Independent Breast Screening Review: government response

Department of Health and Social Care | March 2019| Independent Breast Screening Review: government response
The Department of  Health and Social Care have published the government’s response to recommendations made by the Independent Breast Screening Review.

The Independent Breast Screening Review looked into an incident in the breast screening programme in England, which resulted in thousands of women aged between 68 and 71 not being invited to their final breast screening. The review published its report in December 2018.

This document sets out the government’s response to each recommendation made in the report. The government has accepted all the recommendations.

Full details from the Department of Health and Social Care

Improving patient experience through stratification of the prostate cancer follow up pathway

Atlas of Shared Learning | March 2019| Improving patient experience through stratification of the prostate cancer follow up pathway

A recent addition to NHS England’s Atlas of Shared Learning is a case study that comes from nurses in the Urology Unit at The Royal Marsden NHS Foundation Trust who led the development and implementation of a new prostate cancer follow-up pathway. This pathway has significantly improved patient outcomes, experience and use of resources locally (Source: NHS England).

Read the case study at NHS England 

Annals of Oncology article: European cancer mortality predictions for the year 2019 with focus on breast cancer; “pancreas and lung cancer still show unfavourable trends”

M Malvezzi, M. et al | 2019| European cancer mortality predictions for the year 2019 with focus on breast cancer| Annals of Oncology| mdz051|  https://doi.org/10.1093/annonc/mdz051

A new piece of research that used cancer death certifications and population data from the World Health Organization and Eurostat databases estimated that there would be a reduction in cancer rates between 2014 and 2019, anticipating that this would be a reduction in male cancer rates (6 per cent) and females (4 per cent). The findings have now been published in the journal Annals of Oncology.

Introduction

Abstract

Background

To overcome the lag with which cancer statistics become available, we predicted numbers of deaths and rates from all cancers and selected cancer sites for 2019 in the European Union (EU).

 

Materials and methods

We retrieved cancer death certifications and population data from the World Health Organization and Eurostat databases for 1970–2014. We obtained estimates for 2019 with a linear regression on number of deaths over the most recent trend period identified by a logarithmic Poisson joinpoint regression model. We calculated the number of avoided deaths over the period 1989–2019.

 

Results

We estimated about 1 410 000 cancer deaths in the EU for 2019, corresponding to age-standardized rates of 130.9/100 000 men (−5.9% since 2014) and 82.9 women (−3.6%). Lung cancer trends in women are predicted to increase 4.4% between 2014 and 2019, reaching a rate of 14.8. The projected rate for breast cancer was 13.4. Favourable trends for major neoplasms are predicted to continue, except for pancreatic cancer. Trends in breast cancer mortality were favourable in all six countries considered, except Poland. The falls were largest in women 50–69 (−16.4%), i.e. the age group covered by screening, but also seen at age 20–49 (−13.8%), while more modest at age 70–79 (−6.1%). As compared to the peak rate in 1988, over 5 million cancer deaths have been avoided in the EU over the 1989–2019 period. Of these, 440 000 were breast cancer deaths.

 

Conclusion

Between 2014 and 2019, cancer mortality will continue to fall in both sexes. Breast cancer rates will fall steadily, with about 35% decline in rates over the last three decades. This is likely due to reduced hormone replacement therapy use, improvements in screening, early diagnosis and treatment. Due to population ageing, however, the number of breast cancer deaths is not declining.

See also:

OnMedica UK has fastest falling breast cancer rates in Europe

The full article is available from Annals of Oncology 

[NICE guideline] Lung cancer: diagnosis and management [NG122]

NICE | March 2019 | Lung cancer: diagnosis and management NICE guideline 

This guideline covers diagnosing and managing non-small-cell and small-cell lung cancer. It aims to improve outcomes for patients by ensuring that the most effective tests and treatments are used, and that people have access to suitable palliative care and follow-up (Source: NICE).

Full details from NICE 

 

NICE: Promising lung cancer treatment (durvalumab) approved for Cancer Drugs Fund

NICE |  March 2019 | Promising lung cancer treatment approved for Cancer Drugs Fund

NICE has unveiled a promising lung cancer treatment has been approved for the Cancer Drugs Fund, as a result of a NICE recommendation. Today NICE has published draft final guidance.

Durvalumab helps the body’s immune system to find and attack cancer cells, by blocking the PD-L1 protein which disguises cancer.

In a clinical trial people taking it went for an average of around 2 years without the disease progressing, versus 6 months for those without. The committee agreed that it was plausible that between 27% and 40% of people taking durvalumab would have 5 years of progression-free survival.

The draft guidance is available from NICE 

Read the full details from NICE 

See also:

NICE Lung cancer: diagnosis and management

University of Newcastle Promising lung cancer treatment available on the NHS

Epithelial ovarian cancer

Lhereux, S., Gourley, C.,  Vergote, I.  &Oza, A.  M. | 2019 | Epithelial ovarian cancer| The Lancet| 393 | 10177|p1240- 1253 | doi: https://doi.org/10.1016/S0140-6736(18)32552-2

A new article published in The Lancet looks at the impact of recent developments in the understanding of invasive ovarian cancer.

Summary

Epithelial ovarian cancer generally presents at an advanced stage and is the most common cause of gynaecological cancer death. Treatment requires expert multidisciplinary care. Population-based screening has been ineffective, but new approaches for early diagnosis and prevention that leverage molecular genomics are in development. Initial therapy includes surgery and adjuvant therapy. Epithelial ovarian cancer is composed of distinct histological subtypes with unique genomic characteristics, which are improving the precision and effectiveness of therapy, allowing discovery of predictors of response such as mutations in breast cancer susceptibility genes BRCA1 and BRCA2, and homologous recombination deficiency for DNA damage response pathway inhibitors or resistance (cyclin E1). Rapidly evolving techniques to measure genomic changes in tumour and blood allow for assessment of sensitivity and emergence of resistance to therapy, and might be accurate indicators of residual disease. Recurrence is usually incurable, and patient symptom control and quality of life are key considerations at this stage. Treatments for recurrence have to be designed from a patient’s perspective and incorporate meaningful measures of benefit. Urgent progress is needed to develop evidence and consensus-based treatment guidelines for each subgroup, and requires close international cooperation in conducting clinical trials through academic research groups such as the Gynecologic Cancer Intergroup.

Epithelial ovarian cancer generally presents at an advanced stage and is the most common cause of gynaecological cancer death. Treatment requires expert multidisciplinary care. Population-based screening has been ineffective, but new approaches for early diagnosis and prevention that leverage molecular genomics are in development. Initial therapy includes surgery and adjuvant therapy. Epithelial ovarian cancer is composed of distinct histological subtypes with unique genomic characteristics, which are improving the precision and effectiveness of therapy, allowing discovery of predictors of response such as mutations in breast cancer susceptibility genes BRCA1 and BRCA2, and homologous recombination deficiency for DNA damage response pathway inhibitors or resistance (cyclin E1). Rapidly evolving techniques to measure genomic changes in tumour and blood allow for assessment of sensitivity and emergence of resistance to therapy, and might be accurate indicators of residual disease. Recurrence is usually incurable, and patient symptom control and quality of life are key considerations at this stage. Treatments for recurrence have to be designed from a patient’s perspective and incorporate meaningful measures of benefit. Urgent progress is needed to develop evidence and consensus-based treatment guidelines for each subgroup, and requires close international cooperation in conducting clinical trials through academic research groups such as the Gynecologic Cancer Intergroup.

This article is available to Rotherham NHS staff, request from the Library & Knowledge Service 

NHS waiting times for elective and cancer treatment

This report examines waiting time standards for elective and cancer treatment and factors associated with performance in meeting these standards | National Audit Office

This review presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance. It draws together existing evidence and analysis by the Department, NHS England, NHS Improvement and other stakeholders. The National Audit Office builds on this evidence base with it’s own analysis to provide added insight into:

• changes in waiting times performance, and variations in that performance;
• the impact of waiting times performance on patients;
• the factors that influence waiting times performance; and
• NHS England’s and NHS Improvement’s approach to managing and improving waiting times performance.

The report concludes that while increased demand and funding constraints affect the entire system, other factors are linked with differences in performance both over time and across trusts. These include staff shortages for diagnostic services, a lack of available beds, inefficient processes and, in some cases, patient choices. The report calls for significant investment in staffing and infrastructure to meet new commitments outlined in the new NHS Long Term Plan.

• Full report – NHS waiting times for elective and cancer treatment
• Summary – NHS waiting times for elective and cancer treatment
• ePub – NHS waiting times for elective and cancer treatment
• Press Release

See also: NHS must focus on routine care to tackle growing waiting lists, says spending watchdog | BMJ

Clinical oncology workforce census

Royal College of Radiologists workforce report highlights continuing struggle to staff UK cancer centres

This report from the Royal College of Radiologists provides information on the number, distribution and working patterns of consultant-grade oncologists employed in NHS cancer centres. It also forecasts workforce numbers and working patterns and estimates the extent to which future workforce supply and demand for cancer treatments are aligned. The report is intended to inform local and national oncology workforce training, planning and policy.

Based on data from every UK cancer hospital, the report reveals:

Image source: http://www.rcr.ac.uk

• One-in-six UK cancer centres now operates with fewer clinical oncology consultants than five years ago
• Vacancies for clinical oncology posts are now double what they were in 2013 – with more than half of vacant posts empty for a year or more
• The UK’s clinical oncology workforce is currently 18 per cent understaffed – without investment the shortfall is predicted to grow to at least 22 per cent by 2023
• To close the gap between supply and demand for cancer doctors, oncology trainee numbers need to at least double. Even with that investment, the gap would not be closed until 2029.

Full report: Clinical Oncology UK Workforce Census Report 2018

Low levels of exercise are beneficial for adults

Even low levels of leisure-time physical activities are beneficial for adults, whilst doing more vigorous exercise has additional health benefits in terms of reducing mortality.  Authors call for the promotion of any amount and intensity of physical activity, to reduce mortality risk in the general population | British Journal of Sports Medicine

Abstract
Background:  Evidence on the role of very low or very high volumes of leisure time physical activity (PA) on the risk of all-cause and cause-specific mortality is limited. We aimed to examine the associations of different levels of leisure time PA with the risk of all-cause, cardiovascular disease (CVD) and cancer-specific mortality.

Methods:  Data were from 12 waves of the National Health Interview Surveys (1997–2008) linked to the National Death Index records through 31 December 2011. A total of 88 140 eligible participants aged 40–85 years were included.

Results:  Compared with inactive individuals, those performing 10–59 min/week of PA had 18% lower risk of all-cause mortality. Those who reported 1–2 times (150–299 min/week) the recommended level of leisure time PA had 31% reduced risk of all-cause mortality. Importantly, the continued benefits were observed among those performing leisure time PA 10 or more times the recommended minimum level. In addition, there was a larger reduction in all-cause and cause-specific mortality for vigorous vs. moderate intensity PA.

Conclusions: We found that beneficial association between leisure time PA and mortality starts from a low dose. Doing more vigorous exercise could lead to additional health benefits.

Full abstract at British Journal of Sports Medicine

Full reference: Zhao M, Veeranki SP, Li S, et al | Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults | British Journal of Sports Medicine | Published Online First: 19 March 2019

See also: Even low amounts of exercise are beneficial | OnMedica

Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study

Tian, Y.  et al. | 2019|  Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study | BMJ |364|l803 |doi: https://doi.org/10.1136/bmj.l803

The BMJ has published a cohort study that looked at relatives with colorectal cancer, unlike previous research this study also focused on second-degree relatives half siblings. The research identifies that second- degree relatives, for example half siblings, also had an association with colorectal cancer risk similar to that in first-degree relatives such as siblings or parents. 

Abstract

Objective To explore the risk of colorectal cancer in family members of patients with colorectal cancer, with an emphasis on subtypes of second degree relatives, especially half siblings, which were lacking in the literature.

Design Ambidirectional cohort study.

Setting Nationwide Swedish Family Cancer Data (record linkage).

Participants All people residing in Sweden and born after 1931, with their biological parents, totalling more than 16 million individuals (follow-up: 1958-2015); of those with clear genealogy, 173 796 developed colorectal cancer.

Main outcome measures Lifetime (0-79 years) cumulative risk and standardised incidence ratio of colorectal cancer among first degree relatives and second degree relatives.

Results The overall lifetime cumulative risk of colorectal cancer in siblings of patients was 7%, which represents a 1.7-fold  (n=2089) increase over the risk in those without any family history of colorectal cancer. A similarly increased lifetime cumulative risk (6%) was found among half siblings. The risk in people with colorectal cancer in both a parent and a half sibling (n=32) was close to the risk in those with both an affected parent and an affected sibling (n=396). Family history of colorectal cancer in only one second degree relative other than a half sibling (without any affected first degree relatives), such as a grandparent, uncle, or aunt, showed minor association with the risk of colorectal cancer.

Conclusion Family history of colorectal cancer in half siblings is similarly associated with colorectal cancer risk to that in siblings. The increase in risk of colorectal cancer among people with one affected second degree relative was negligible, except for half siblings, but the risk was substantially increased for a combination of family history in one affected second degree relative and an affected first degree relative (or even another second degree relative). These evidence based findings provide novel information to help to identify people at high risk with a family history of colorectal cancer that can potentially be used for risk adapted screening.

Full abstract available from the BMJ

Read and download the full article online from the BMJ