Nurse-led telephone triage for people with suspected colorectal cancer

Crisford, M. et al. 2016. Cancer Nursing Practice. 15 (1) pp.18-25.

Image source: Carsten Knoch

The two-week rule was introduced to address delays in cancer diagnosis. It requires patients with suspected cancer to be seen by a specialist within two weeks of GP referral and has implications for colorectal departments in terms of managing demands on service provision.

In one NHS trust it was addressed by introducing a nurse-led telephone triage assessment to determine patients’ suitability for investigations before attending outpatient clinic. The assessment was developed by a Delphi survey. An audit evaluated whether time from referral to investigation had reduced since introduction of the assessment.

Data were collected retrospectively from 40 patients before its introduction and compared with 40 patients after its introduction. Time to investigation was reduced in the telephone assessment group: a mean of 12.5 days versus 21.2 days, with a mean difference of -8.7 days.

Introduction of telephone assessment reduced time from GP referral to investigation and enabled earlier detection of cancer in line with healthcare policy.

Read the abstract here

Talking about sex with health professionals: the experience of people with cancer and their partners

Gilbert, E. et al. European Journal of Cancer Care. Volume 25, Issue 2, pages 280–293, March 2016

Changes to sexuality can be one of the most difficult aspects of life following cancer. This study examines the experience of discussing sexuality post cancer with health care professionals (HCPs), from the perspective of women and men with cancer (PWC), and their partners (PPWC), across a range of cancer types.

A total of 657 PWC (535 women, 122 men) and 148 PPWC (87 women, 61 men) completed a survey containing closed and open-ended items, analysed by analysis of variance and thematic analysis.

Discussions about sexuality with a HCP were more likely to be reported by men (68%) compared to women PWC (43%), and by women (47%) compared to men PPWC (28%), as well as by those with a sexual or reproductive cancer. Men PWC and women PPWC were most likely to want to discuss sexuality with a HCP, with men PWC and PPWC reporting highest levels of satisfaction with such discussions. Open-ended responses revealed dissatisfaction with the unwillingness of HCPs to discuss sexuality, unhappiness with the nature of such discussion, and positive accounts of discussions about sexuality with HCPs.

These findings lend support to the notion that people with cancer and their partners may have unmet sexual information and support needs.

Read the abstract here

Development of a conceptual model of cancer caregiver health literacy

Yuen, E. Y. N. et al. European Journal of Cancer Care. Volume 25, Issue 2, pages 294–306, March 2016

Image source: Rachel Johnson

Caregivers play a vital role in caring for people diagnosed with cancer. However, little is understood about caregivers’ capacity to find, understand, appraise and use information to improve health outcomes. The study aimed to develop a conceptual model that describes the elements of cancer caregiver health literacy.

Six concept mapping workshops were conducted with 13 caregivers, 13 people with cancer and 11 healthcare providers/policymakers. An iterative, mixed methods approach was used to analyse and synthesise workshop data and to generate the conceptual model.

Six major themes and 17 subthemes were identified from 279 statements generated by participants during concept mapping workshops. Major themes included: access to information, understanding of information, relationship with healthcare providers, relationship with the care recipient, managing challenges of caregiving and support systems.

The study extends conceptualisations of health literacy by identifying factors specific to caregiving within the cancer context. The findings demonstrate that caregiver health literacy is multidimensional, includes a broad range of individual and interpersonal elements, and is influenced by broader healthcare system and community factors. These results provide guidance for the development of: caregiver health literacy measurement tools; strategies for improving health service delivery, and; interventions to improve caregiver health literacy.

Read the abstract here

Aspirin and colorectal cancer: the promise of precision chemoprevention

Drew, D. A. et al. Nature Reviews Cancer 16, 173–186 (2016). Published online: 12 February 2016

Aspirin (acetylsalicylic acid) has become one of the most commonly used drugs, given its role as an analgesic, antipyretic and agent for cardiovascular prophylaxis. Several decades of research have provided considerable evidence demonstrating its potential for the prevention of cancer, particularly colorectal cancer. Broader clinical recommendations for aspirin-based chemoprevention strategies have recently been established; however, given the known hazards of long-term aspirin use, larger-scale adoption of an aspirin chemoprevention strategy is likely to require improved identification of individuals for whom the protective benefits outweigh the harms. Such a precision medicine approach may emerge through further clarification of aspirin’s mechanism of action.

Figure 2: The hypothesized inter-related mechanisms of aspirin chemoprevention.

Image source: Drew, D.A. et al. in NRC

Read the abstract here

Should the Benefit of Adjuvant Chemotherapy in Colon Cancer Be Re-Evaluated?

Påhlman, L. A. et al. Journal of Clinical Oncology. Published online: February 22, 2016

Because favorable effects on survival were seen in randomized trials conducted during the 1980s, adjuvant chemotherapy in colon cancer was established as routine therapy in stage III disease in the United States in 1990.¹ Follow-up trials in the United States, Asia, and Europe^2,3 soon meant that it became recommended therapy worldwide, not only in stage III but in stage II disease as well, if risk factors for recurrence were present. Additional trials established the combination of a fluoropyrimidine and oxaliplatin as reference treatment for patients with stage II disease with risk factors who are fit for therapy and for those with stage III disease.^4–6 The addition of oxaliplatin in the treatment of elderly patients has been questioned.⁷ Here we present arguments questioning not only the addition of oxaliplatin in the treatment of some younger patients as well but also the offering of adjuvant chemotherapy at all to some of these patients.

Medical care continuously develops, and as a consequence, treatment results improve. This development has also been seen in colon (and rectal) cancer, and the improvements actually challenge the established benefit of adjuvant chemotherapy in colon (and rectal) cancer. We question whether the risk of recurrence is sufficiently high for most patients with stage II disease, even when risk factors are present, and for some patients with stage III disease in the presence of high-quality, modern, multidisciplinary team care to motivate adjuvant chemotherapy.

Read the full comment article here

Leukaemia ‘firsts’ in cancer research and treatment

Greaves, M. Nature Reviews Cancer. 16, 163–172 (2016)

Our understanding of cancer biology has been radically transformed over recent years with a more realistic grasp of its multilayered cellular and genetic complexity. These advances are being translated into more selective and effective treatment of cancers and, although there are still considerable challenges, particularly with drug resistance and metastatic disease, many patients with otherwise lethal malignancies now enjoy protracted remissions or cure.

One largely unheralded theme of this story is the extent to which new biological insights and novel clinical applications have their origins with leukaemia and related blood cell cancers, including lymphoma. In this Timeline article, I review the remarkable and ground-breaking role that studies in leukaemia have had at the forefront of this progress.

Image source: Greaves, M.

Read the abstract here

Distribution and prognosis of uncommon metastases from non-small cell lung cancer

Fei-Yu Niu et al. BMC Cancer. 2016 (16:149)

Image source: Wellcome Images

Image of bone smear showing metastatic carcinoma of the humerus. Patient has primary lung cancer.

Background: According to the literature and our experience, the most common sites of non-small cell lung cancer (NSCLC) metastases include the brain, bone, liver, adrenal glands, contralateral lung and distant lymph nodes. Metastases to other organs are relatively rare. There have been numerous case reports and a few small case series of uncommon metastases derived from NSCLC.

Methods: We defined all organs except the common metastatic sites mentioned above as uncommon sites of metastasis. Patients with uncommon metastases among 2,872 consecutive NSCLC patients with stage IV disease at the Guangdong Lung Cancer Institute (GLCI) from 2006 to 2012 were included in this study. The diagnosis of uncommon metastases was based on pathology or imaging studies.

Results: Uncommon metastases were diagnosed in 193 cases at anatomical sites such as the soft tissue, kidney, pancreas, spleen, peritoneum, intestine, bone marrow, eye, ovary, thyroid, heart, breast, tonsil and nasal cavity. Uncommon metastases were identified as independent poor prognostic factors through a multivariate analysis with a HR (hazard ratio) of 1.29 [95 % confidence interval (CI) 1.09–1.52, P < 0.01]. Those patients who received systemic therapy plus local treatment had a better survival rate than did those who received systemic therapy only (P < 0.01); all patients received best supportive care.

Conclusions: Metastases to the above mentioned sites are infrequent. The presentation of uncommon metastases tends to indicate a poor outcome, and selected patients may benefit from local treatment.

Read the full article here

NHS breast screening programme

The Health and Social Care Information Centre has published a report on the NHS breast screening programme in England in 2014/15.

It includes data on women invited for breast screening, coverage, uptake of invitations, outcomes of screening and cancers detected.

Breast cancer ‘first response’ at 10-year low

BBC Health News // 24th February 2016

Image source: Wellcome Images.

The proportion of women in England taking up their initial invitation for breast cancer screening is at its lowest level in a decade, figures show. The Health and Social Care Information Centre data showed the proportion of women aged 50-70 screened fell to 63.3% in 2014-15, from 70.1% in 2004-05. Breast screening coverage – the overall number checked – has also fallen for the fourth year in a row.

Experts said the reasons for the falls needed to be urgently investigated. Under the NHS Breast Screening Programme, women are usually invited for their first routine check between the ages of 50 and 53, then normally invited back every three years until the age of 70. There are also pilots at most of England’s screening centres, where the age range invited for screening is being extended to those aged 47-49 and 71-73.

Overall, 2.11 million women were screened in 2014-15, from a total of 2.8 million who were invited. Coverage of women aged 53 to 70 was 75.4% at 31 March 2015, down from a peak of 77.2% in 2011. Cancer was more likely to be found among the older women screened.

Read the full news story here

View the HSCIC original publication here

Highlights from the Gastrointestinal Cancers Symposium

Highlights from the Gastrointestinal Cancers Symposium by BMJ talk medicine

A critical review of key studies from the ASCO 2016 Gastrointestinal Cancers Symposium, held January 2016, is presented in this podcast. A number of tumor areas, including gastric, esophageal and colorectal cancers, are considered with an emphasis on recent developments in immunotherapy. Studies reviewed include the CheckMate-032 trial, which assessed the activity of the anti-PD-1 antibody nivolumab in patients with advanced gastric or gastroesophageal junction cancer, the KEYNOTE-028 trial, for which results of the esophageal carcinoma cohort treated with pembrolizumab were presented, and updated results of a trial considering PD-1 blockade in mismatch repair deficient non-colorectal gastrointestinal cancers. Biomarkers are further considered in the Mavericc trial which sought to stratify metastatic colorectal cancer patients by ERCC1 in order to predict their response to platinum-based treatments.

Neoadjuvant therapy was considered with the results of a study, from the Polish Colorectal Study Group, using neoadjuvant chemoradiation for fixed cT3 or cT4 rectal cancers, and the 5-year follow up results of the ACCORD 12 trial, which aimed to assess an increased radiation dose plus oxaliplatin versus standard radiotherapy of 45 Gy with concurrent capecitabine in rectal cancer.