NHS England | 4 April 2021 | Thousands of patients set to benefit from five-minute breast cancer treatment
A new treatment will benefit over 3 600 patients with breast cancer reducing the amount of time needed to be spent in hospital for patients with HER-2 positive breast cancer. PHESGO will be offered to patients with breast cancer undergoing chemotherapy, it is injected and will take five minutes to prepare and administer, compared with two infusions that can take up to two and a half hours.
The injection will be offered to eligible people with HER2-positive breast cancer, which accounts for 15% of all breast cancers, and can be given alongside chemotherapy or on its own.
The five-minute jab significantly cuts the Covid infection risk for cancer patients by reducing the amount of time spent in hospital and frees up time for clinicians in chemotherapy units.
Paula Lamb, 51, who is a housewife from Newton-le-Willows, is one of the first patients to receive the treatment. She was diagnosed with breast cancer in 2014 and then developed secondary lung and liver cancers and is receiving treatment at the Clatterbridge Cancer Centre.
She said: “I’m currently on a combination of medications which take about an hour and a half to two hours to administer all together, and I have to go in to hospital to have them every three weeks.
“It feels absolutely amazing to be one of the first people to receive this treatment through the NHS and it really could not have come at a better time as lockdown lifts and I can stop shielding. Having a five minute treatment means I’ll have more time to get out on walks, for my gardening, knitting and to help my daughter practise her cricket skills. It’s a real life-changer.” (Source: NHS England)
NICE | March 2021 | Triple therapy recommended by NICE for patients with multiple myeloma
A new second line triple therapy is to be offered to NHS patients in England with multiple myeloma after NICE recommended its use.
Carfilzomib with dexamethasone and lenalidomide could be offered to around 2,000 patients with multiple myeloma who have had at least one previous therapy, which include bortezomib.
Clinical trial evidence shows that carfilzomib with lenalidomide and dexamethasone gives longer periods of remission and people live longer, compared with the current second line treatment lenalidomide plus dexamethasone.
Evidence seen by NICE’s independent appraisal committee shows the benefit of the triple therapy treatment appears to continue for up to six years. There is uncertainty about how long the benefit lasts after this.
IQVIA Institute | March 2021 | Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic
This report, from The IQVIA Institute for Human Data Science, highlights some of the approaches already being taken to address the ongoing impact of COVID-19 on health services across Europe has in most cases led to significant reductions in cancer screening, testing and diagnosis. The resultant delays in diagnosis are impacting cancer treatment and survival. The publication also makes a number of suggestions for what should be done going forward. It considers different stakeholders – from local pharmacies to national and international organisations – and their roles, as well as multi-stakeholder collaboration and cooperation. It aims to highlight initiatives adopted in some countries that can be shared more widely. It is also intended to provide a platform for additional activity during 2021 focused on specific types of cancer and expanded local, country-specific initiatives.
Reduced screening and testing causes
Source: IQVIA Institute for Human Data Science
Key points
Reduced screenings and testing can be attributed to both health system issues and patient concerns
Re-prioritisation of health system resources has caused a reduction in capacity and significant disruption to the provision of health services
Patient attitudes and concerns about engaging with the health system, especially for asymptomatic conditions and preventative measures, have also triggered the steep decline in screenings and testing
Recommendations
The response to the COVID-19 pandemic has already shown that much can be achieved by embracing innovation and adapting quickly
There is an ongoing need for collaboration at all levels and for organisations to learn quickly and share good practice
There is a shared responsibility to take action, which will require leadership, flexibility and cultural change in order for the lessons from this pandemic to be learned and to achieve greater resilience going forward
Registration required to download the report Cancer won’t wait: building resilience in cancer screening and diagnostics in Europe based on lessons from the pandemic
NHS England | 11 March 2021 | NHS rolls out capsule cameras to test for cancer
NHS England has announced that miniature cameras will be rolled out to patients undergoing cancer checks and for other tests such as for Crohn’s disease; endoscopies have traditionally meant patients would have to visit hospital to have a tube inserted, whereas this trial of the new technology means that people can go about their normal day after swallowing a minature camera- colon capsule endoscopy.
More than 10,000 NHS patients across England will receive the capsule cameras
NIHR | March 2021 | To improve team decision-making in cancer care: streamline workload, shorten meetings, address logistics and keep a gender balance on the team
A multi-disciplinary approach to decision making in cancer care is recognised as being the ‘gold-standard’, although evidence of its effectiveness remains unclear. Authors of this study set out to test, for the first time, the functional perspective of group DM in cancer MDTs, operationalized as two specific hypotheses: (H1) the interaction process, the internal factors, external circumstances, and case complexity will impact on the quality of DM for patients; and (H2) there will be a difference in the interaction process, internal and external factors, and quality of DM between the first and second half of a MDT meeting. The researchers followed three MDTs at university hospitals in Greater London and Derbyshire. Each MDT comprised around 14-15 members and specialised in breast, colorectal and gynaecological cancers. Between 2015-16, the researchers videoed 30 meetings in which more than 800 patients were discussed. Some patients had complex cancer; others had suspected cancer or benign disease (Source: NIHR & Soukop, et al. 2021).
Key findings:
decision-making was better in larger teams, in those which had a balance of genders, and when more complex cases were being discussed (since these discussions involved more team members). Question-and-answer style communication was helpful
barriers to decision-making during the meetings included antagonism, tension, and lack of acknowledgement of other members’ contributions; gender imbalance; and logistical issues with administration, equipment and meeting attendance
time and workload pressures hindered decision-making. The longer the meeting, and the more cases discussed, the worse the quality of decision-making and communication. The optimal number of patients discussed was 20. Beyond that, the quality of decision-making went down with every treatment recommendation made and negative reactions increased.
first versus second half of the meeting had different challenges. Patients discussed in the first half of the meeting had more complex needs. In the second half, cases were more straightforward, but less time was spent discussing them as team members became tired. They also started to leave so the remaining group had less broad expertise.
Following the research, the team recommend:
Streamlining MDT workload to help reduce the time all MDT members spend in the meetings. Only patients with complex needs requiring input from various specialists should be discussed. The MeDiC tool may help to select patients.
A maximum limit on the number of cases discussed at a single meeting.
A mandatory short break during the meeting.
Better preparation to smooth out logistical issues ahead of meetings, for example, using a checklist to ensure all information is readily available.
An MDT meeting chair who does not contribute to the clinical discussion could steer the team through the workload by reducing tensions, promoting positive interaction and communication, and ensuring a more uniform decision-making process.
Staff selection for MDTs should factor in gender. (Source: NIHR)
Abstract
Background
Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case‐complexity affect the quality of MDT decision making.
Methods
This was a cross‐sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions.
Results
The full regression model with the variables proposed by the functional perspective was significant, R2 = 0.52, F(20, 801) = 43.47, P < .001, adjusted R2 = 0.51. Positive predictors of DM quality were asking questions (P = .001), providing answers (P = .001), team size (P = .007), gender balance (P = .003), and clinical complexity (P = .001), while negative socioemotional reactions (P = .007), gender imbalance (P = .003), logistical issues (P = .001), time‐workload pressures (P = .002), and time spent in the meeting (P = .001) were negative predictors. Second half of the meetings also saw significant decrease in the DM quality (P = .001), interactions (P = .001), group size (P = .003), and clinical complexity (P = .001), and an increase in negative socioemotional reactions (P = .001) and time‐workload pressures (P = .001).
Discussion
To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in cancer MDTs. One novel finding is the effect of sociocognitive factors on team DM quality, while another is the cognitive‐catch 22 effect: while the case discussions are significantly simpler in the second half of the meeting, there is significantly less time left to discuss the remaining cases, further adding to the cognitive taxation in teams who are now rapidly attempting to close their time‐workload gap. Implications are discussed in relation to quality and safety.
Image source: Soukup, et al. 2021
Graphical representation of the functional perspective of group decision making as applied to cancer multidisciplinary team meetings. Note. Reprinted with permission from Soukup, 2017.52
NHS | February 2021 | NHS patients to benefit from first full access deal in Europe for new CAR-T therapy recommended by NICE
NHS patients are to be among the first in the world to be offered access to a cutting-edge cancer treatment after NICE recommended its use.
NHS clinicians in England will now be able to consider the treatment for some patients with a form of lymphoma, a cancer that attacks the immune system.
NICE | 17 February 2021 | Niraparib for maintenance treatment of advanced ovarian, fallopian tube and peritoneal cancer after response to first-line platinum-based chemotherapy
NICE has published Evidence-based recommendations on niraparib (Zejula) for maintenance treatment of advanced (FIGO stages 3 and 4) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer after response to first-line platinum-based chemotherapy in adults.
Brown, T., Cruickshank, S. & Noblet, M. | 2021 | Specialist breast care nurses for support of women with breast cancer | Cochrane Database of Systematic Reviews | Issue 1. Art. No.: CD005634| DOI: 10.1002/14651858.CD005634.pub3. Accessed 15 February 2021.
This Cochrane review considers the question: which interventions carried out by specialist breast care nurses (SBCNs) improve quality of life outcomes for women with a diagnosis of breast cancer?
14 studies with a total of 2905 participants, and four ongoing studies. Thirteen studies involved women with primary disease and one study involved women with advanced disease (sometimes referred to as metastatic or secondary disease). We grouped the studies: psychosocial nursing interventions both in primary disease and in advanced disease and SBCN‐led interventions delivering follow‐up care.
The reviewers report that there was only one study which showed that there was no difference in quality of life outcomes at three months following a brief psychosocial nursing intervention compared with standard care for 105 women with newly diagnosed advanced breast cancer.
The evidence suggests that psychosocial interventions carried out by SBCNs for women with a primary diagnosis of breast cancer, may improve or are at least as effective as standard care for general health‐related quality of life, cancer‐specific quality of life, anxiety and depression outcomes and satisfaction with care.
The certainty of the evidence in this review was generally appraised as very low to moderate using the GRADE rating system (Schünemann 2020).
In future studies, the expertise of the SBCN needs to be better articulated for there to be a meaningful and successful translation to practice, and for SBCNs to have more impact in the area of psychosocial support. Qualification and training of the SBCN needs to be more clearly reported as well as the description of the intervention.
Full details and the systematic review are available from Cochrane
NICE | February 2021 | Skin cancer drug recommended for routine NHS use
NICE has today (Friday 12 February 2021) issued final draft guidance which recommends the routine use of nivolumab (Opdivo; Bristol-Myers Squibb) as an option after surgery for some people with melanoma.
For the last two years nivolumab was recommended for use within the Cancer Drugs Fund as an option for the adjuvant treatment of completely resected melanoma in adults with lymph node involvement or metastatic disease.
This allowed for patients to access the drug while data on its effectiveness was collected to address significant clinical uncertainty and before it could be considered for routine commissioning.
The data from the Cancer Drugs Fund and the key clinical trial are still quite immature so it is uncertain if nivolumab increases the length of time people live, or by how much (overall survival).
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