The perceptions of a surgical cure

Ashray Gunjur, The Lancet Oncology: Published Online 25 June 2015
Summary: One of the most important discussions between an oncologist and patient relates to the goals of care, whether these are to alleviate symptoms and maximise quality of life, prolong life, or provide a reasonable chance at a cure. A novel study of a large American cohort explores perceptions of patients with recently diagnosed lung or colorectal cancer and suggests that most patients feel that their cancer-directed surgery has cured them, even when this might be at odds with the actual evidence for their disease

via The perceptions of a surgical cure – The Lancet Oncology.

New NICE ‘Suspected cancer: recognition and referral’ guidelines

View the new suspected cancer guidelines here

There are options to choose from a list of cancer sites:

1.1 Lung and pleural cancers
1.2 Upper gastrointestinal tract cancers
1.3 Lower gastrointestinal tract cancers
1.4 Breast cancer
1.5 Gynaecological cancers
1.6 Urological cancers
1.7 Skin cancers
1.8 Head and neck cancers
1.9 Brain and central nervous system cancers
1.10 Haematological cancers
1.11 Sarcomas
1.12 Childhood cancers
1.13 Non‑site‑specific symptoms

See what different organisations are saying:

Early in-patient palliative care consultation saves costs

The Lancet Oncology

With an ageing population and expensive anticancer treatments becoming the standard of care, the cost of oncology care is increasing rapidly. However, a new study has shown that early in-patient palliative care consultation—with its focus on symptom management, psychosocial support, and advanced care planning—has the added benefit of substantial cost savings for hospitals.

May and colleagues investigated hospital stay costs in 969 adult patients admitted to hospital with advanced malignancy, of whom 256 (26%) had a palliative care consultation organised by their attending physician, while 713 (74%) received usual care. Their analysis took into account time to consultation: 197 (77%) of 256 had their first consultation within 2 days of admission, and 231 (90%) of 256 within 6 days.

Strikingly, this small difference in time to consultation seemed to have a major effect on the monetary cost of care. Compared with no intervention, mean hospital cost savings (standardised to 2011 values) were US$2280 (95% CI 1122–3438; p<0·001) for the group receiving their first in-patient palliative care contact within 2 days and $1312 (56–2568; p=0·04) for those receiving this contact within 6 days. These savings represent a relative cost reduction of 24% (within 2 days) and 14% (within 6 days). Secondary analyses show that these savings are mediated mostly by reduced use of intensive care services and reduced pharmaceutical and laboratory costs.

Read the full article via Early in-patient palliative care consultation saves costs.

Long-term adverse outcomes in survivors of childhood bone sarcoma

British Journal of Cancer (2015) 112, 1857–1865

Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study.
Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital status, alcohol and smoking habits, and educational qualifications were investigated for survivors who completed a questionnaire.
Results: Survivors were seven times more likely to experience all-cause mortality than expected, and there were substantial differences in risk depending on tumour type. Beyond 25 years follow-up the risk of dying from all-causes was comparable to the general population. This is in contrast to dying before 25 years where the risk was 12.7-fold that expected. Survivors were also four times more likely to develop a SPN than expected, where the excess was restricted to 5–24 years post diagnosis. Increased health-care usage and poor health status were also found. Nonetheless, for some psychosocial outcomes survivors were better off than expected.
Conclusions: Up to 25 years after 5-year survival, bone sarcoma survivors are at substantial risk of death and SPNs, but this is greatly reduced thereafter. As 95% of all excess deaths before 25 years follow-up were due to recurrences and SPNs, increased monitoring of survivors could prevent mortality. Furthermore, bone and breast SPNs should be a particular concern. Since there are variations in the magnitude of excess risk depending on the specific adverse outcome under investigation and whether the survivors were initially diagnosed with osteosarcoma or Ewing sarcoma, risks need to be assessed in relation to these factors. These findings should provide useful evidence for risk stratification and updating clinical follow-up guidelines.

Read the full artilce via British Journal of Cancer – Abstract of article: Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study.

Probing ways to convince young women not to use indoor tanning

Messages with images depicting the harsh realities of melanoma are more powerful than the text-only warning required by the U.S. Food and Drug Administration in persuading women to reconsider indoor tanning.

The study, published in the American Journal of Public Health, is the first to examine use of persuasive messaging and graphic imagery for indoor tanning device warnings — the source of thousands of skin cancer cases, including melanoma, each year.

“In terms of a public health issue, indoor tanning is a perfect storm — young people, primarily women, indoor tan, which raises their risk of potentially deadly skin cancer. Yet, there are few prevention efforts targeting young adult women,” says the study’s lead investigator, Darren Mays, PhD, MPH, an assistant professor of oncology at Georgetown Lombardi Comprehensive Cancer Center in Washington.

Research shows that nearly 30 percent of young U.S. non-Hispanic white women use indoor tanning machines annually, and half of these women tan 10 times or more every year.

Read the full article via Probing ways to convince young women not to use indoor tanning — ScienceDaily.

Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk

JAMA Oncol. Published online June 11, 2015

Objective  To investigate in this secondary analysis the associations of overweight and obesity with risk of postmenopausal invasive breast cancer after extended follow-up in the Women’s Health Initiative (WHI) clinical trials.

Design, Setting, and Participants  The WHI clinical trial protocol incorporated measured height and weight, baseline and annual or biennial mammography, and adjudicated breast cancer end points in 67 142 postmenopausal women ages 50 to 79 years at 40 US clinical centers. The women were enrolled from 1993 to 1998 with a median of 13 years of follow-up through 2010; 3388 invasive breast cancers were observed.

Main Outcomes and Measures  Height and weight were measured at baseline, and weight was measured annually thereafter. Data were collected on demographic characteristics, personal and family medical history, and personal habits (smoking, physical activity). Women underwent annual or biennial mammograms. Breast cancers were verified by medical records reviewed by physician adjudicators.

Results  Women who were overweight and obese had an increased invasive breast cancer risk vs women of normal weight. Risk was greatest for obesity grade 2 plus 3 (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, >35.0) (hazard ratio [HR] for invasive breast cancer, 1.58; 95% CI, 1.40-1.79). A BMI of 35.0 or higher was strongly associated with risk for estrogen receptor–positive and progesterone receptor–positive breast cancers (HR, 1.86; 95% CI, 1.60-2.17) but was not associated with estrogen receptor–negative cancers. Obesity grade 2 plus 3 was also associated with advanced disease, including larger tumor size (HR, 2.12; 95% CI, 1.67-2.69; P = .02), positive lymph nodes (HR, 1.89; 95% CI, 1.46-2.45; P = .06), regional and/or distant stage (HR, 1.94; 95% CI, 1.52-2.47; P = .05), and deaths after breast cancer (HR, 2.11; 95% CI, 1.57-2.84; P < .001). Women with a baseline BMI of less than 25.0 who gained more than 5% of body weight over the follow-up period had an increased breast cancer risk (HR, 1.36; 95% CI, 1.1-1.65), but among women already overweight or obese we found no association of weight change (gain or loss) with breast cancer during follow-up. There was no effect modification of the BMI-breast cancer relationship by postmenopausal hormone therapy, and the direction of association across BMI categories was similar for never, past, and current hormone therapy use.

Conclusions and Relevance  Obesity is associated with increased invasive breast cancer risk in postmenopausal women. These clinically meaningful findings should motivate programs for obesity prevention.

Read the full article via JAMA Network | JAMA Oncology | Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk:  A Secondary Analysis of the Women’s Health Initiative Randomized Clinical Trials.

‘Smoking Still Kills’ – that’s why we’re committed to a strategy to tackle tobacco

From Cancer Research UK

 Four in 10 cancers in the UK can be prevented, with tobacco use continuing to be the most important preventable cause. Quitting smoking is the single best thing an individual can do for their health; implementing a comprehensive tobacco control plan is the single best thing the country can do for public health.

Cancer Research UK has a long track record in funding tobacco research, and of funding advocacy programmes, including our long-term funding for the excellent work ASH undertakes.

We believe that continued investment in research is essential to underpin an evidence-based approach to tobacco policy and practice. And as we provide new investment and adapt to new challenges, we must also redouble our efforts to address established challenges, such as deep-rooted smoking-related health inequalities which exist across the UK.

One third of all cigarettes smoked in England are smoked by people with a mental health disorder, while smoking rates in the prison population are estimated to be at least eight in ten and as high as nine in ten among homeless people.

Read the full blog post via ‘Smoking Still Kills’ – that’s why we’re committed to a strategy to tackle tobacco – Cancer Research UK – Science blog.

Living longer with cancer is not the same as living well

An estimated 200,000 cancer survivors are left in pain following treatment and others endure long term conditions, costing the NHS £270m a year. In this Health Service Journal article, Juliet Bouverie argues that the updated cancer strategy needs to reflect a more personalised model to rectify this.

Juliet Bouverie is Director of Services and Influencing for Macmillan Cancer Support.

Smoking still kills

ASH has published Smoking still kills: protecting children reducing inequalities. As the five-year strategy set out in the Government’s Tobacco Control Plan for England comes to an end in 2015, this report proposes new targets for a renewed national strategy to accelerate the decline in smoking prevalence over the next decade. A key recommendation of the report is for the Government to impose an annual levy on tobacco companies and for the money raised to be used to pay for measures such as mass media campaigns and stop smoking services.

Additional links: RCM press release   Royal College of Physicians press release

Cancer survival in the UK

 Public Health England’s National Cancer Intelligence Network has published in conjunction with Cancer Research UK Major resections by cancer site, in England; 2006 to 2010.  Cancer survival in the UK is lower than in many comparable countries. This difference may be caused by a number of factors, including later diagnosis and less access to optimal treatment. Although surgery can be used in combination with radiotherapy and/or chemotherapy, experts believe that it is responsible for around half of the cases where cancer is cured, making it the most effective form of treatment.  This report examines the variation in this key cancer treatment: it presents major surgical resections for 20 sites by sex and age-groups, using the most recently available data in England.

(To view this report click on the link above and then click on most recent)