British Psychological Society: Psychological insights for cancer services recovery planning #covid19rftlks

British Psychological Society | July 2020| Psychological insights for cancer services recovery planning

Like all in our society and our colleagues in health services, psychological care specialists in cancer and palliative care have been trying to make sense of our recent experiences of the pandemic and to anticipate and prepare for what might come next for patients and ourselves.

This document is for healthcare professionals working in psychological services for people with cancer or receiving palliative care, who are preparing for the ‘next normal’.

Psychological insights for cancer services recovery planning

NICE: Cancer patients to benefit from new histology independent treatment

NICE | July 2020 | Cancer patients to benefit from new histology independent treatment

Entrectinib (Rozlytrek, Roche), a revolutionary treatment for a range of cancers, is the second histology independent drug to be recommended by NICE for use on the Cancer Drugs Fund (CDF).

As a histology independent treatment, entrectinib targets all solid tumours that have a certain genetic mutation (a neurotrophic tyrosine receptor kinase (NTRK) gene fusion), regardless of where the cancer originated in the body.

This is particularly beneficial to patients with some rare types of cancer where the treatments are currently limited.

The final draft decision is set to benefit adults and children 12 years and older, with advanced NTRK fusion-positive solid tumours, who have no satisfactory treatment options. Eligible patients will have access to entrectinib through the CDF once the marketing authorisation has been granted.

Further information available from NICE

Cancer care during and after the pandemic

Cancer care during and after the pandemic | BMJ (editorial) 2020; 370: m2622 | 2nd July 2020

The covid-19 pandemic has had a drastic effect on the entire cancer continuum through interruption, delays, and altered modes of screening, diagnosis, and treatment as well as follow-up and palliative care.

This editorial makes the point that many of the strategies used to manage cancer care during the pandemic, such as remote consultations, are not new, and it is unfortunate that it took a pandemic to accelerate their adoption. It is critical that these innovations are not scaled down without examining their effect on patient outcomes (which may be both positive and negative) and equity of access.

Full editorial: Cancer care during and after the pandemic

Case 22-2020: A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic #covid19rftlks

Spring, L. M. et al. (2020) |A 62-Year-Old Woman with Early Breast Cancer during the Covid-19 Pandemic| NEJM |DOI: 10.1056/NEJMcpc2002422

Presentation of Case

Dr. Aditya Bardia: A 62-year-old woman was evaluated at this hospital after she had identified a mass in her left breast, confirmed by her physician on physical examination, during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The patient, who was of Ashkenazi Jewish ancestry, had no known family history of breast or ovarian cancer. Medical history included asthma and a fibroadenoma in the left breast, for which she had undergone excisional biopsy 30 years earlier. Menarche had occurred at 12 years of age and menopause at 54 years of age; she had not received hormone-replacement therapy.

Physical examination revealed a mass, measuring 3 cm in greatest dimension, in the left breast. No other masses or axillary lymph nodes were palpable. The patient underwent imaging studies in accordance with the American College of Radiology guidelines.1 Both breasts were imaged, since the patient’s last mammogram had been obtained 7 years earlier.



Dr. Gary X. Wang:
 Mammography revealed an irregular mass with spiculated margins underlying the skin marker in the left breast, with imaging characteristics highly suggestive of cancer. Subsequent ultrasound examination revealed a solid, irregular mass in the left breast that measured 3.1 cm by 1.5 cm by 1.2 cm and normal left axillary lymph nodes. Tissue sampling with core-needle biopsy under ultrasonographic guidance was performed.

Cancer x Coronavirus: The impact on young people #covid19rftlks

Teenage Cancer Trust | June 2020 | Cancer x Coronavirus: The impact on young people

Coronavirus has disrupted the lives of all young people across the UK.
Schools and universities have shut, interrupting education at a critical time. Family, friends and partners have been cut off, breaking social connections. Those taking their first steps into work have found the jobs market stalled. Facing cancer on top of that feels unimaginably tough. Many young people with cancer are also deemed to be in the group most vulnerable to coronavirus, whilst the current evidence suggests that the majority of people their age are generally at less risk – further setting young people with cancer apart from their peers. Many have had to ‘shield’ – isolating themselves completely from others, for up to three months. They’ve told us how difficult this has been.


Even as schools start to return, rules about meeting others relax, and the rest of us slowly start to return to something approaching normality, young people with cancer face an
uncertain future.
Living with cancer already puts young people’s lives on hold while their peers move on. Living during a global pandemic adds a further layer of uncertainty and isolation.
We’re deeply concerned about the toll this period has taken on young people already going through one of the hardest times of their life.

The Teenage Cancer Trust has adapted its own Teenage Cancer Trust services,
staffed by specialist nurses and support teams, to the best of our ability to meet young people’s changing needs during the pandemic, including providing much more of our
peer support online.
But we wanted to find out how far young people with cancer feel their care has been disrupted by coronavirus.
I’d like to thank every young person who has shared their experiences for this project.
This report includes some clear recommendations for government and healthcare providers to take on board.
We’re also reviewing our own services to see where we can do more to meet some of the clear needs this research has identified. Creativity, determination and going the extra
mile have helped us to keep supporting young people – but we won’t stop there. As the situation evolves, so will our support so we can keep being there for young people
through this crisis and beyond.
Cancer is tough enough on its own. If we don’t get the next steps right, the long-term impact on young people with cancer will be significant.

Cancer x Coronavirus: The impact on young people

The Lancet: Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective #covid19rftlks

Barry, A. et al (2020). Management of primary hepatic malignancies during the COVID-19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective. The Lancet Gastroenterology & Hepatology| DOI:https://doi.org/10.1016/S2468-1253(20)30182-5

Summary

Around the world, recommendations for cancer treatment are being adapted in real time in response to the pandemic of COVID-19. We, as a multidisciplinary team, reviewed the standard management options, according to the Barcelona Clinic Liver Cancer classification system, for hepatocellular carcinoma. We propose treatment recommendations related to COVID-19 for the different stages of hepatocellular carcinoma (ie, 0, A, B, and C), specifically in relation to surgery, locoregional therapies, and systemic therapy. We suggest potential strategies to modify risk during the pandemic and aid multidisciplinary treatment decision making. We also review the multidisciplinary management of intrahepatic cholangiocarcinoma as a potentially curable and incurable diagnosis in the setting of COVID-19.

Management of primary hepatic malignancies during the COVID -19 pandemic: recommendations for risk mitigation from a multidisciplinary perspective

Sheffield Teaching Hospitals: New pain-free device to detect oral cancer to be developed

Sheffield Teaching Hospitals | June 2020 | New pain-free device to detect oral cancer to be developed

A research collaboration involving Sheffield Teaching Hospitals NHS Foundation Trust has been awarded £1m in funding from SBRI Healthcare – an NHS England initiative – to test and develop a pain-free, non-invasive and instantaneous method to detect oral cancer.

Once built and tested, the new device could enable doctors to detect oral cancer earlier and more accurately, reducing the need for patients to have invasive biopsies. This in turn could provide better outcomes for patients and significant cost savings for the NHS.

The pioneering device is to be developed with medical device diagnostics company Zilico Ltd – born out of a partnership between the University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust – using the same patented technology as its ZedScan device, which is now in use in the NHS for the early and non-invasive diagnosis of cervical cancer.

Researchers from Sheffield Teaching Hospitals and the University of Sheffield previously demonstrated that the principle of its electrical impedance spectroscopy (EIS) technology, where normal, precancerous and cancerous tissue can be differentiated according to its electrical properties could be useful for detecting oral cancer. The ‘proof of concept’ study involved 47 patients who were recruited from the Charles Clifford Dental Hospital.

Typically, suspicious oral lesions are inspected and diagnosed visually, but the visual indicators of disease can be misleading or non-apparent in some cases. Many other signs and symptoms of mouth cancer such as constant bad breath and difficulty chewing or swallowing can also be caused by other things than cancer, so a definitive diagnosis can only be made through a biopsy of the tissue.

The new device could enable patients to receive real-time diagnosis at the primary point of their care and the University is now working with Zilico to develop a functional prototype to be assessed and trialled for use in the NHS.

It is anticipated that the prototype will be ready for testing on a group of volunteers, with the aim to progress the project to a full clinical trial in the next 12 months.

Read the full news story here

See also:

University of Sheffield Scientists to develop pain-free device to detect oral cancer

[NICE Technology appraisal guidance [TA632]] Trastuzumab emtansine for adjuvant treatment of HER2-positive early breast cancer

NICE | June 2020 | Trastuzumab emtansine for adjuvant treatment of HER2-positive early breast cancer

Evidence-based recommendations on trastuzumab emtansine (Kadcyla) for human epidermal growth factor receptor 2 (HER2)‑positive early breast cancer in adults who have residual invasive disease in the breast or lymph nodes after neoadjuvant taxane-based and HER2‑targeted therapy.

Full details from NICE

NICE recommends treatment for type of small-cell lung cancer

NICE  |  May 2020 | NICE recommends treatment for type of small-cell lung cancer

A new treatment option for patients with extensive-stage small-cell lung cancer has been approved by NICE.

In new draft guidance, atezolizumab (also called Tecentriq and made by Roche) with carboplatin and etoposide has been recommended as an option for untreated extensive-stage small-cell lung cancer (ES-SCLC).

Around 2400 people in England have ES-SCLC, of whom around 1200 people will be eligible for treatment with atezolizumab with carboplatin and etoposide.

The positive recommendation follows consultation on NICE’s previous draft guidance which did not recommend the treatment. The company has since agreed on a new price for atezolizumab with NHS England and Improvement, which means that the treatment is now considered a cost-effective use of NHS resources.

The clinical trial evidence for the combination treatment was based on patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. Clinical experts suggested that the effects of the treatment may be different for people with a score of 2 or higher, that is, a more severe illness, so atezolizumab with carboplatin and etoposide was recommended only for patients with an ECOG performance status of 0 or 1.

Meindert Boysen, deputy chief executive officer and director of the Centre for Health Technology Evaluation at NICE, said: “We are pleased to be able to recommend this new treatment that could extend the life of patients with this type of lung cancer.

“I know how important this news will be for patients suffering with this condition, for which there are currently few treatment options. Atezolizumab with carboplatin and etoposide may offer valuable time for patients to spend with their loved ones.”

ES-SCLC is a form of lung cancer accounting for 1 in 8 lung cancer cases in the UK. It is an aggressive disease that progresses rapidly, with a significant negative impact on the quality of life of patients.

Clinical trial evidence suggests that atezolizumab with carboplatin and etoposide increases the time before the disease worsens by around 1 month compared with standard chemotherapy (5.2 months versus 4.3 months respectively).

It also suggests that atezolizumab plus carboplatin and etoposide increases overall survival compared with standard chemotherapy. However, the long-term benefit on overall survival was uncertain.

NICE expects to publish its final guidance on atezolizumab for ES-SCLC in June 2020 (Source: NICE)

Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer