treatment. <a href="http://meeting.ascopubs.org/cgi/content/short/23/16_suppl/1535">Research has now linked</a> it to increased survival rates for brain tumour patients and, because its patent has expired, it is cheaply available at less than <a href="http://www.evidence.nhs.uk/formulary/bnf/current/4-central-nervous-system/43-antidepressant-drugs/431-tricyclic-and-related-antidepressant-drugs/tricyclic-antidepressants/clomipramine-hydrochloride">10p a tablet</a>. Clomipramine (sold under the brand name Anafranil) has been used for decades to treat patients with depression. Yet surprisingly – some might say scandalously – it has still not been through the clinical trials that would allow it to be prescribed for brain tumour patients.</p>
<p>Clomipramine’s use as an antidepressant has somewhat declined since it was first introduced in the 1950s, due to the development of selective serotonin reuptake inhibitor (SSRI) drugs such as Prozac. But its potential use as a brain cancer drug comes from the fact that it can cross the blood-brain barrier, which protects the brain from toxins in the blood but can also prevent drugs from entering.</p>
<p>The <a href="http://europepmc.org/theses/eth/272349">first piece of research</a>, carried out by a PhD student in my lab, made the important discovery that clomipramine specifically targeted brain tumour cells – but not healthy brain cells. <a href="http://eprints.port.ac.uk/7632/">Additional studies</a> confirmed that clomipramine worked by targeting these cells’ energy source (mitochondria). Depending on the dose used, this would set up <a href="https://theconversation.com/how-self-destructing-cells-may-hold-key-to-cancer-cure-31707">cell death</a> in a way that was reversible after 24 hours but irreversible after 48 hours, even at a relatively low dose.</p>
<p>This is very different from the way that current gold-standard brain tumour therapy works, which <a href="http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/temozolomide">typically involves</a> killing both cancer and normal cells by targeting their nuclei.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142910/original/image-20161024-28376-2j90bw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Brain barrier.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p><a href="http://www.nature.com/bjc/journal/v104/n1/full/6605996a.html">Research has shown</a> that clomipramine is linked to a reduction in the likelihood of developing a tumour by 40%-50% depending on the dose, and 64% for patients taking the drug long-term. We (<a href="https://www.ncbi.nlm.nih.gov/pubmed/8927228">and others</a>) <a href="https://www.ncbi.nlm.nih.gov/pubmed/20332444">have also shown</a> that using other repurposed drugs as well can make cancer cells more sensitive to clomipramine and enhance its anti-tumour effect.</p>
<p>But the evidence needed to change a drug’s licence so it can be prescribed for a specific condition can only be obtained with a robust clinical trial. <a href="http://meeting.ascopubs.org/cgi/content/short/23/16_suppl/1535">The trials</a> that have so far been carried out with brain tumour patients unfortunately are not enough. One was a pilot with a small sample size (50 patients) and the second was halted because it had too few patients who complied with the trial rules after the initial 12 months.</p>
<h2>Anecdotal evidence</h2>
<p>Publicity for the drug has resulted in many doctors giving their brain tumour patients clomipramine anyway. In these anecdotal cases, some patients have gone on to survive for periods of up to ten years – and even 17 years in a couple of instances.</p>
<p>But because these patients were not controlled by a clinical trial – for example taking recorded doses and consistent biological measurements – any results can’t be used to change the licence. So even with compelling laboratory and anecdotal evidence, many doctors still only prescribe within the existing guidelines. This helps them to avoid being liable for negligence if a patient is harmed.</p>
<p>Some politicians in the UK have tried to alter the law to make it easier to for promising off-patent drugs to be used for cancer treatment within the regulations. But the <a href="http://services.parliament.uk/bills/2015-16/accesstomedicaltreatmentsinnovation/documents.html">latest law</a>, which came into effect in March 2016, was very watered down. Its main outcome was a searchable database that will record doctor’s medical innovations. This could be a useful reference but doesn’t provide any protection against negligence to encourage more doctors to trial drugs like clomipramine.</p>
<p>So this brings us back to the need for a robust clinical trial. Our laboratory research aims to find partner drugs that can target multiple specific biological pathways and to personalise patient therapies. But finding the funds for a clinical trial is difficult, especially <a href="https://www.braintumourresearch.org/statistics">less than 2%</a> of national cancer research money may be spent on brain tumour research. But without this funding, we won’t be able to reveal the full potential of clomipramine to save the lives of brain cancer patients.</p>
<p><em>Listen to Geoff talk in more depth about clomipramine on The Conversation’s podcast, The Anthill.</em></p>
<iframe width="100%" height="166" scrolling="no" frameborder="no" src="https://w.soundcloud.com/player/?url=https%3A//api.soundcloud.com/tracks/283008303&color=ff5500&auto_play=false&hide_related=false&show_comments=true&show_user=true&show_reposts=false"></iframe><img src="https://counter.theconversation.com/content/67346/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Pilkington receives funding from Brain Tumour Research. </span></em></p>The well-used drug clomipramine could target tumour cells and leave normal cells healthy – if scientists could get enough evidence for it.Geoff Pilkington, Professor of Cellular and Molecular Neuro-Oncology, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/613762016-06-29T19:46:12Z2016-06-29T19:46:12ZGlioblastoma: why these brain cancers are so difficult to treat<figure><img src="https://images.theconversation.com/files/128011/original/image-20160624-28366-1lzm508.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Glioblastomas are often resistant to the one type of drug that breaks the blood-brain barrier.</span> <span class="attribution"><a class="source" href="http://healthhub.brighamandwomens.org/five-things-you-need-to-know-about-glioblastomas#sthash.Gjm7LSGW.vq7cd4lH.dpbs">HealthHub</a></span></figcaption></figure><p>You find yourself sitting in your doctor’s surgery. It’s only been a few days since your initial visit to check on these pounding headaches you’ve been waking up with, along with some dizziness, nausea and vomiting, and a general drowsy and disconnected feeling. </p>
<p>You thought it was a flu or other common virus, but the doctor has run a few tests, including an MRI. Then your world collapses as you’re told you have a brain tumour. A biopsy would have to be taken, but if this shows it’s glioblastoma multiforme (or commonly just called glioblastoma) you may only have as little as a few months to live.</p>
<p>This is the scenario faced by the around one thousand Australians diagnosed with glioblastoma each year. </p>
<p>While it is important to note the symptoms outlined above can occur for a variety of other reasons, they commonly occur in glioblastoma patients, who, depending on the location of the tumour in the brain, may also have a range of other symptoms, including weakness on one side of the body, memory and speech difficulties, and changes in vision.</p>
<p>Glioblastoma can affect any age group, but is more common in older people (average age of diagnosis is 64), and for reasons that are not clear, is somewhat more common in males. </p>
<p>The exact cause of glioblastoma is not known. The tumour arises from astrocytes, cells named because of their star shape, that make up the supportive tissue of the brain. These tumours usually grow very fast, and can easily invade surrounding normal brain tissue, making it a particularly aggressive form of cancer where treatment success is still very limited.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/128436/original/image-20160628-28373-45jfwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">These tumours grow from astrocytes - the cells that make up the supportive tissue in the brain.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>Treatment for glioblastoma normally involves surgical removal of the bulk of the tumour, followed by radiation and chemotherapy with a drug called temozolomide. </p>
<p>Even with this treatment, however, the prognosis for glioblastoma patients is bleak, with only half the patients surviving for 15 months, with less than 5% of patients still alive five years after diagnosis. These are particularly sobering statistics, much worse than other common cancers. </p>
<h2>Why is glioblastoma so hard to treat?</h2>
<p>Surgical removal of the entire tumour is almost impossible, and in most cases less than 90% can be removed. Glioblastoma is often referred to as having finger-like tentacles that extend some distance from the main tumour mass into surrounding normal brain tissue. </p>
<p>Unlike tumours in other parts of the body where a clear margin of normal tissue surrounding the tumour can often be taken to maximise the chances of complete tumour removal, this is generally not feasible for the brain where a balance has to be made between tumour removal and risks to cognitive function, or indeed immediate patient survival. </p>
<p>So some tumour is inevitably left and can reform in the initial tumour site or in other areas of the brain.</p>
<p>Another reason they are so tough to treat is that many drugs cannot efficiently enter the brain to act on the tumour. There is a unique barrier, termed the “blood-brain barrier” that limits the passage of molecules, like many chemo drugs, from the bloodstream into the brain. </p>
<p>Many drugs that may block glioblastoma growth in the lab simply do not work effectively in patients because of this barrier. The chemotherapy drug temozolomide does cross the blood-brain barrier, which is a major reason for its clinical use for this cancer.</p>
<p>However glioblastoma cells are often resistant to temozolomide. Many glioblastomas produce a protein (called MGMT) which can limit the effects of temozolomide. The presence of MGMT can be a good indication of whether a patient will respond to chemo drugs, and thus how long they will survive.</p>
<p>Many solid tumours presenting in other parts of the body can often grow very large without immediate impact on the patient. The physical location of glioblastoma within the confined space of the skull, and surrounded by vital normal brain tissue, however, means that even small increases in tumour size can have serious effects on cognitive function or patient survival. This is why effective therapy has to happen quickly, with little margin for error. </p>
<p>The challenge remains for researchers and doctors to develop better therapies for this devastating disease. Numerous <a href="http://www.clinicaltrials.gov/">pre-clinical studies and clinical trials</a> are currently in progress, exploring multiple avenues to tackle this cancer, such as better temozolomide-like drugs, targeted therapies aimed at the defective genes thought to drive glioblastoma development, tumour-killing viruses, or immunotherapies harnessing the body’s own immune system to target the cancer.</p>
<p>Some of these approaches show considerable promise, providing hope for the future.</p><img src="https://counter.theconversation.com/content/61376/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stuart Pitson receives funding from the Neurosurgical Research Foundation and the National Health and Medical Research Council of Australia. </span></em></p>Glioblastoma is an aggressive form of brain cancer that has a very poor prognosis. Despite the current best therapies half its sufferers survive for 15 months and less than 5% are alive after 5 years.Stuart Pitson, NHMRC Senior Research Fellow, Centre for Cancer Biology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575662016-04-13T04:58:01Z2016-04-13T04:58:01ZMany survivors of childhood brain cancer have cognitive difficulties, but these can be treated<figure><img src="https://images.theconversation.com/files/118278/original/image-20160412-15883-1k64orx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Side effects of brain tumour treatment can impact upon academic learning.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lesbians/4415982057/in/photolist-7Je4BF-7JhZAy-7JhZcu-pjnmQi-7JhZeJ-7JhZa5-4Jm8pF-qnjrh3-nLsAxq-7Je4uV-aWNCVV-7JhZaS-7SSDZj-7JhZ8m-7Je4tV-7JhZ3U-EvDU8-pFSert-8cYDmt-4GvMhN-7Je4wP-7Gr2Z6-dQF4tx-p2Sr1S-4RoZJU-82hq5J-4d2kwm-r9C5Pv-8hjM81-eHVYaa-MUERN-7Je4pp-7JhZtU-7Je4qB-aeBBLd-9FCyih-7UeUMj-7Je4gP-dsiPUn-4jQ49K-r5khtZ-pjktMq-9mgTvc-7Je4yr-to17Ga-bgvLVi-7Je4sx-7Je4vF-a7LsHN-7JhZbo">lesbianheart/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The case of <a href="http://www.theguardian.com/australia-news/2016/apr/11/chemotherapy-challenge-would-come-too-late-to-change-boys-treatment?utm_source=esp&utm_medium=Email&utm_campaign=Australia+Morning+mail+new+030615&utm_term=166554&subid=16443583&CMP=ema_1731">six year old Oshin Kiszko</a> who was ordered by a judge to undergo chemotherapy for his medulloblastoma – the most common type of malignant brain tumour in children – against the wishes of his parents, raises some pertinent questions.</p>
<p>Among these is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24616367">how parents can better be helped</a> to make decisions about whether or not their child should undergo aggressive treatment for their cancer.</p>
<p>After the shock of a brain cancer diagnosis, families will understandably first ask: “Will my child survive?” While modern medicine can now go some way to answering this question, the one that shortly follows is just as important: “What future does my child face?”</p>
<p>Cancer in a child’s brain has the potential to impact their overall future health and cause long-term disturbances to the central nervous system of survivors. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118254/original/image-20160412-21965-1016i57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Effects of cancer treatment can make social interaction less simple than child’s play.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/98289645@N00/394540090/">James Roe/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>These include cognition and communication difficulties that, if not addressed, can <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674758/">affect academic achievement</a> and social skill development; impacting interpersonal relationships, job successes and overall life quality. Early intervention in neurocognition and communication can lessen the impact of such difficulties on survivors.</p>
<h2>How brain cancer disrupts development</h2>
<p>Cancer is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674758/">the leading cause of death</a>, after accidents, in children aged under 15 years. In Australia, brain cancer is the most common form of solid cancer in children and <a href="http://www.aihw.gov.au/acim-books/">accounts for a quarter</a> of all cancers.</p>
<p>Treatment and technology advances mean children now have a much better chance of surviving brain cancer. With <a href="http://childrenscancer.canceraustralia.gov.au/types-childrens-cancers/brain-and-cns-tumours/chance-cure">survival rates of childhood cancers at 83%</a>, the majority can enjoy full and satisfying lives.</p>
<p>But some may <a href="http://www.cpcancer.com/article/S0147-0272(03)00026-6/abstract">struggle with cognitive and communication</a> difficulties, including with their IQ, visual-perceptual skills, attention, memory, vocabulary, grammar, social and problem solving skills. </p>
<p>Many factors impact long-term outcomes in these areas. There are the direct effects of cancer on the delicate structures of the brain and the pressure inside the skull caused by the tumour. Others include the length of time the cancer has been growing in the brain, the child’s age, how aggressive the cancer is, its symptoms, and the treatments required to combat it.</p>
<p>Children diagnosed with <a href="http://www.ejpn-journal.com/article/S1090-3798(09)00195-0/abstract">brain cancer at a younger age</a> are more at risk of long-term cognition and communication difficulties. This is because the developing brain is particularly vulnerable to cancer. </p>
<p>Historically, <a href="http://www.ibl.liu.se/forskarutbildning/forskarkurser-psykologi/utvecklingspsykologi/filarkiv/1.229164/PlasticityMaureenD.pdf">it was believed</a> that the brain’s ability for change (neuroplasticity) meant children could make a rapid and full recovery after brain cancer treatment. But recent <a href="http://onlinelibrary.wiley.com/doi/10.1002/pbc.25596/abstract">research has shown</a> cancer can cause long-term changes to brain structure and function. The effects of treatment can also leave a permanent mark.</p>
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<img alt="" src="https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=341&fit=crop&dpr=1 600w, https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=341&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=341&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=429&fit=crop&dpr=1 754w, https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=429&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/118451/original/image-20160413-15861-12mnmrv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=429&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cerebellum (in red) is the brain site most commonly affected by childhood cancers.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Cerebellum.png">Life Sciences Databases/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Most at risk are the <a href="http://www.hindawi.com/journals/np/2013/698528/">processes of acquiring new skills</a> in cognition and communication during development. Radiation and chemotherapy drugs can have <a href="http://www.ncbi.nlm.nih.gov/pubmed/21410597">harsh effects on neurodevelopmental processes</a>, such as myelination, which begins before birth and continues into adolescence. </p>
<p>During this time, brain neurons are being covered with myelin – an essential protective substance that increases the efficiency and speed of signals around the brain. Disruption of this process reduces white matter volume in the brain, which <a href="http://www.ncbi.nlm.nih.gov/pubmed/22898373">has been directly linked</a> to cognitive and communication deficits. </p>
<p>Children under three are <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612581/">considered most at risk</a> due to rapid ongoing myelination processes that can in some cases go on until seven years of age.</p>
<p>The cerebellum – the most common site for childhood brain cancer – is intrinsically fragile as its nervous tissue takes a particularly long time to develop. Disruption of this has been <a href="https://www.researchgate.net/publication/223084401_Cerebellar_contribution_to_behaviour_and_cognition_in_children">linked to behavioural disturbances</a> such as autism.</p>
<p>Survivors can have difficulties that range in severity: from mild to profound impairments, that can severely disrupt their quality of life. Besides struggling in areas such as attention and problem solving, <a href="http://www.ncbi.nlm.nih.gov/pubmed/17627128">studies have also noted</a> social language deficits, such as not understanding jokes, hidden meanings, and sarcasm.</p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/23444345">study of 110 children with medulloblastoma</a> who had received reduced dose radiation and chemotherapy treatment, for instance, reported progressive declines in both intelligence scores and academic attainment measures some years after treatment.</p>
<h2>Treatment is available</h2>
<p>It can often take years for subtle deficits to become noticeable in survivors of brain cancer. They can show up when children start school, make new friends, transition to high school, navigate social media, adapt to teaching styles and language of the classroom and go for their first job.</p>
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<span class="caption">Many non-medical intervention programs following brain cancer survival show excellent results.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dieselhorst/2173326160/">dieselhorst/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Even if children don’t show signs of these difficulties at discharge from hospital and rehabilitation, they are still likely to lag behind their peers. That is, if they are not routinely monitored throughout development and provided early and ongoing intervention and support. </p>
<p>Many non-medical <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3674758/">intervention programs</a> for cognitive and communication deficits following brain cancer survival show excellent success. </p>
<p>Approaches include <a href="http://jpo.sagepub.com/content/29/1/45.short">providing general resources and strategies</a> for integrating into school, regular surveillance and monitoring to map appropriate recovery processes, cognitive behavioural training programs, peer-group programs, skills-based training, vocabulary and word learning interventions, social skills programs and peer buddy systems.</p>
<p>Health professionals have an opportunity to ensure optimum quality of life for these children, who now have a much better chance of surviving brain cancer thanks to modern medicine and research. </p>
<p>Improving the lives of survivors now shares attention with the vital work dedicated to improving cure rates in childhood cancer research, and more positively and effectively addresses the concerns of parents who hope for a normal and bright future for their child after cancer.</p><img src="https://counter.theconversation.com/content/57566/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kimberley Docking has previously received funding from the Cancer Council Queensland. </span></em></p>Early intervention in neurocognition and communication can address communication and cognition difficulties in survivors of childhood brain cancer and increase their quality of life.Kimberley Docking, Lecturer & Research Fellow in Speech Pathology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/196572014-03-05T03:46:43Z2014-03-05T03:46:43ZExplainer: brain tumours that affect children<figure><img src="https://images.theconversation.com/files/41911/original/x6g3gv8v-1392780692.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Malignant tumours known as medulloblastoma account for more deaths in children than leukaemia.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/advocacy_project/4864664013/sizes/l/">The Advocacy Project/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Malignant brain tumours are the most common cause of cancer death in children. And the most common of these are called medulloblastoma. </p>
<p>Although these tumours can occur in both children and adults (they account for between a fifth and a quarter of all tumours diagnosed in the brain and spinal cord), they are ten times more frequent in kids.</p>
<p>Still, most people have not heard of medulloblastoma, most likely because it’s much rarer than cancers more typically associated with childhood, such as leukaemia. But the fact that it contributes so significantly to brain tumours that account for more deaths in children than leukaemia is a testament to medulloblastoma’s aggressiveness and to how far we need to progress to find a cure. </p>
<p>Other than people with two very rare genetic conditions, there’s no way to determine ahead of time what children are at risk for the disease. By the time the tumour is detected it has well and truly taken hold.</p>
<p>Although recent therapeutic advances have improved the five-year survival rates for average-risk patients, the outcome for high-risk patients remains poor. </p>
<p>Even people who survive are often left with significant neurological, physical and intellectual disabilities as a consequence of existing treatments, which generally call for surgical tumour removal, followed by radiotherapy and chemotherapy.</p>
<h2>The nature of cancer</h2>
<p>A tumour is an abnormal growth of cells. To understand medulloblastoma or any brain tumour, you first need to understand how cancers grow and develop. </p>
<p>Think of cell growth as being controlled in the same way as your car. The car has an accelerator and a brake, which can speed it up or stop it. Cells are similar; they receive signals to tell them to start growing and dividing to create new cells or to stop, to use their accelerator or their brake. </p>
<p>Now imagine what would happen if their accelerator was jammed on, or if their brakes stopped working. They would keep growing and multiplying when they weren’t supposed to, resulting in one of the group of diseases known as cancer.</p>
<p>These faulty signals occur as a result of genetic damage. As we grow and age, our genetic material accumulates changes. This might be a result of environmental factors, such as smoking or sunlight, or it might be random chance as our genetic material is replicated in new cells. </p>
<p>Some of the changes to the genetic code will be harmless and won’t have an effect on our body. Other changes will combine to cause damage, including interfering with the signals that regulate cellular growth and ensure cells stop multiplying. This is why more cancers are found in older people – they have had longer to accumulate genetic damage.</p>
<p>In recognition of the fact that genetic damage plays a role in cancer, there are efforts around the world, including in Australia, to <a href="https://theconversation.com/beginning-of-the-end-for-cancer-10327">map the genomes of tumours</a>. Comparing them with normal cells from the same part of the body enables us to compile an atlas of the genetic changes that lead to cancer. </p>
<p>Other efforts involve identifying the genes that drive tumour growth, which is exactly what a group of collaborators and I set out to do for medulloblastoma.</p>
<h2>What we found</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/24167280">Research I recently published</a> with some colleagues identified 53 genes that appear to drive the development of medulloblastoma. These candidate genes seem to deregulate two cellular processes. </p>
<p>The first is apoptosis, otherwise known as cell death. Apoptosis occurs when a cell basically commits suicide (it is programmed to kill itself). This is a necessary process that occurs tens of billions of times in your body. </p>
<p>If apoptosis occurs at levels that are too low, cells are able to grow and spread when they shouldn’t, resulting in cancer. </p>
<p>The second process that these medulloblastoma genes appear to affect is translational elongation. This is one of the stages of translation, where the genetic code in your body is translated into proteins. </p>
<p>Medulloblastoma may not have as good a prognosis as some other childhood cancers, but the better our understanding of this disease, the more likely we are to develop improved treatments that increase survival rates without major side effects. </p>
<p>After all, people think of leukaemia as a common cause of childhood cancer death precisely because it was – until medical research improved its prognosis.</p><img src="https://counter.theconversation.com/content/19657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon Wainwright receives funding from the National Health and Medical Research Council of Australia. He is Professor of Molecular Genetics and Director, Institute for Molecular Bioscience (IMB) at The University of Queensland.</span></em></p>Malignant brain tumours are the most common cause of cancer death in children. And the most common of these are called medulloblastoma. Although these tumours can occur in both children and adults (they…Brandon Wainwright, Director, Institute for Molecular Bioscience, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/137652013-05-30T05:52:55Z2013-05-30T05:52:55ZCutting-edge particle physics could bring cancer therapy home<figure><img src="https://images.theconversation.com/files/23556/original/3vnzf72n-1368392274.jpg?ixlib=rb-1.1.0&rect=0%2C39%2C1320%2C924&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Hadron Collider was built to find the Higgs Boson but it might also help us discover better ways to treat cancer.</span> <span class="attribution"><span class="source">PA/CERN</span></span></figcaption></figure><p>The recent case of Neon Roberts <a href="http://www.guardian.co.uk/society/2012/dec/21/neon-roberts-radiotherapy-mother-wishes">and the legal dispute</a> over his treatment for a brain tumour threw the spotlight on the potential risks of using radiotherapy to treat complex cancers in children.</p>
<p>Radiotherapy is an effective way of targeting cancerous tumours but it can also affect the surrounding healthy tissues. Unpleasant side effects can include permanent damage to precious organs or the appearance of new cancers caused by the radiation - these are particularly difficult problems in growing children. Proton beam radiotherapy, which uses high energy charged particles (CPs) to target cancers more directly, can be less damaging than using X-rays but is hugely expensive. </p>
<p>Scientists behind the Large Hadron Collider at CERN are <a href="http://www.telegraph.co.uk/science/large-hadron-collider/10003417/Large-Hadron-Collider-scientists-developing-new-cancer-treatments.html">planning to develop the technology</a> - built to discover the higgs boson particle - to futher study how CPs can be used to kill cancer cells while limiting the amount of radiation for surrounding healthy tissues. </p>
<p>The project is not yet funded and would require considerable multinational support but the scientists at CERN are at the cutting edge of particle physics research and the opportunity to develop proton beam therapy is an important one.</p>
<p>In children, the risk of new cancers caused by radiation (which can appear two to 50 years after treatment) could be cut by using CPs. The reduction in unnecessary radiation should also make it more effective as a therapy for children with rare cancers - in the brain or the spine for example - and improve the quality of life for patients cured after radiation alongside other treatments such as surgery and chemotherapy.</p>
<p>But CPs and proton beam therapy is costly, largely because of the initial cost of the equipment. Expensive particle accelerators have only recently become commercially available and the treatment is only available <a href="http://www.clatterbridgecc.nhs.uk/patients/treatment/protontherapy/">in one hospital in the UK</a> which treats eye tumours. Since 2008, the majority of young people funded by the NHS are referred overseas.</p>
<p>This is where the Large Hadron Collider, the world’s largest particle accelerator, could prove useful in improving our knowledge of these beams and how different types of cells react to intense, localised radiation produced by these beams.</p>
<p>When a fast charged particle is used in treatment, it leaves a “dose” of ions (atoms with an electrical charge) along its path. The clustering of this ionisation changes according to the type of tissue and the distance the particle travels. Too much clustering of radiation in some areas causes bigger biological effects, which can be measured using something called the relative biological effect(RBE).</p>
<p>In principle, this RBE effect requires treatment to be varied according to different types of cancer in different parts of the body. In a brain cancer, for example, if the area around the tissue being treated contains important structures such as optic nerves which link the eyes to the brain, then serious damage will occur if the relative biological effect RBE is larger in these nerves than in the tumour. This could lead to blindness. This is less important in tissues such as the lungs and the special case of the liver, which is able to regenerate. Getting the sums wrong, though, could mean that too little radiation is sent to the tumour.</p>
<p>At present the scope for research in hospital-based CP centres is limited but there is considerable potential to develop CP technology, its dependability, accuracy and how someone receiving treatment goes through the process, with greater use of automation and computers.</p>
<p>Scientists at CERN are already working to develop smaller proton beam devices that could be used in hospitals and have also identified one type of particle accelerator that could be modified in order to study RBE. This can also be tested on “phantoms” - artificial humanoid body like shapes - to simulate the conditions within the body. </p>
<p>High quality imaging technology such as CT and MR scanners are also essential to the success of CP therapy, but if this type of therapy is developed further and costs brought down, it means that more people - and children - will be able to have their treatment here at home. </p><img src="https://counter.theconversation.com/content/13765/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bleddyn Jones has previously received grants form Medical Research Council UK</span></em></p>The recent case of Neon Roberts and the legal dispute over his treatment for a brain tumour threw the spotlight on the potential risks of using radiotherapy to treat complex cancers in children. Radiotherapy…Bleddyn Jones, Professor of Clinical Radiation Biology, University of OxfordLicensed as Creative Commons – attribution, no derivatives.