Psychosocial interventions for informal caregivers of people living with cancer

Treanor,  C.J. | 2019| Psychosocial interventions for informal caregivers of people living with cancer| Cochrane Database of Systematic Reviews |6. Art. No| CD009912| DOI: 10.1002/14651858.CD009912.pub2.

Reviewers have assessed the effectiveness of psychosocial interventions designed to improve the quality of life (QoL), physical health and well‐being of informal caregivers of people living with cancer compared with usual care. Their findings have now been published by Cochrane. 

Psychosocial support for informal caregivers of people living with cancer

Background

Increasingly, people who are not health professionals provide care for a partner, family member or friend affected by cancer, which can have negative effects on their health and well‐being. Psychosocial interventions that comprise psychological or social support and involve direct interaction between a healthcare professional and caregivers (or caregiver‐patient pairs) may help to address the negative health effects for caregivers.

Review question

What is the effectiveness of psychosocial interventions compared to usual care for informal caregivers of people living with cancer on a range of outcomes related to health and well‐being?

Results

We found19 trials that compared psychosocial interventions with usual care, in studies that included almost four thousand participants. Studies included caregivers of people affected by different cancers across all stages of the disease. There were differences in intervention make‐up. Intervention examples include providing information and/or teaching caregivers (or caregiver‐patient pairs) coping, communication or problem‐solving skills to manage symptoms or improve relationships. Interventions were delivered by nurses, psychologists or other professionals on an outpatient basis or at home via telephone.

There may be a minimal benefit for caregiver quality‐of‐life immediately after the intervention, but this may not last. Psychosocial interventions may have little to no effect on quality of life for patients six to 12 months post‐intervention, but we are uncertain whether or not interventions improve quality of life for patients immediately post‐intervention.

Psychosocial interventions may have little to no effect on caregiver depression, anxiety, distress and physical health and patient anxiety and distress at any time after the intervention, or on patient depression immediately and patient physical health six to 12 months post‐intervention. Psychosocial interventions probably have little to no effect on patient physical health immediately post‐intervention or patient depression three to six months post‐intervention.

Three studies reported adverse effects including increased distress and sexual function‐related distress and lower relationship satisfaction levels for carers, increased distress levels for patients, and intervention content that was seen as inappropriate for some participants. No studies looked at cost‐effectiveness or intervention satisfaction for caregivers or patients. Because the quality of evidence was low generally, findings must be treated with caution.

Conclusion

Psychosocial interventions do not impact to a clinically meaningful degree outcomes for caregivers irrespective of patient cancer stage or type. Perhaps, other outcomes (e.g. relationship quality) or other psychosocial interventions (e.g. meditation) may be more helpful for caregivers. Interventions should be subjected to better conducted trials. Intervention development should involve caregivers and pay particular attention to individual personal needs (Source: Cochrane).

Read the full review and abstract at Cochrane Library

NHS prepares to fast-track ‘game changing’ cancer drugs that target genetic mutations

The NHS is preparing to fast-track the introduction of ‘game changing’ new cancer drugs that target tumours according to their genetic make-up rather than where they originate in the body | NHS England

The revolutionary treatments – known as ‘tumour agnostic’ drugs – can be used against a wide range of cancers and could offer hope to patients with rare forms of the disease that may previously have been untreatable.

The first of the new cancer drugs, which target genetic mutations that accelerate the growth of many types of tumours and have particular benefits for children, are set to come on to the market within months.

With such treatments, testing the tumour’s genes or other molecular features assists in deciding which treatments may be best for an individual with cancer, regardless of where the cancer is located or how it looks under the microscope. Molecular testing therefore becomes a first and essential element of treatment planning.

Around 850 patients a year could benefit from the frontrunners while many thousands a year are eventually expected to benefit from other tumour agnostic treatments on the horizon.

Full story at NHS England

 

The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics

Sinclair J, McCann M, Sheldon E, et al | 2019| The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics| BMJ Open |e027371|doi:10.1136/bmjopen-2018-027371

New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.

The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 

Abstract

Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

Societal impact of treatment of early breast cancer

RAND Europe has the findings from a study on the societal impact of early breast cancer.  The findings are published in the following reports:

• Understanding the societal impact of treatment of early breast cancer: What are the non-clinical outcomes associated with disease progression? – summary report of the cross-analysis of data gathered through the three phases
• A Review of the Research Landscape for Treatment of Early Breast Cancer – this first phase was a mapping review on the published literature of the impacts of treatment of early breast cancer
• Findings from a systematic review to explore the patient and societal impacts of disease progression in women who were treated for early breast cancer – this second phase was a systematic review on non-clinical outcomes of recurrence after treatment of early breast cancer
• Factors affecting access to treatment of early breast cancer: Case studies from Brazil, Canada, Italy, Spain and UK – this third phase was a qualitative study assessing the factors affecting access and delivery of treatment for early breast cancer.

Waiting times for elective and cancer treatment

Only 38% of NHS trusts meeting 62-day waiting times standard for referral to treatment for cancer patients. Waiting list for elective care has increased by 1.5 million since March 2013.

The Public Accounts Committee has published NHS waiting times for elective and cancer treatment. The report finds the percentage of patients treated within waiting times standards continues to get worse for both elective (non-urgent care) and cancer treatment.

It also finds NHS organisations are not being sufficiently held to account for ensuring patients’ rights to treatment within maximum waiting times for elective care and that national organisations lack curiosity regarding the impact of longer waits on patient outcomes and patient harm.

• Report summary
• Report conclusions and recommendations
• Full report: NHS waiting times for elective and cancer treatment

Further detail: NHS failure to meet waiting times targets risks patients’ lives

 

Teenagers and Young Adults Cancer Services

NHS England | June 2019 | Teenagers and Young Adults Cancer Services

NHS England has launched a 60-day consultation to seek views on proposed changes to teenager and young adult’s cancer services. These are used by teenagers and young people aged between 16 up to the day before their 25th birthday. In some cases, and with the agreement of Children’s Cancer Services, they may also treat teenagers from the age of 13.

The aim of the service specifications is to improve the outcomes and experience of teenagers and young adults with cancer.

This consultation guide sets out:

• How care is currently provided.
• The proposed changes and reasons for these.
• How the proposed changes will be implemented

The consultation is open until 4 August 2019

Full details are available from NHS England 

Related:

NHS England The UK should stop obsessing over GDP. Wellbeing is more telling

Improving outcomes for people with skin tumours including melanoma

NICE | 2019| 2019 surveillance of melanoma: assessment and management (NICE guideline NG14) and improving outcomes for people with skin tumours including melanoma (NICE guideline CSG8)

NICE will update the following guidelines:

• Melanoma: assessment and management (NICE guideline NG14)
• Improving outcomes for people with skin tumours including melanoma (NICE guideline CSG8)

Full details are available from NICE 

[NHS England Consultation] Children’s Cancer Services

NHS England | June 2019 |Children’s Cancer Services

NHS England has launched a 60-day consultation to seek views on proposed changes to children’s cancer services. These are used by children aged between 0 and 16. In some cases, and with the agreement of Teenage and Young Adult’s Cancer Services, they may also treat teenagers up to the age of 18.

The aim of the service specifications is to improve the outcomes and experience of children and young people with cancer.

This consultation guide sets out:

• How care is currently provided.
• The proposed changes and reasons for these.
• How the proposed changes will be implemented.
• The consultation has been open from Wednesday 5 June and will run until Sunday 4 August 2019

See also:

NHS England blog 

A data-driven approach to cancer care

This publication brings together healthcare experts to discuss the potential of a data-driven approach to cancer care. 

The following articles show how data are currently shaping the delivery of cancer care, how to gain the most from data that are currently available and how to maximise the potential of this data in the future:

• Health inequalities data tell an unjust tale of two cities
• Simple changes could improve cancer care now
• The right data?
• The evolution of cancer data to improve patient care
• Accelerating research and improving patient care
• Building a picture of patient benefit
• How NICE can keep pace with science

Full report: A data-driven approach to cancer care | Reform | AbbVie UK

India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme

University of Manchester |June 2019 | India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme

A paediatrician from the University of Manchester, Professor Vaskar Saha has helped cure children diagnosed with acute lymphoblastic leukaemia (ALL) by 15% during the five years he has led the ICICLE (Indian Childhood Collaborative Leukaemia Group) clinical project, in partnership with Tata Medical Centre, Kolkata.

Survival rates of most cancers in India are usually 15-25% lower than the United Kingdom. However, with Professor Saha’s work challenging the stereotype that cancer cure is a prerogative of affluent nations, his research has increased survival rates in Kolkata from 65% in 2014 to 80% in 2019.

Vaskar Saha, Professor of Paediatric Oncology at The University of Manchester and Senior Paediatric Consultant and Director of Translational Cancer Research at the Tata Medical Centre, Kolkata, said: “In the UK, 450 children are diagnosed annually with ALL, of which 400 will survive. In India, 9,000 of the 15,000 children diagnosed annually will survive.

“Not so long ago, four in ten Indian children would die because of poor treatment and relapse. The former was mainly due to the absence of standardisation in testing and treatment.

“If we can improve outcomes in India by 10%, then an additional 1,500 children a year grow up to lead normal lives.”

Professor Saha divides his time between Manchester and Tata Medical Centre

Before the ICICLE project launched, excellent medical centres across India were common and most children with acute lymphoblastic leukaemia were able to get the drugs they needed.

Historically, hospitals in India often work in isolation without exposure to the international research community. Travel costs to faraway hospitals were also difficult for poor families or those on low incomes.

Once clinicians started sharing their knowledge and standardised systems were put in place, change began to take root. (Source: University of Manchester)

Read the full story from the University of Manchester India’s childhood leukaemia survival rate leaps to 80%, thanks to Manchester scheme