78 NHS trusts to receive new cancer screening machines

78 trusts will receive funding for new machines that will improve patient experience and lead to earlier diagnosis | via Department of Health and Social Care

The Rotherham NHS Foundation Trust is one of 78 trusts that will benefit from funding for new cancer testing and detection technology.  The new machines will improve screening and early diagnosis of cancer, and are part of the government’s commitment to ensure 55,000 more people survive cancer each year.

Last month the Prime Minister announced the extra £200 million in funding for new cancer screening equipment. 78 trusts will receive funding over the next 2 years to replace, refurbish and upgrade:

• CT and MRI scanners – bringing in alternatives with lower radiation levels
• breast screening imaging and assessment equipment

Replacing and upgrading machines will improve efficiency by:

• making them easier to use
• being quicker to scan and construct images
• reducing the need to re-scan

This new equipment also brings new capability, with many machines enabled for artificial intelligence (AI) so the NHS is ready for the challenges of the future.

Each trust has been allocated funding for new machines based on an assessment of local infrastructure and local population need. They will all contribute to the NHS Long Term Plan’s goal of catching three-quarters of all cancers earlier when they are easier to treat.

Full story at Department of Health and Social Care

See also: Full list of trusts that will receive funding.

International alliance sets bold research ambition to detect the (almost) undetectable

Cancer Research UK| October  2019 | International alliance sets bold research ambition to detect the (almost) undetectable

Developing radical new strategies and technologies to detect cancer at its earliest stage is the bold ambition of a new transatlantic research alliance, announced today by Cancer Research UK and partners.

Cancer Research UK is setting out a bold ambition to jump-start this under-explored field of research, collaborating with teams of scientists from across the UK and the US.

The International Alliance for Cancer Early Detection (ACED) is a partnership between Cancer Research UK, Canary Center at Stanford University, the University of Cambridge, the OHSU Knight Cancer Institute, UCL and the University of Manchester.

Scientists in the Alliance will work together at the forefront of technological innovation to translate research into realistic ways to improve cancer diagnosis, which can be implemented into health systems. Potential areas of research include: ​

• Developing new improved imaging techniques and robotics, to detect early tumours and pre-cancerous lesions
• Increasing understanding of how the environment surrounding a tumour influences cancer development
• Developing less invasive and simpler detection techniques such as blood, breath and urine tests, which can monitor patients who are at a higher risk of certain cancers
• Searching for early stress signals sent out from tumours or surrounding damaged tissue as a new indication of cancer
• Looking for early signs of cancer in surrounding tissue and fluids to help diagnose hard to reach tumours
• Harnessing the potential of artificial intelligence and big data to look for signs of cancer that are undetectable to humans.

As part of the Cancer Research UK’s early detection strategy, the charity will invest an essential cash injection of up to £40 million over the next five years into ACED. Stanford University and the OHSU Knight Cancer Institute will also significantly invest in the Alliance, taking the total potential contributions to more than £55 million (Source: Cancer Research UK).

Full details of the project are available from Cancer Research UK

See also:

BMJ New UK and US research alliance aims to detect cancer earlier and improve screening

Targeted breast cancer treatment approved for NHS use in England

Cancer Research UK | October 2019 | Targeted breast cancer treatment approved for NHS use in England

A new treatment for early stage breast cancer will be made available for certain patients on the NHS in England.

Following the recommendation from the National Institute for Health and Care Excellence (NICE), neratinib (Nerlynx) will be offered as an extended treatment for breast cancer patients who’ve had another targeted treatment, trastuzumab (Herceptin), within the last year.

The new treatment is said to “significantly reduce the proportion of breast cancer relapses”, according to short-term trial data.

Neratinib blocks the cancer growth by interfering with chemical signals sent between cells.

It’s recommended for use for patients whose cancer tests positive for hormone receptors and a molecule called HER2. The treatment will only be available to adults who’ve been treated with trastuzumab within the last year, and where trastuzumab was used after initial treatment to help stop their cancer coming back.

This is the first treatment available for patients who have previously taken trastuzumab that maintain the intended effect of that treatment (adjuvant therapy).

Further criteria which patients will have to meet in order to access the drug include:

• Trastuzumab is the only treatment they’ve taken that targets the molecule HER2
• If trastuzumab was given before surgery, there were still signs of cancer in the tissue samples removed during surgery (Source: Cancer Research UK)

Read the press release from Cancer Research UK

Full details available from NICE 

Adult screening programmes review

Report of The Independent Review of Adult Screening Programmes in England | NHS England 

This report makes recommendations for overhauling national screening programmes to improve earlier diagnosis and cancer survival.  It calls for people to be given much greater choice over when and where they are screened; increase uptake through social media campaigns and text reminders; and roll out local initiatives which have boosted uptake.

Full detail at NHS England

See also: NHS England news release

Music in palliative care

Pommeret, S. et al. | Music in palliative care: a qualitative study with patients suffering from cancer | BMC Palliative Care | Volume 18, Article number 78 (2019)

Abstract

Background

The palliative care unit is an emotionally challenging place where patients and their families may feel at loss. Art can allow the expression of complex feelings. We aimed to examine how cancer patients hospitalized in the palliative care unit experienced a musical intervention.

Methods

We conducted a qualitative study based on semi-structured interviews. The study took place in a palliative care unit from 18 January 2017 to 17 May 2017. Two artists performed in the palliative care unit once a week from 9:30 am to 5:30 pm. The data from patient interviews were analysed based on an inductive approach to the verbatim accounts.

Results

The accounts we gathered led us to weigh the positive emotions engendered by this musical intervention against the potential difficulties encountered. The artists opened a parenthesis in the care process and brought joy and well-being to the palliative care unit. Patients also encountered difficulties during the intervention: reference to an altered general state, to loss of autonomy; a sense of the effort required, of fatigue; an adaptation period; reference to the end of life, to death; a difficulty in choosing songs.

Conclusions

Although music appeared to benefit the patients, it sometimes reminded them of their altered state. The difficulties experienced by patients during the experience were also related to physical exhaustion. Additional studies are needed to determine the benefits of music for patients and their families in the palliative care unit.

Full document at BMC Palliative Care

Depression and anxiety among people living with and beyond cancer

Niedzwiedz, C. L. et al. | Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority | BMC Cancer | Volume 19, Article number: 943 (2019)

Abstract

Background

A cancer diagnosis can have a substantial impact on mental health and wellbeing. Depression and anxiety may hinder cancer treatment and recovery, as well as quality of life and survival. We argue that more research is needed to prevent and treat co-morbid depression and anxiety among people with cancer and that it requires greater clinical priority. For background and to support our argument, we synthesise existing systematic reviews relating to cancer and common mental disorders, focusing on depression and anxiety.

We searched several electronic databases for relevant reviews on cancer, depression and anxiety from 2012 to 2019. Several areas are covered: factors that may contribute to the development of common mental disorders among people with cancer; the prevalence of depression and anxiety; and potential care and treatment options. We also make several recommendations for future research. Numerous individual, psychological, social and contextual factors potentially contribute to the development of depression and anxiety among people with cancer, as well as characteristics related to the cancer and treatment received. Compared to the general population, the prevalence of depression and anxiety is often found to be higher among people with cancer, but estimates vary due to several factors, such as the treatment setting, type of cancer and time since diagnosis. Overall, there are a lack of high-quality studies into the mental health of people with cancer following treatment and among long-term survivors, particularly for the less prevalent cancer types and younger people. Studies that focus on prevention are minimal and research covering low- and middle-income populations is limited.

Conclusion

Research is urgently needed into the possible impacts of long-term and late effects of cancer treatment on mental health and how these may be prevented, as increasing numbers of people live with and beyond cancer.

Full article at BMC Cancer

Rucaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer [ID1485]

NICE |  October 2019 | Rucaparib for maintenance treatment of relapsed platinum-sensitive ovarian, fallopian tube or peritoneal cancer [ID1485]

NICE has announced it has approved the medication for ovarian cancer- rucaparib-  can now be offered to women with relapsed ovarian, fallopian tube or peritoneal cancer, that has responded to platinum-based chemotherapy. Taken as a tablet, twice daily, it slows the progression of cancer by preventing cancer cells repairing so slowing down the tumour’s growth.

Around 1,350 people in England could benefit from this new treatment which will be available immediately through the CDF.

This approval is a change from the committee’s initial decision, where uncertainties in the evidence, and the price of rucaparib, meant it could not be recommended for routine use on the NHS.

Clinical trial evidence shows that rucaparib prevents cancer progression for twice as long as the placebo treatment (median of 10.8 months in the rucaparib group compared with 5.4 months in the placebo group). However, it is not known how this will translate into overall extended life expectancy due to incomplete trial data.

The drug company has since proposed an alternative price for rucaparib. If this revised commercial arrangement is supported with long-term overall survival data, rucaparib has the potential to be a cost-effective use of NHS resources. The committee therefore decided to include rucaparib in the CDF to allow this long-term data to be collected (Source: NICE).

The guidance is expected to be published on 13 November 2019.

Read the press release here

NICE Another treatment option for ovarian cancer approved for the Cancer Drugs Fund

In the news:

OnMedica Watchdog approves ovarian cancer treatment

BMJ: Children with cancer are missing out on precision medicine, study finds

 Fulchand, S. | 2019|Children with cancer are missing out on precision medicine, study finds | BMJ  | 366 |l5696|  doi: https://doi.org/10.1136/bmj.l5696 (Published 24 September 2019) 

Researchers from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust in London set out to evaluate whether their methods of DNA analysis could inform clinical treatment in young people with solid tumours. The study has now been published in The European Journal of Cancer 

Read the full BMJ article Children with cancer are missing out on precision medicine, study finds  

For a copy of the article contact the Library & Knowledge Service

Abstract  

Background

For children with cancer, the clinical integration of precision medicine to enable predictive biomarker–based therapeutic stratification is urgently needed.

 

Methods

We have developed a hybrid-capture next-generation sequencing (NGS) panel, specifically designed to detect genetic alterations in paediatric solid tumours, which gives reliable results from as little as 50 ng of DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissue. In this study, we offered an NGS panel, with clinical reporting via a molecular tumour board for children with solid tumours. Furthermore, for a cohort of 12 patients, we used a circulating tumour DNA (ctDNA)–specific panel to sequence ctDNA from matched plasma samples and compared plasma and tumour findings.

 

Results

A total of 255 samples were submitted from 223 patients for the NGS panel. Using FFPE tissue, 82% of all submitted samples passed quality control for clinical reporting. At least one genetic alteration was detected in 70% of sequenced samples. The overall detection rate of clinically actionable alterations, defined by modified OncoKB criteria, for all sequenced samples was 51%. A total of 8 patients were sequenced at different stages of treatment. In 6 of these, there were differences in the genetic alterations detected between time points. Sequencing of matched ctDNA in a cohort of extracranial paediatric solid tumours also identified a high detection rate of somatic alterations in plasma.

 

Conclusion

We demonstrate that tailored clinical molecular profiling of both tumour DNA and plasma-derived ctDNA is feasible for children with solid tumours. Furthermore, we show that a targeted NGS panel–based approach can identify actionable genetic alterations in a high proportion of patients.

The article is available in full from the BMJ 

Research can be read at European Journal of Cancer 

Early suppression of male hormones is better than delayed therapy for advanced prostate cancer on balance

NIHR | October 2019 | Early suppression of male hormones is better than delayed therapy for advanced prostate cancer on balance

Offering early hormone suppression therapy to men with advanced prostate cancer that is causing no symptoms improves outcomes compared with waiting until symptoms of cancer spread arise. Early treatment is associated with 23 to 57 fewer deaths per 1,000 men over five years, depending on the men’s baseline risk. However, this comes with an increased chance of some non-serious side effects.

Hormone suppression works by lowering levels of the male sex hormones that fuel the cancer’s growth. It is the mainstay of treatment for advanced prostate cancer, but the best time to initiate therapy has been debated. This updated Cochrane review identified 10 trials comparing early suppression therapy with delaying treatment until there was evidence that the cancer had spread or the patient developed symptoms.

Early treatment is likely to be the better strategy, particularly as findings relating to side effects are less certain. Individual treatment decisions would need to be based on informed discussion between patient and doctor (Source: NIHR).

Abstract

Background: Standard androgen suppression therapy (AST) using surgical or medical castration is considered a mainstay of advanced hormone-sensitive prostate cancer treatment. AST can be initiated early when disease is asymptomatic or deferred when patients suffer symptoms of disseminated prostate cancer.

Objectives: To assess the effects of early versus deferred standard AST for advanced hormone-sensitive prostate cancer.

Search Methods: For this Cochrane Review update, we performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Web of Science; last searched November 2018) and two clinical trial registers, with no restrictions on the language of publication or publication status. We also searched bibliographies of included studies and conference proceedings (last searched January 2019).

Selection Criteria: We included all randomised controlled trials (RCTs) with a direct comparison of early versus deferred standard AST. We excluded all other study designs. Participants included had advanced hormone-sensitive prostate cancer receiving surgical or medical castration.

Data collection and analysis: Two review authors independently classified studies and abstracted data. The primary outcomes were time to death of any cause and serious adverse events. Secondary outcomes were time to disease progression, time to death from prostate cancer, adverse events and quality of life. We performed statistical analyses using a random-effects model and assessed the certainty of evidence according to GRADE. We performed subgroup analyses for advanced but non-metastatic disease (T2-4/N+ M0), metastatic disease (M1), and prostate-specific antigen (PSA) relapse.

Main results: We identified seven new RCTs since publication of the original review in 2002. In total, we included 10 RCTs.Primary outcomesEarly AST probably reduces the risk of death from any cause over time (hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.75 to 0.90; moderate-certainty evidence; 4767 participants). This corresponds to 57 fewer deaths per 1000 participants at 5 years for the moderate risk group and 23 fewer deaths  per 1000 participants at 5 years in the low risk group. We downgraded for study limitations. Early versus deferred AST may have little or no effect on serious adverse events    which corresponds to 6 more serious adverse events (6 fewer to 18 more) per 1000 participants. We downgraded the certainty of evidence for study limitations and selective reporting.Secondary outcomesEarly AST probably reduces the risk of death from prostate cancer over time. This corresponds to 62 fewer prostate cancer deaths per 1000 at 5 years for the moderate risk group and 24 fewer death from prostate cancer  per 1000 men at 5 years in the low risk group. We downgraded the certainty of evidence for study limitations. Early AST may decrease the rate of skeletal events corresponding to 23 fewer skeletal events per 1000 (95% CI 31 fewer to 7 fewer). We downgraded for study limitations and imprecision. It may also increase fatigue, corresponding to 31 more men with this complaint per 1000. We downgraded for study limitations and imprecision. It may increase the risk of heart failure corresponding to 27 more events per 1000. We downgraded the certainty of evidence for study limitations and imprecision.Global quality of life is probably similar after two years as assessed with the EORTC QLQ-C30 (version 3.0) questionnaire with higher scores reflecting better quality of life. We downgraded the certainty of evidence for study limitations.

Authors’ Conclusions: Early AST probably extends time to death of any cause and time to death from prostate cancer. It may slightly decrease the rate of skeletal events. Rates of serious adverse events and quality of life may be similar. It may increase fatigue and may increase the risk of heart failure. Better quality trials would be particularly important to better understand the outcomes related to possible treatment-related harm, for which we only found low-certainty evidence.

Record numbers beating breast cancer in the UK

More than 130,000 UK breast cancer deaths have been avoided in the last 30 years, according to new Cancer Research UK analysis to mark breast cancer awareness month

Breast cancer deaths in the UK hit a record high in 1989, when around 15,600 women lost their lives to the disease – but thanks to research developing new tests and better treatments, the death rate for women has since fallen by 44%.

This considerable drop is due to major advances in diagnosis and treatment. In the last three decades, we have seen improvements in surgical techniques and use of radiotherapy, new drugs being made available, and the impact of the national breast screening programme.

Full story at Cancer Research UK

See also: Breast cancer deaths almost halved since 1989, UK figures show | The Guardian