ROCHESTER, Minn. ― Mayo Clinic Cancer Center announced on Tuesday, Aug. 31, that it is following recommendations from the National Comprehensive Cancer Network that encourage cancer patients to receive a third dose of a messenger RNA COVID-19 vaccine. The Moderna and Pfizer COVID-19 vaccines are messenger RNA vaccines.

If patients were vaccinated with the Johnson & Johnson COVID-19 vaccine, no third dose is recommended at this time. The Johnson & Johnson COVID-19 vaccine is an adenovirus vaccine ― not a messenger RNA vaccine.

"The updated guidelines for cancer patients from NCCN are based on the latest data and approvals from the FDA (Food and Drug Administration) and CDC (Centers for Disease Control and Prevention) regarding administration of a third messenger RNA vaccine dose for cancer patients and immunocompromised people," says Robert McWilliams M.D., a medical oncologist. Dr. McWilliams is chair of Mayo Clinic's Cancer Center Practice Committee.

Here's who should receive a third dose of a messenger RNA COVID-19 vaccine:

• Patients with new or recurring solid tumors receiving treatment within one year of their initial vaccine dose, regardless of their type of cancer therapy.
• Patients with active blood cancers, regardless of whether they receive cancer therapy.
• Patients who received a stem cell transplant or engineered cellular therapy, such as chimeric antigen receptor-T cell therapy, especially within the past two years.
• Patients who received allogeneic stem cell transplants and are on immunosuppressive therapy or transplant patients with a history of graft-versus-host disease, regardless of transplant timing.
• Patients with an additional immunosuppressive condition, such as HIV or patients being treated with immunosuppressive agents unrelated to their cancer therapy.

Review the updated vaccination guidelines for cancer patients on the National Comprehensive Cancer Network website.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center.

Media contact: 

• Joe Dangor, Mayo Clinic Public Affairs, newsbureau@mayo.edu

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“Dry mouth is something that when you have a life threatening illness, at first may not seem like a big deal. However, this condition can extend long after radiation treatments are complete. It’s probably the top concern I have from head and neck cancer patients. Unfortunately, there aren’t many therapeutics available commercially for these patients,” says Jeffrey Janus, M.D., an Ear, Nose and Throat specialist at Mayo Clinic in Florida.

Currently there is only supportive care —  no cure — for the decrease in saliva that comes from xerostomia. Besides being uncomfortable, chronic dry mouth can lead to difficulties with chewing, tasting, speaking and swallowing. It can also cause tooth decay.

Mayo Clinic Center for Regenerative Medicine, Department of Laboratory Medicine and Pathology and Department of Otolaryngology are collaborating on ways to address the unmet needs of these patients.

The question investigators are seeking to answer is whether the body’s healing abilities could be unleashed to restore natural lubrication of salivary glands. The research will focus on the regenerative abilities of epithelial cells found within many glands in the body, including salivary, mammary and prostate glands. They hope to discover whether epithelial cells could be tapped to regenerate salivary gland tissue to produce natural saliva.

Building on existing research

Previous studies showing epithelial cells purified from mammary glands could regenerate functionally-intact mammary glands piqued the interest of the research team. Could the same concept be applied to heal and restore saliva in salivary glands? Their research will build on this existing body of knowledge.

“In many ways salivary glands resemble mammary glands. As early as 2006, it was shown that a single transplantable mammary cell could regenerate highly complex lactational structure. That was the genesis of the concept that glands represent epithelial stem cells and that we might be able to harness these rare cells for treatment of dry mouth,” says Nagarajan Kannan, Ph.D., a scientist with the Department of Laboratory Medicine and Pathology and head of the Stem Cell and Cancer Biology Lab at Mayo Clinic.

To validate this theory, the team has identified a few hurdles to overcome that could stall the research.

First, they need robust human tissue samples to test their theory. They’ve planned to establish a biobank of the three different types of human salivary glands with samples from consenting men and women. Second, they are developing robust methods to isolate and study epithelial cells from salivary glands. Third, they need a model in which to investigate whether those cells could regenerate human salivary tissue. To address this issue, they will study epithelial cells in immune-deficient mice that have been biologically engineered to mimic injured human salivary glands.

“Using this model, we can now start testing how the salivary cells permanently engraft and regenerate into salivary structure and restore saliva. Our model measures how saliva production drops and holds at a decreased level. It is the best model available for studying how human salivary samples perform over time,” says Dr. Kannan.

No specific date has been set for advancing this concept into human clinical trials. However, Dr. Kannan and Dr. Janus are hoping the preclinical studies will lay the foundation for early safety studies within the next year or two.

“I’m hopeful that if we can show this is safe and effective, we can immediately transition into using this regenerative procedure using silo endoscopy, which is like endoscopy of the salivary glands, to implant these cells in early clinical trials,” says Dr. Janus.

Accelerating the findings toward clinical practice is a priority. The team will not only work across departments at Mayo Clinic, but will also collaborate with experts outside of Mayo Clinic to move the research forward as quickly as possible.

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Older adults and those with serious chronic medical conditions, such as heart disease, diabetes and lung disease, are at higher risk of developing serious complications if infected with SARS-CoV-2, the virus that causes COVID-19.

But what about patients with cancer?

Cancer patients may be at a higher risk of infection and more severe symptoms, though temporarily, due to weakened immune system from cancer treatment. "However, we have very limited information at the present time," says Dr. Rafael Fonseca, a hematologist and interim executive director of the Mayo Clinic Cancer Center.

Dr. Fonseca says he and his team are receiving many questions from patients with cancer who are concerned and want to understand better what a potential with COVID-19 infection might mean. "From what we know, infection with COVID-19 seems to be more difficult, more aggressive and with worse outcomes in people who are, in general, unwell and are of advancing age. And what we're seeing is this is predominantly in older males that we have seen the effect."

Watch: Dr. Rafael Fonseca discusses COVID-19 and patients with cancer.

Journalists: Broadcast-quality sound bites with Dr. Fonseca are in the downloads at the end of the post. Please courtesy "Rafael Fonseca, M.D. / Hematology / Mayo Clinic."

"We don't fully understand the implications of having cancer and being infected with SARS-CoV-2, but what we are telling patients, as we’re getting these questions, that until we know more, it is prudent for them to be extra cautious and, hopefully through those behaviors, prevent them becoming infected. So be extra careful with regards to the sanitation of your hands, the good practice of social distancing that we have all seen in the news, and certainly try to avoid exposure to individuals who may be potentially ill," says Dr. Fonseca.

Not all cancers act the same 

"Cancer is a very broad word and could encompass a relatively minor cancer with perhaps no implications or no difference from someone who is otherwise healthy with regards to COVID-19 to a more extreme situation where a patient with cancer might be facing a situation of a more advanced disease or a treatment that might be more immunosuppressive, that is, that would bring the immune system down more than average and then, particularly in those groups of patients, we might think of a different way to approach their care."

"Furthermore, some treatments may affect different how a person may be able to fight off an infection or not," says Dr. Fonseca. "Some of the treatments that bring down a certain type of white cells create what we call myelosuppression, that is, the neutrophils are down. That is usually thought of to be more important for bacterial infections. Some other cancer treatments may affect more the way our immune system responds, and there’s a number of cells there like the lymphocytes. So maybe that’s more important for viruses. But this is all speculative because we really don’t have information at this point.

Dr. Fonseca encourages patients with cancer to have ongoing conversations with their oncologists for information on their specific cancer and their treatment.

To reduce infection, consider these tips:

• Avoid contact with people who are sick.
• Practice social distancing.
• Wash your hands often with soap and water, or use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose and mouth if your hands aren't clean.
• Determine who can care for you if you become ill.

Also, consider these recommendations for supplies:

• Contact your health care provider to ask about obtaining extra necessary medications in case you need to stay home for a prolonged period of time.
• If you cannot get extra medications, consider using mail-order for medications.
• Be sure you have over-the-counter medicines and medical supplies, such as tissues, to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
• Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.

Check the CDC website for additional updates on COVID-19.
For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

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Mayo Clinic researchers recently used emoji to help patients measure their overall well-being during treatment. The study used two scales — a mood scale and an ordinal scale — featuring a total of 10 different emoji. The emoji expressions, ranging from smiling faces to large frowns, help patients express their current mood.

"Medicine has gotten so complicated," says Dr. Carrie A. Thompson, a hematologist and the study's lead author. "So to have something simple that breaks down the barriers of communication, health literacy, language — we all know emoji. We all know what emotions various faces reflect."

The research to determine how a patient was managing treatment through the use of emoji included ways doctors could track patients' progress using apps on phones or watches. While further research is needed to validate these findings, the possibility of using this technology to improve future patient care is promising.

"If we can demonstrate that simple emoji are valid and reliable measurements of patient well-being, it could transform the way patient wellbeing assessments are accomplished," says Dr. Thompson. Learn more about this study.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

"The scale works really well, and that's one of the things we wanted to determine was, is this a valid scale," says Dr. Thompson. "Is this something that is scientifically proven to say what we think patients are trying to say? And we found that it did, and it works very, very well."

Dr. Thompson says the research looked at how doctors could track their patients' progress using an Apple Watch and an app on their phones. Patients could rate how they were feeling using a scale of five universally recognized emojis.

"Medicine has gotten so complicated," she says. "So to have something that's simple that breaks down the barriers of communication, healthy literacy, language, financial status – we all know emojis. We all know what various faces mean."

Dr. Thompson hopes simpler communication with emojis will lead to better care of patients.

"Getting information in between appointments to accurately know how patients are doing is going to make a big difference," she says. "And, hopefully, then that will lead to providers providing better care."

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ROCHESTER, Minn. — The Mayo Clinic Cancer Center has received a supplemental grant from the National Cancer Institute to ensure that all cancer patients who use tobacco have access to treatment for their tobacco use. The two-year, $500,000 grant, part of the National Cancer Institute's Cancer Moonshot initiative, will fund programs at the Mayo Clinic Cancer Center and the Mayo Clinic Nicotine Dependence Center that will expand tobacco cessation treatment services for cancer patients.

“This grant will help us increase assistance to cancer patients who use tobacco by providing evidence-based tobacco cessation support,” says Thulasee Jose, M.D. a research fellow working on the project. “We want to make sure that tobacco use treatment is an integral part of cancer care at the Mayo Clinic. Quitting can increase the chances of successful treatment and decrease the chance of cancer recurrence.”

“Almost 30 percent of all cancer deaths are related to smoking,” says J. Taylor Hays, M.D., medical director for the Mayo Clinic Nicotine Dependence Center (NDC). “The NDC provides counseling to help patients explore opportunities for quitting using motivational techniques and medications proven to increase the chance of successfully quitting tobacco for good.”

The program for cancer patients will draw on the expertise of the Mayo Clinic Nicotine Dependence Center. The center was one of the first in the country to focus exclusively on treatments for tobacco dependence. The center’s model of care has become the standard in many health care facilities across the U.S. The center's treatment team offers patient support in developing the motivation and skills required to stop using tobacco.

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About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call the Clinical Trials Referral Office at 1-855-776-0015 (toll-free).

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network.

Media contact:

• Joe Dangor, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Cancer caregivers and quality of life — new study opportunity
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Chemotherapy treatment carries with it a host of potential side effects — fatigue, hair loss and more. Learn about managing chemotherapy side effects.

The post Fertility Preservation: Your Options Before Cancer Treatment appeared first on Mayo Clinic News Network.

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The study found few of the available treatment strategies are being offered or prescribed by doctors. Regular physical activity, such as walking with a pedometer, has been shown to ease fatigue. Learning stress reduction and coping techniques can help patients alter daily habits and increase restfulness. However, only one-tenth of patients said their oncology teams instructed them to become more active or try other non-medication-related fatigue-reducing measures. More than 35 percent of patients had been offered sleep-enhancing medication, even though drugs have been shown to be the least effective approach.

"Fatigue is a factor that not only significantly diminishes quality of life but is also associated with reduced survival," says study author Andrea Cheville, M.D., a physiatrist with the Mayo Clinic Department of Physical Medicine and Rehabilitation. "Our results suggest that cancer patients are not receiving appropriate treatment for a significant and widespread problem."

Researchers queried 160 stage IV cancer patients, men and women, who had moderate to severe fatigue (greater than five on an 11-point scale). Participants with lung, breast, colon or prostate cancer were asked whether their oncology teams had mentioned any of the cancer-fatigue treatments recommended by the National Comprehensive Cancer Network guidelines, such as increasing exercise, seeking psychosocial and behavioral help, and medications. Patients were asked about the extent of the information they had received, whether physicians had provided specific counseling, instructions and recommendations or a prescription to address fatigue.

While age and gender were not factors in whether patients received treatment for fatigue, their type of cancer was. Only 15 percent of patients with colon cancer and 17 percent with prostate cancer had their fatigue addressed; 48 percent of breast cancer patients had been advised of psychosocial interventions. When researchers asked about patients' habits at home, they found significant room for improvement.

"We found the vast majority of patients were not engaging in behavioral practices that could reduce fatigue and potentially enhance quality of life," Dr. Cheville says. "And almost a third reported napping during the day, which can actually worsen fatigue."

For Dr. Cheville, whose research focuses on improving the delivery of supportive care to patients, the study provides a wake-up call.

"We could be doing a much better job addressing fatigue, with more reliable instruction for patients and offering treatments that have been shown to work," she says.

Oncologists, whose jobs are growing more complex and whose patient bases continue to expand, may not have time or resources to address quality-of-life concerns. Ultimately, she says, the medical field may require specialists who focus on supportive care issues in cancer treatment, including pain, fatigue and depression.

The study was supported by a grant from the U.S. Department of Defense. Other authors include Jeffrey Basford, M.D., Ph.D., of Mayo Clinic's Department of Physical Medicine and Rehabilitation.

Media Contact: Bryan Anderson, 507-284-5005 (days), newsbureau@mayo.edu

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MULTIMEDIA ALERT: Video of Andrea Cheville, M.D., available on the Mayo Clinic News Network.

"As doctors, we often tell patients that exercise is important, but to this point, nobody had studied what patients know about exercise, how they feel about it and what tends to get in the way," says lead author Andrea Cheville, M.D., of Mayo Clinic's Department of Physical Medicine and Rehabilitation. The study is part of a series of investigations looking at exercise habits among cancer patients. Researchers found that patients who exercised regularly before their diagnosis were more likely to exercise than those who had not. Many patients considered daily activities, such as gardening, sufficient exercise. "There was a real sense of 'What I do every day, that's my exercise,'" says Dr. Cheville, noting that most patients didn't realize daily activities tend to require minimal effort. "Most were not aware that inactivity can contribute to weakening of the body and greater vulnerability to problems, including symptoms of cancer." In addition, researchers found that patients took exercise advice most seriously when it came directly from their oncologists, but none of those studied had discussed it with them. "Generally, patients are not being given concrete advice about exercise to help them maintain functionality and to improve their outcomes," Dr. Cheville says. Exercise can improve patients' mobility, enable them to enjoy activities and keep them from becoming isolated in their homes. It can contribute to overall feelings of strength and physical safety, ease cancer-related fatigue and improve sleep. The researchers plan to investigate how to make the message about exercise meaningful to patients to optimize symptom relief and enhance recovery. The study was funded by a grant from the Fraternal Order of Eagles. Other authors include Ann Marie Dose, Ph.D.; Jeffrey Basford, M.D.; Ph.D., and Lori Rhudy, Ph.D.; all of Mayo Clinic.

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About Mayo Clinic:

Recognizing 150 years of serving humanity in 2014, Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit 150years.mayoclinic.org, www.mayoclinic.org and newsnetwork.mayoclinic.org.

Media Contact: Bryan Anderson, 507-284-5005 (days), newsbureau@mayo.edu

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