They held a conference in Lausanne

Lake Geneva (Lac Léman)

It was the Swiss who announced  “Gender-based approaches to studying and treating disease have remained largely unexplored in medical oncology…. sex is a major factor in disease risk and response to treatment.  This seems to have overlooked the PC  brigade with all their tick-box surveys.  Sometimes males and females don’t need equal treatment, and doctors need to acknowledge that we might react differently to drugs.  Perhaps this could be one explanation as to why Britain lags behind Europe for cancer survival.

Recent Conference

At the recent ESMO workshop (European Society For Medical Oncology), ‘Gender medicine meets oncology’, experts discussed the concepts and methods of gender medicine and their implications for clinical practice and research in oncology.

According to Dr. Anna Dorothea Wagner from Lausanne University Hospital, who initiated the workshop  “the need for further research to understand gender impacts in oncology is significant.” 

“With efforts to include sex aspects in biomedical research abounding in other areas, like cardiovascular medicine, it was high time for us in the oncology field to take notice”.   Having been a cancer patient in UK for some years, one wonders why this obvious fact hasn’t penetrated some thick brains?

Wagner’s paper had already pointed to various areas in which gender differences have been known to exist for many years but are still poorly understood. These were picked up at the ESMO workshop in Lausanne, where discussions focussed on the differences in body composition, hormones, genetic makeup and metabolism. For example, women experience higher toxicity with certain types of drugs, which is likely a result of their metabolising these differently from men, due to factors that could range from higher body fat levels to differences in the activity of drug-metabolising enzymes.

  • On a purely anecdotal aspect, it can seem that more women than men suffer weight gain during treatment.
  • On a personal note, this could explain why my all-male team treated my complaints about skin lesions resulting from Tamoxifen side effects with complete disdain, trying to make me believe they were “due to your age” ! 

“Toxicity is a problem in itself, not least because it can cause cancer patients to discontinue treatment,” Wagner explained. In the case of chemotherapy, however, where chemotherapy-related toxicity is usually correlated with response, lower rates of toxicity observed in men could therefore be interpreted as a sign of relative underdosing, which may help to explain their poorer prognosis in several cancer types. “This surely deserves further investigation, as gender-specific treatment strategies might be able to improve outcomes, in particular with regard to doses and types of drugs,” said Wagner.

Drug Trials

Looking back on various Dept. Health committees I sat on, it seemed to be the men who had talked about being on trials;  as a woman I was never offered the chance. 

There are known to be differences in immune responses between men and women, but when it comes to drug development, recent efforts to bring more women into traditionally male-dominated phase I and phase II trials have been only moderately successful, with enrollment of female patients remaining at a low 37%. Additionally, almost two thirds of clinical trials still do not report any results by gender.

While gender differences in efficacy are reported more often, gender differences related to toxicity are only rarely analysed and systematically reported.

So if you have a reaction to cancer drugs, perhaps you might ask the obvious “when prescribing, did you take in to account what is my gender?”

For more information see

https://www.esmo.org/Conferences/Workshops-Courses/ESMO-Workshop-Gender-Medicine-Meets-Oncology

2 “Sex Differences in Efficacy and Toxicity of Systemic Treatments: An Undervalued Issue in the Era of Precision Oncology”, by B. C. Özdemir et al. Journal of Clinical Oncology. doi: 10.1200/JCO.2018.78.3290

About the European Society for Medical Oncology (ESMO)

ESMO is the leading professional organisation for medical oncology. With 18,000 members representing oncology professionals from over 150 countries worldwide, ESMO is the society of reference for oncology education and information. ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide. www.esmo.org

 

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