Multi-disciplinary team meetings: cancer care

This guidance sets out how Multi-Disciplinary Teams (MDTs) can provide the most effective clinical management by focussing on patients with the most complex needs | NHS England | NHS Improvement

This guidance has been developed to enable cancer multi-disciplinary teams (MDTs) to respond to the changing landscape in cancer care, as recognised in the NHS Long Term Plan and the Independent Cancer Taskforce Report.

The guidance sets out how MDT Meetings (MDTMs) can continue to provide effective clinical management by remaining focussed on discussion of those patient cases which require full multidisciplinary input. This approach aims to support MDTMs in three ways:

  • Firstly, it should help to ensure there is adequate time for discussion of cases where it is  needed, by allowing more focus on complex cases in the MDTM.
  • Secondly, streamlining should ensure that valuable diagnostic and clinical time is used most effectively by creating more flexibility in management of the MDTM.
  • Thirdly, the policy will increase the transparency and consistency of care by agreeing the treatment or care any patient should expect to receive across Cancer Alliances.

Streamlining Multi-Disciplinary Team Meetings – Guidance for Cancer Alliances | NHS England | NHS Improvement

Ovarian cancer disease profile

Disease profile in England: Incidence, mortality, stage and survival for ovary, fallopian tube and primary peritoneal carcinomas |  Public Health England

This report provides a detailed insight into the status of ovarian cancer in England.  It is the first report from the Cancer Audit Feasibility Pilot project which runs for two years and includes details of disease incidence, mortality and survival.

National bowel cancer audit annual report

National Bowel Cancer Audit Annual Report 2019 | The Healthcare Quality Improvement Partnership

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Image source: https://www.hqip.org.uk/

This tenth report of the audit includes data on over 30,000 patients diagnosed with bowel cancer between 01 April 2017 and 31 March 2018.  For the first time, indicators of return to theatre and robotic surgery are reported and the measure of adjuvant chemotherapy for stage III colon cancer is reported at trust/hospital level in England. The report discusses several key findings for care pathways, surgical care, survival, rectal cancer and National Cancer Registry data.

Full report at HQIP

Amount and intensity of leisure-time physical activity and lower cancer risk

Matthews, C. E. et al. | Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk | Journal of Clinical Oncology | published online December 26th 2019.

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Purpose
To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.

Methods
Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).

Results
A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.

Conclusion
Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.

Full document available at Journal of Clinical Oncology

Testicular cancer: one cycle of chemo just as effective

Cullen, M., et al |2020|The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in High-risk, Stage 1 Nonseminomatous or Combined Germ Cell Tumours of the Testis|European Urology|

European Urology has published a paper based on a study that looked at the efficacy of one cycle of chemotherapy for patients with testicular cancer rather than two.  While standard treatment in Europe involves two cycles of chemotherapy the researchers of this trial  show that one cycle has few adverse effects and comparable outcomes
to those seen with two cycles. 

Abstract
Background: Standard management in the UK for high-risk stage 1 nonseminoma germ cell tumours of the testis (NSGCTT) is two cycles of adjuvant bleomycin, etoposide (360 mg/m2 ), and cisplatin (BE360P) chemotherapy, or surveillance.
Objective: To test whether one cycle of BE500P achieves similar recurrence rates to two cycles of BE360P.
Design, setting, and participants: A total of 246 patients with vascular invasion–positive stage 1 NSGCTT or combined seminoma + NSGCTT were centrally registered in a single-arm prospective study.
Intervention: One cycle comprising bleomycin 30000 IU on days 1, 8, and 15, etoposide 165 mg/m2 on days 1–3, and cisplatin 50 mg/m2 on days 1–2, plus antibacterial and granulocyte colony stimulating factor prophylaxis.
Outcome measurements and statistical analysis: The primary endpoint was 2-yr malignant recurrence (MR); the aim was to exclude a rate of 5%. Participants had regular imaging and tumour marker (TM) assessment for 5 yr.
Results and limitations: The median follow-up was 49 mo (interquartile range 37–60). Ten patients with rising TMs at baseline were excluded. Four patients had MR at 6, 7, 13, and 27 mo; all received second-line chemotherapy and surgery and three remained recurrence-free at 5 yr. The 2-yr MR rate was 1.3% (95% confidence interval 0.3–
3.7%). Three patients developed nonmalignant recurrences with localised teratoma differentiated, rendered disease-free after surgery. Grade 3–4 febrile neutropenia occurred in 6.8% of participants.
Conclusions: BE500P is safe and the 2-yr MR rate is consistent with that seen following two BE360P cycles. The 111 study is the largest prospective trial investigating one cycle of adjuvant BE500P in high-risk stage 1 NSGCTT. Adoption of one cycle of BE500P as standard would reduce overall exposure to chemotherapy in this young population.
Patient summary: Removing the testicle fails to cure many patients with high-risk primary testicular cancer  since undetectable cancers are often present elsewhere. A standard additional treatment in Europe is two cycles of chemotherapy to eradicate these. This trial shows one cycle has few adverse effects and comparable outcomes
to those seen with two cycles

 

The 111 Study: A Single-arm, Phase 3 Trial Evaluating One Cycle of  Bleomycin, Etoposide, and Cisplatin as Adjuvant Chemotherapy in 
High-risk, Stage 1 Nonseminomatous or Combined Germ Cell
Tumours of the Testis

In then news:

BBC News Testicular cancer: ‘Kinder’ chemotherapy is ‘just as effective’

International evaluation of an AI system for breast cancer screening

McKinney, S. M., et al. |2020| International evaluation of an AI system for breast cancer screening| Nature| 577|(7788)| P. 89-94.

An international team of researchers including experts from Imperial College London trained and tested an artificial intelligence (AI) system screening using a simulation of the double-reading process that is used in the UK.  29000 mammography images were used to demonstrate that the AI system was able to correctly identify cancers from the images with a similar degree of accuracy to expert radiologists, and holds the potential to assist clinical staff in practice. 

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The authors of the paper found that the computer algorithm (AI system) maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening (Source: Imperial College London). 

Full press release from Imperial College London Artificial intelligence could help to spot breast cancer

Screening mammography aims to identify breast cancer at earlier stages of the disease, when treatment can be more successful1. Despite the existence of screening programmes worldwide, the interpretation of mammograms is affected by high rates of false positives and false negatives2. Here we present an artificial intelligence (AI) system that is capable of surpassing human experts in breast cancer prediction. To assess its performance in the clinical setting, we curated a large representative dataset from the UK and a large enriched dataset from the USA. We show an absolute reduction of 5.7%and 1.2% (USA and UK) in false positives and 9.4% and 2.7% in false negatives. We provide evidence of the ability of the system to generalize from the UK to the USA. In an independent study of six radiologists, the AI system outperformed all of the human readers: the area under the receiver operating characteristic curve (AUC-ROC) for the AI system was greater than the AUC-ROC for the average radiologist by an absolute margin of 11.5%. We ran a simulation in which the AI system participated in the double-reading process that is used in the UK, and found that the AI system maintained non-inferior performance and reduced the workload of the second reader by 88%. This robust assessment of the AI system paves the way for clinical trials to improve the accuracy and efficiency of breast cancer screening.

Paper: International evaluation of an AI system for breast cancer screening

In the news:

BBC |  AI ‘outperforms’ doctors diagnosing breast cancer

BMJ |  AI system outperforms radiologists in first reading of breast cancer screening, study claims