Bowel cancer deaths drop by a third in 20 years

The rate of people dying from bowel cancer in the UK has plummeted by more than 30 per cent in the last 20 years | Cancer Research UK 

170814-bowel-cancer-mortality-rates

Image source: CRUK 

Bowel cancer was responsible for 38 deaths per 100,000 people in 1995, falling to 26 deaths per 100,000 people by 2015. The drop in rates, taking into account changing population figures, equates to a decrease in bowel cancer deaths from 17,600 in 1995 to 15,800 in 2015.

Experts believe better treatment lies behind the dramatic drop in deaths. Improved public awareness among both patients and doctors, the bowel screening programme, may also be playing a part.

Read the full blog post here

Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme

The aim of this study was to determine whether a supplementary leaflet providing the ‘gist’ of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP | BMC Cancer

email-marketing-2362038_960_720.png

The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59–74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet (‘SI’). The intervention group received the SI booklet and the Gist leaflet (‘SI + Gist’) which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles.

In November 2012, 163,525 individuals were allocated to either the ‘SI’ intervention (n = 79,104) or the ‘SI + Gist’ group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92–1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups.

Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research.

Full reference: Smith, S.G. et al. (2017) Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer. 17:543

Faster access to cancer drugs

Patients getting faster access to cancer drugs as NICE approves three quarters of the Cancer Drugs Fund | NICE

medical-1572978_960_720

Liver cancer drug, sorafenib has been approved for routine NHS use, marking three quarters of the way through the Cancer Drugs Fund (CDF) without a negative decision.

NICE has recommended sorafenib, also known as Nexavar, made by Bayer to be routinely available for some patients on the NHS.

Sorafenib is one of the 24 drugs NICE was asked to appraise from the CDF, and all have been approved so far for routine NHS use.

Its positive recommendation means that NICE is three quarters of the way through the CDF with 18 drugs now approved.

Companies, like Bayer have provided discounts and in some cases additional evidence meaning the drugs can be considered as cost effective for routine NHS.

Read the full news story here

Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life

Little is known about the patterns and predictors of the use of end-of-life health care among patients with acute myeloid leukemia (AML) | Journal of Clinical Oncology

End-of-life care is particularly relevant for older adults with AML because of their poor prognosis.

We performed a population-based, retrospective cohort study of patients with AML who were ≥ 66 years of age at diagnosis and diagnosed during the period from 1999 to 2011 and died before December 31, 2012. Medicare claims were used to assess patterns of hospice care and use of aggressive treatment. Predictors of these end points were evaluated using multivariable logistic regression analyses.

In the overall cohort (N = 13,156), hospice care after AML diagnosis increased from 31.3% in 1999 to 56.4% in 2012, but the increase was primarily driven by late hospice enrollment that occurred in the last 7 days of life. Among the 5,847 patients who enrolled in hospice, 47.4% and 28.8% started their first hospice enrollment in the last 7 and 3 days of life, respectively. Among patients who transferred in and out of hospice care, 62% received transfusions outside hospice. Additionally, the use of chemotherapy within the last 14 days of life increased from 7.7% in 1999 to 18.8% in 2012. Patients who were male and nonwhite were less likely to enroll in hospice and more likely to receive chemotherapy or be admitted to intensive care units at the end of life. Conversely, older patients were less likely to receive chemotherapy or have intensive care unit admission at the end of life, and were more likely to enroll in hospice.

End-of-life care for older patients with AML is suboptimal. Additional research is warranted to identify reasons for their low use of hospice services and strategies to enhance end-of-life care for these patients.

Full reference: Wang, R. et al. (2017) Health Care Use by Older Adults With Acute Myeloid Leukemia at the End of Life. Journal of Clinical Oncology. Published online: 7th August 2017

Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women

Concurrent chemoradiotherapy (CCRT) is the standard treatment for local advanced cervical cancer. However, for elderly patients, studies are limited and the outcomes are controversial | BMC Cancer

Methods: We retrospectively analyzed the elderly cervical cancer patients treated with radical RT or CCRT between January 2006 and December 2014. For external beam radiotherapy, 50Gy in 25 fractions or 50.4Gy in 28 fractions were delivered via 3-dimensional conformal radiation therapy or intensity modulated radiation therapy. High-dose-rate intracavitary brachytherapy was performed with a dose of 30-36Gy in 5–7 fractions to point A. Concurrent chemotherapy regimens included weekly cisplatin and paclitaxel.

Conclusion: Elderly cervical cancer patients could tolerate radical RT and CCRT very well and get a favored survival. Compared with RT, CCRT could improve the survival of elder cervical cancer patients with similar nonhematological toxicity. CCRT should be considered in elderly cervical cancer patients.

Full reference: Wang, W. et al. (2017) Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women. BMC Cancer 17:510

Identifying critical steps towards improved access to innovation in cancer care

Investment in innovation must be balanced with the need to ensure the sustainability of healthcare budgets, and all health professionals have a responsibility to help achieve this balance | European Journal of Cancer

light-bulbs-1125016_960_720

Highlights:

  • Innovation in cancer care does not have to be complex or expensive.
  • An innovation’s value depends on patient outcomes, quality of life and system costs.
  • A whole-system, whole-patient approach is required to guide investment in innovation.
  • Patients must be more involved in defining and assessing the value of innovation.
  • Investment in real-world data is essential to shape decisions about interventions.

Full reference: Aapro, M. et al. (2017) Identifying critical steps towards improved access to innovation in cancer care: a European CanCer Organisation position paper. European Journal of Cancer. Volume 82 – pp. 193–202

 

The annual cancer patient experience survey (CPES) suggests that services are improving.

National Cancer Patient Experience Survey

Patients scored their overall experience at 8.74 out of 10, compared with 8.70 last year. This year’s CPES sought views on the experiences of care of more than 118,000 NHS patients who had treatment in hospital from April to June 2016 after a primary diagnosis of cancer.

The report for The Rotherham Foundation Trust can be accessed here.

The report for Rotherham CCG can be accessed here.