A new piece of research that examines the quality of life for UK men living with advanced and localised prostate has been published in The Lancet Oncology.
Little is known about the health-related quality of life (HRQOL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQOL in men with all stages of prostate cancer and identify implications for health-care delivery.
For this population-based study, men in the UK living 18–42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered, which contained validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), measured with the Expanded Prostate Cancer Index Composite short form (EPIC-26), plus questions about use of interventions for sexual dysfunction) and generic HRQOL (assessed with the 5-level EuroQol five dimensions questionnaire [EQ-5D-5L] measuring mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, plus a rating of self-assessed health). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups. Each model included adjustment for age, socioeconomic deprivation, and number of other long-term conditions.
35 823 (60·8%) of 58 930 men responded to the survey. Disease stage was known for 30 733 (85·8%) of 35 823 men; 19 599 (63·8%) had stage I or II, 7209 (23·4%) stage III, and 3925 (12·8%) stage IV disease. Mean adjusted EPIC-26 domain scores were high, indicating good function, except for sexual function, for which scores were much lower. Compared with men who did not receive androgen deprivation therapy, more men who received the therapy reported moderate to big problems with hot flushes, low energy, and weight gain. Poor sexual function was common, regardless of stage, and more than half of men were not offered any intervention to help with this condition. Overall, self-assessed health was similar in men with stage I–III disease, and although slightly reduced in those with stage IV cancer, 23·5% of men with metastatic disease reported no problems on any EQ-5D dimension.
Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localised disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required.
The Movember Foundation, in partnership with Prostate Cancer UK.
The full article can be requested by Rotherham NHS staff here
NICE | February 2019 | NICE draft guidance recommends pertuzumab for new breast cancer indication after improved price offer from company
NICE has published final draft guidance recommending pertuzumab (Perjeta, Roche) for treating early HER2-positive breast cancer in people whose disease has spread to their lymph nodes.
This positive recommendation is for people who have had surgery for their breast cancer and whose cancer has already spread to their lymph nodes. The estimated 2700 people in this subgroup have a higher risk of their cancer returning.
The evidence shows that adding pertuzumab to trastuzumab and chemotherapy after surgery increased the proportion of people whose disease didn’t spread. However, there is a lack of evidence on how long, if at all, adding pertuzumab might increase the overall length of time people live.
Final guidance is expected to be published in March (Source: NICE).
Health Quality Improvement Programme | February 2019 | National Lung Cancer Audit: Clinical Outcome Publication Report 2018
Health Quality Improvement Programme (HQIP) have produced the fifth report on the individual activity of surgeons and their contribution to lung cancer care. The data relate to patients diagnosed with lung cancer who underwent surgery during the period between 1 January and 31 December 2016.
In addition to publishing the number of operations performed by hospitals and by individual consultant surgeons, the following outcomes are reported:
the proportion of patients who survive at 30 days, 90 days and 1 year after their operation for each unit
the median length of stay in hospital following an operation
the proportion of patients who were readmitted within 90 days of hospital discharge
the pooled resection rates for the lung cancer team meetings (MDTs) which a surgical unit serves (Source: HQIP)
Health Quality Improvement Partnership | February 2019 | National Prostate Cancer Audit: Annual Report 2018
Health Quality Improvement Partnership (HQIP) have published the results of their national prostate cancer audit in the report National Prostate Cancer Audit: Annual Report 2018.
There are over 40,000 new diagnoses of prostate cancer every year in the UK and over 11,000 men die because of the disease. This makes prostate cancer the second most common cause of cancer-related death for men in the UK.
This report presents results for men diagnosed with prostate cancer between 1st April 2016 and 31st March 2017 in England and Wales. It reports on specific diagnostic, staging and treatment information as well as core performance indicators in order to compare diagnostic specialist MDTs or treatment centres. This is the first report which combines English and Welsh data as well as using patient-reported experience (PREMs) and outcome measures (PROMs) as performance indicators.
Reporting on a total of 14 performance indicators, the NPCA is the first national audit which is able to report on process and outcome measures from all aspects of the care pathway for men with prostate cancer (Source: HQIP).
Winter 2019 will be a landmark for the National Health Service, as it will mark the opening of the NHS’s first high energy proton beam therapy unit, at the Christie NHS Foundation Trust in Manchester. Adrian Crellin, NHS England clinical lead for proton beam therapy says: “It is a confirmation that radiation oncology is absolutely a key part of modern cancer treatment.”
The two new £125m (€140m; $160m) centres will each treat up to 750 patients a year. “Many of the patients we’ll be treating will be children, young people, and those with what could loosely be termed as rarer tumours,” says Ed Smith, who heads the Christie unit.
Research has advanced since the NHS announced investment in the two national proton beam centres in 2012. Smith, a consultant clinical oncologist, says protons now have “an increasingly proved role in the indications we will treat” and suggests the evidence is “beginning to firm up” for the reduction of long term toxicities.
Conventional radiotherapy uses x rays from multiple directions; a modern variant is high precision, intensity modulated radiotherapy (IMRT), which aims to maximise the dose to the tumour while minimising the dose to the surrounding tissue (Source: The BMJ).