Effectiveness of critical care pathways for head and neck cancer surgery: A systematic review

 Gordon, S.A. & Reiter, E.R. Head & Neck. Published online: 8 July 2016

N0014037 MRI scan; spinal cord cancer (glioma), cervical
Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows MRI of lateral neck showing cervical cord glioma.

Background: Critical care pathways (CCPs) are implemented within health care systems as a means to systematically decrease resource utilization, whereas maintaining a high level of care for patients with a specific diagnosis. Previous studies have shown equivocal results for CCPs in head and neck cancer surgery.

Methods: We conducted a systematic review evaluating studies of CCPs for head and neck cancer surgery, with individual outcome measures analyzed separately to describe the effect of each implemented pathway.

Results: Ten before and after studies were included for systematic review. Nine reported statistically significant decreases in median/mean length of stay and 5 reported statistically significant decreases in cost of care per case.

Conclusion: Although the results are encouraging and point toward the ability of CCPs to decrease length of stay and cost of care, the evidence cannot be considered exhaustive because of the studies’ inability to account for temporal trends. Further controlled studies are recommended to validate the benefits of CCPs.

Read the abstract here

Use of Online Communication by Patients With Newly Diagnosed Breast Cancer During the Treatment Decision Process

Wallner, L. P. et al. JAMA Oncology. Published online July 28 2016

social-media-1430531_960_720Online communication (including email, social media, and web-based support groups) could be used to enhance cancer treatment decision making and care support. Yet, little is known about whether and how patients with newly diagnosed cancer use these technologies during the treatment decision process and even less is known about whether online communication use influences patient appraisals of decision making. Therefore, we characterized online communication use in a diverse, population-based sample of women with a new diagnosis of breast cancer and assessed whether the use of these modalities resulted in increased satisfaction and decision deliberation during the breast cancer treatment decision process.

Read the full article here


Introduction of screening could significantly reduce lung cancer deaths

ScienceDaily. Published online 28 July 2016.

Image source: Anne Weston, LRI, CRUK – Wellcome Images // CC BY-NC-ND 4.0

Image shows scanning electron micrograph of lung cancer cells

The introduction of lung cancer screening in the UK could significantly reduce deaths in high risk groups, without causing participants the undue stress sometimes associated with medical tests.

Published in Thorax, a trial led by Cardiff University looked at long-term psychosocial outcomes of CT screening for lung cancer and found that it did not cause unnecessary anxiety, even though fear and stigma can sometimes be barriers to participation in screening.

Lung cancer is the leading cause of cancer-related mortality in the UK, killing almost 40,000 people per year. Additionally, around three quarters of patients are diagnosed at a late stage when fewer treatment options are available. With early detection of lung cancer about seven out of ten patients survive for a year or more.

Read the full commentary here

Read the original research abstract here

Prospective Quality of Life in Men Choosing Active Surveillance Compared to Those Biopsied but not Diagnosed with Prostate Cancer

Pham, K.N. et al. The Journal of Urology. August 2016. 196 (2).pp. 392–398

B0006629 Prostate cancer cells
Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

Image shows a colour-enhanced electron micrograph of a clump of prostate cancer cells.

Purpose: Active surveillance is an important alternative to definitive therapy for men with low risk prostate cancer. However, the impact of active surveillance on health related quality of life compared to that in men without cancer remains unknown. In this study we evaluated health related quality of life outcomes in men on active surveillance compared to men followed after negative prostate needle biopsy.

Materials and Methods: A prospective study was conducted on men who were enrolled into the Center for Prostate Disease Research Multicenter National Database and underwent prostate needle biopsy for suspicion of prostate cancer between 2007 and 2014. Health related quality of life was assessed at biopsy (baseline) and annually for up to 3 years using SF-36 and EPIC questionnaires. Health related quality of life scores were modeled using generalized estimating equations, adjusting for baseline health related quality of life, and demographic and clinical characteristics.

Results: Of the 1,204 men who met the initial eligibility criteria 420 had a negative prostate needle biopsy (noncancer comparison group). Among the 411 men diagnosed with low risk prostate cancer 89 were on active surveillance. Longitudinal analysis revealed that for most health related quality of life subscales there were no significant differences between the groups in adjusted health related quality of life score trends over time.

Conclusions: In this study most health related quality of life outcomes in patients with low risk prostate cancer on active surveillance did not differ significantly from those of men without prostate cancer. A comparison group of men with a similar risk of prostate cancer detection is critical to clarify the psychological and physical impact of active surveillance.

Read the abstract here

‘We urgently need kinder treatments for children’ – Noemi and Zofeya’s story

Cancer Research UK. Published online: 25 July 2016

When she was 4 years old, Zofeya was diagnosed with medulloblastoma, a type of brain tumour. Now 7, Zofeya lives with her parents Noemi and Matthew, and brother Malacai, in Bedfordshire.

Here, Noemi shares her daughter’s story – one of several that feature in the CRUK Annual Review, which highlights the progress we’ve made this year.

Read the full blog post here

How Variable Is Our Delivery of Information? Approaches to Patient Education About Oral Chemotherapy in the Pediatric Oncology Clinic

Khan, J.M. et al. Journal of Pediatric Health Care. Published online: July 23 2016

bubble-602146_960_720In pediatric patients with acute lymphoblastic leukemia, adherence to oral chemotherapy relies largely on a parent’s comprehension of the drug’s indication and administration guidelines. We assessed how pediatric oncology providers educate families about oral chemotherapy.

We conducted a cross-sectional survey of 68 physicians and nurses from 9 institutions in the Dana-Farber Cancer Institute Acute Lymphoblastic Leukemia Consortium.

The inter-individual approach to patient education is variable and may consist of handouts, treatment calendars, and discussions. The extent of teaching often varies depending on a provider’s subjective assessment of a family’s needs. Twenty-five percent of providers suggested standardizing patient teaching.

When developing educational models, care teams should consider approaches that (a) objectively identify families in need of extensive teaching, (b) designate allotted teaching time by nursing staff during clinic visits, and (c) maintain the variation and dynamism that informs a successful provider-patient relationship.

Read the abstract here

1.7 million people may have undiagnosed lung or heart disease

Public Health England is urging anyone with persistent cough or unusual breathlessness to see their GP in case they have lung or heart disease | The Guardian

About 1.7 million people in England could be living with undiagnosed lung cancer, lung disease or heart disease, which are among the country’s biggest killers, a government agency has warned.

Public Health England (PHE) is urging anyone with a persistent cough, or who gets breathless doing everyday tasks that never previously troubled them, to see their GP in case they have one of the conditions.

Launching its latest “Be Clear on Cancer” campaign on Thursday, it said that the conditions together kill more than 100,000 people a year, but finding them early makes them more treatable.

PHE estimates that there are about 80,000 undiagnosed cases of lung cancer, 1 million cases of chronic obstructive pulmonary disease (COPD) – which includes emphysema and chronic bronchitis – and 600,000 undiagnosed cases of coronary heart disease.

Read more via The Guardian

Related: Be Clear on Cancer respiratory symptoms campaign launches

NHS England struggling to meet cancer waiting list targets

More than 2,000 people waited more than two months to start treatment in May, new figures show | story via The Guardian

The NHS is under fire for leaving cancer patients facing stressful delays before starting treatment because hospitals cannot cope with the growing number of people suspected to have the disease.

New NHS figures show hospitals in England failed to ensure people with suspected breast cancer were seen by a specialist within 14 days and that enough cancer patients had their first treatment within 62 days of referral by their GP.

Hospitals are meant to treat 85% of those suspected to have cancer within 62 days of their GP referring them. But just 81.4% of such patients underwent their first treatment in May, according to the service’s latest monthly performance statistics, which showed the service had also breached a number of other key targets.

That was down from 82.8% the previous month and means the service has not met the target at all in 2016, which in turn has left more than 10,000 patients waiting longer than the NHS Constitution says they should. The NHS has only met the target once since January 2015.

Full story online via The Guardian

New findings concerning hereditary prostate cancer

Story below via ScienceDaily

It is a well-known fact that men with a family history of prostate cancer run an increased risk of developing the disease. The risk for brothers of men with prostate cancer is doubled. But a doubled risk of what, exactly? Prostate cancer my be an indolent condition that does not require treatment, or aggressive and fatal. Obviously, it makes a big difference whether a man has an increased risk of developing the indolent or the aggressive form, but until now these different risks have not been known.

The Swedish researchers studied the risk of cancer in over 50,000 brothers of men with prostate cancer. Thirty per cent of the men that had one brother only with prostate cancer were diagnosed with prostate cancer by age 75 years, about double the Swedish national average risk of 13 per cent. Their risk of aggressive prostate cancer was much lower: 9 per cent (national average risk 5 per cent).

In men that had both a father and a brother with prostate cancer, the risk of any form of prostate cancer was as high as 48 per cent; the risk of the aggressive form was 14 per cent.

Full Reference: Ola Bratt, et al. Family History and Probability of Prostate Cancer, Differentiated by Risk Category – a Nationwide Population-Based Study. Journal of the National Cancer Institute, Volume 108 Issue 10 October 2016

Revolutionary surgery for lung cancer

A major international clinical trial is about to be launched to test a minimally invasive and safer surgical approach for patients with lung cancer: video-assisted thoracoscopic (VATS) lobectomy with ultrasonic pulmonary artery sealing. | via ScienceDaily

The University of Montreal Hospital Research Centre (CRCHUM) is launching a major international clinical trial to test a minimally invasive and safer surgical approach for patients with lung cancer: video-assisted thoracoscopic (VATS) lobectomy with ultrasonic pulmonary artery sealing.

B0006883 Lung cancer cells
Image shows lung cancer cell dividing. Source: Anne Weston, Wellcome images // CC BY-NC-ND 4.0

Currently, pulmonary lobectomy is the most commonly performed lung cancer operation in the world. It involves opening the chest and cutting the ribs to remove the lung lobe containing the cancerous tumour. But it leaves a long scar, and patients take up to six months to recover from this invasive and risky procedure. In the past 20 years, a new technique has developed: video-assisted thoracoscopic (VATS) lobectomy. Instead of making a long incision in the chest and breaking the ribs, surgeons simply make small holes to reach the target area. Their actions are guided by a miniature video camera inserted in the chest wall through one of the holes.

Read more at ScienceDaily