National Bowel Cancer Audit: The feasibility of reporting patient outcome measures

Health Quality Improvement Programme | August 2018| National Bowel Cancer Audit: The feasibility of reporting patient outcome measures as part of  of a national colorectal cancer audit

Health Quality Improvement Programme  (HQIP)  has published the National Bowel Cancer Audit: The feasibility of reporting patient outcome measures

NHS England’s National Cancer PROMs Programme of the National Survivorship Initiative2 collected Patient Reported Outcome Measures (PROMs) for colorectal cancer patients in a one-off study in 2013. Patients were between one- and three-years from diagnosis at the point of being surveyed.


The aim of this study was to link the Patient Reported Outcome Measures (PROMs) for colorectal cancer patients in a one-off study in 2013, survey data to the National Bowel Cancer Audit (NBOCA) data to establish the feasibility of reporting PROMs as part of a national clinical audit. This was assessed according to i) the characteristics of responders compared to all eligible patients ii) the representativeness of the responders at different points along their pathway from diagnosis, iii) hospital trust variation in response rate, and iv) the validity of the measures in comparison to NBOCA measures (Source: HQIP).

The full report is available from HQIP here 
Of interest:

Public Health England & Steve Brine MP Bowel screening to start at 50

‘Workforce crisis’ in Cancer Services

Clinical oncology UK workforce census 2017 report| The Royal College of Radiologists

The clinical oncology UK workforce census report provides a unique profile of the clinical oncology workforce in the UK. This years’ figures highlight the ongoing workforce shortages putting consultants and department under intense pressure. The key findings show that:

  • Demand for cancer services continues to outstrip the workforce supply
  • Increased pressure on services mean that time allocated to supporting professional activities is being erroded, potentially impacting on the quality of services
  • Training numbers are insufficient to replenish the current shortages in the workforce
  • Experienced oncologists are being lost from the workforce through retirements.

Full report: Clinical oncology UK workforce census 2017 report

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How diet, nutrition and physical activity affect cancer risk

The World Cancer Research Fund have published an interactive infographic summarising risk factors for certain cancers.


The full report summarises the wealth of evidence on how diet, nutrition and physical activity can influence the biological processes that underpin the development and progression of cancer.

The report contains the following 10 exposure sections, covering definitions and background information, issues relating to interpretation of the evidence, the evidence itself ( and judgements on the evidence.

View the Interactive Cancer Risk Matrix

Full report: Diet, Nutrition, Physical Activity and Cancer: a Global Perspective

The association of lifetime alcohol use with mortality and cancer risk in older adults

The risk of mortality, and of developing a number of cancers, is lowest in light drinkers consuming an average of less than one drink per day across their lifetime, and the risk of some cancers increases with each additional drink per week, according to a new study.



While current research is largely consistent as to the harms of heavy drinking in terms of both cancer incidence and mortality, there are disparate messages regarding the safety of light-moderate alcohol consumption, which may confuse public health messages. We aimed to evaluate the association between average lifetime alcohol intakes and risk of both cancer incidence and mortality.

Methods and findings
We report a population-based cohort study using data from 99,654 adults (68.7% female), aged 55–74 years, participating in the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Cox proportional hazards models assessed the risk of overall and cause-specific mortality, cancer incidence (excluding nonmelanoma skin cancer), and combined risk of cancer and death across categories of self-reported average lifetime alcohol intakes, with adjustment for potential confounders.

During 836,740 person-years of follow-up (median 8.9 years), 9,599 deaths and 12,763 primary cancers occurred. Positive linear associations were observed between lifetime alcohol consumption and cancer-related mortality and total cancer incidence. J-shaped associations were observed between average lifetime alcohol consumption and overall mortality, cardiovascular-related mortality, and combined risk of death or cancer.

In comparison to lifetime light alcohol drinkers (1–3 drinks per week), lifetime never or infrequent drinkers (<1 drink/week), as well as heavy (2–<3 drinks/day) and very heavy drinkers (3+ drinks/day) had increased overall mortality and combined risk of cancer or death. This analysis is limited to older adults, and residual confounding by socioeconomic factors is possible.

The study supports a J-shaped association between alcohol and mortality in older adults, which remains after adjustment for cancer risk. The results indicate that intakes below 1 drink per day were associated with the lowest risk of death.

Full reference: Kunzmann, A. T. et al. | The association of lifetime alcohol use with mortality and cancer risk in older adults: A cohort study | PLOS Medicine | June 19, 2018
See also: ScienceDaily | Risks of cancer and mortality by average lifetime alcohol intake

Bowel cancer screening

Guidance for providers of bowel scope screening within the NHS Bowel Cancer Screening Programme in England | Public Health England

The UK National Screening Committee recommended the addition of bowel scope screening alongside the existing guaiac faecal occult blood test (gFOBT) following a clinical trial and 11 years of follow-up. These standard operating procedures (SOPs) help commissioners and providers in establishing and implementing bowel scope screening.

Full detail at Public Health England

Cancer patients at increased risk of suicide

The first national study of its kind in England shows cancer patients have a 20% increased risk of suicide | Public Health England

Cancer patients in England are at increased risk of suicide compared to the general population, according to new figures from Public Health England (PHE). The first national study of its kind in England reveals cancer patients have a 20% increased risk of suicide, with the highest risk seen within the first 6 months of diagnosis.

The findings of the study, presented at PHE’s Cancer Services, Data and Outcomes Conference, show cancers with poorer prognoses are associated with the highest risk, including:

  • mesothelioma
  • pancreatic cancer
  • oesophageal cancer
  • lung cancer
  • stomach cancer

The reasons are complex and not fully understood, but may include fear of pain or treatment side-effects.

Advances in care and treatment mean more people with cancer are surviving and living longer; however, this study suggests many are struggling with their diagnosis.

This highlights the need for emotional support – including targeted psychological screening – to be integrated early into cancer care, alongside diagnosis and treatment. It is important for health professionals to consider the risk of suicide to help avoid potentially preventable deaths.

Full detail at Public Health England



Hypnosis may help reduce distress of cancer treatment in children

University of Exeter | June 2018 | Hypnosis may help reduce distress of cancer treatment in children

A team at the University of Exeter have worked alongside Devon Integrated Children’s Service to explore ways of  reducing anxiety in children having treatment for cancer without using drugs. According to the authors of the study almost fifty per cent of children with cancer experience clinically significant emotional distress. This can cause additional anguish for the child and for their families and have a long-lasting impact on mental health. As well as looking at the evidence available on hypnosis, the team also reviewed evidence on listening to music, virtual reality and cognitive behavioural therapy. They found much of the research about whether or not these strategies reduced children’s distress to be  contradictory.

Now, the team report  that hypnosis can reduce the distress associated with injections and other needle procedures, such as extracting bone marrow and giving chemotherapy. Earlier research had found that procedures like these are often more anxiety-inducing for children and young people than the cancer itself.

Tamsin Ford, Professor of Child and Adolescent Psychiatry at the University of Exeter Medical School, said: “Hypnosis is inexpensive to deliver, and our research found that it was the technique that was most studied, and showed promise in reducing children’s anxiety about the many medical procedures they have to endure. We now need high quality trials to be sure whether hypnosis should be adopted in clinics.”(Source: University of Exeter)

An article based on the research’s findings has been published in the journal Psychooncology



Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP.


Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen’s d) and 95% confidence intervals. All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool.


Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual . Evidence from nonhypnosis interventions was equivocal, with some promising individual studies. There was high risk of bias across included studies limiting confidence in some positive effects.


Evidence suggests promise for hypnosis interventions to reduce procedural anxiety in CYP undergoing cancer treatment. These results largely emerge from one research group, therefore wider research is required. Promising evidence for individual nonhypnosis interventions must be evaluated through rigorously conducted randomised controlled trials.

Full reference:

Nunns, M., Mayhew, D., Ford, T, Rogers, M., Curle, C., Logan, S., Moore, D.|2018| Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: A systematic review and meta-analysis| Psychooncology2018 Apr 30|  doi: 10.1002/pon.4749. [Epub ahead of print]


GPs urged to make most of cancer screening dashboard


laptop-3324201_1920NHS Digital in a press release, has urged GPs and health organisations to help to improve rates of potentially lifesaving cervical screening by making the most of an innovative online data tool. The interactive data dashboard provides in-depth information on screening levels and shows where they could be improved. It was launched a year ago by NHS Digital, Public Health England (PHE) and Jo’s Cervical Cancer Trust. Clinical Commissioning Groups (CCGs), GP practices and local authorities can look up their data to see where to focus work on improving coverage rates of the vital test.

The interactive dashboards containing quarterly figures are available for GP data, for Clinical Commissioning Group data and for local authority data.

National Audit of Breast Cancer in Older Patients: 2018 Annual Report

HQIP | June 2018 | National Audit of Breast Cancer in Older Patients: 2018 Annual Report

Health Quality Improvement Programme (HQIP) has  produced a report which presents information on the care received by women diagnosed between 1 January 2014 and 31 December 2016 in England and Wales. As well as describing how these patterns of care differ between women in the younger and older age groups, the report also distinguishes between three main groups of breast cancer – women with ductal carcinoma in situ, with early invasive disease , and with advanced disease.

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The report is primarily written for clinicians, providers of breast cancer services, commissioners and healthcare regulators. A version for patients and the general public will be available in summer 2018 (Source: HQIP).

Further details are available from HQIP 

The report can be read in full here 

The Impact of the National HPV Vaccination Program in England

There has been a significant fall in the number of cases of HPV, the virus that causes cervical cancer, following the introduction of a vaccine for young women | Public Health England | Journal of Infectious Diseases 


HPV infections in women aged 16 to 21 fell by 86% between 2010 and 2016, a new study shows. Experts say these results suggest that the vaccine, introduced just 10 years ago, could eventually lead to a virtual eradication of the disease, which kills around 850 women a year.

Public Health England’s head of immunisation, Dr Mary Ramsay, said: “These results are very promising and mean that in years to come we can expect to see significant decreases in cervical cancer. “The study also reminds us how important it is to keep vaccination rates high to reduce the spread of this preventable infection. I encourage all parents of girls aged 12 to 13 to make sure they take up the offer for this potentially life-saving vaccine.”

Journal reference: Mesher, D. et al. | The Impact of the National HPV Vaccination Program in England Using the Bivalent HPV Vaccine: Surveillance of Type-Specific HPV in Young Females, 2010–2016 | The Journal of Infectious Diseases,

See also:

Public Health Matters blog: Ten years on since the start of the HPV vaccine programme – what impact is it having?

OnMedica: Vaccine could ‘eradicate’ cervical cancer