Concern over diagnostic variability for melanoma

Diagnoses spanning moderately dysplastic nevi to early stage invasive melanoma were neither reproducible nor accurate, according to the results of a large study of pathologists in the US.

Authors of the study, published by The BMJ, have called for efforts to improve clinical practice such as using a standardised classification system, acknowledging uncertainty in pathology reports, and developing tools such as molecular markers to support pathologists’ visual assessments. They also urged doctors to share with their patients that the practice of medicine can be inherently uncertain.

Full story via OnMedica

Link to the research: Elmore JG, et al. Pathologists’ diagnosis of invasive melanoma and melanocytic proliferations: observer accuracy and reproducibility study. BMJ 2017; 357: j2813

Cancer survival in England

Cancer survival in England for specific cancer sites by age, sex and stage at diagnosis. | Office for National Statistics

Key findings:

  • Among the 25 cancers forming the National Statistics, 1-year survival was highest for melanoma of the skin in both men (97.1%) and women (98.5%) and 5-year survival was highest for testicular cancer in men (95.9%) and melanoma of the skin in women (93.9%).
  • Pancreatic cancer had the lowest 1-year survival for men (22.9%) and women (24.7%) and 5-year survival was the lowest for mesothelioma for men (5.5%) and women (3.4%).
  • Adults diagnosed with late cancer (stage 4) in 2015, which had already spread to other parts of the body, have lower 1-year survival compared with those diagnosed in the earliest stage (stage 1), with the lowest survival in lung cancer in men (17.1%) and women (21.6%).
  • Adults diagnosed with melanoma of the skin, prostate and breast cancer (women only) in the earliest stage (stage 1) now have 1-year survival that is comparable to the general population of the same age who have not been diagnosed with cancer.
  • For all childhood cancers combined, the general trend of increasing 5-year survival has continued for children (0 to 14 years), from 67.2% for those diagnosed in 1990 to 85.1% predicted for those children diagnosed in 2016; a similar increasing trend has been observed for 10-year survival.

The full document, Cancer survival in England: adult, stage at diagnosis and childhood – patients followed up to 2016 can be downloaded here

Related: Public Health England blog:  Statistics are important, but some statistics are more important than others!

The Diagnosis and Treatment of Prostate Cancer

This review details recent advances in the diagnosis and treatment of prostate cancer which have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference.


Prostate cancer is the most common cancer diagnosis made in men with more than 160 000 new cases each year in the United States. Although it often has an indolent course, prostate cancer remains the third-leading cause of cancer death in men.

When prostate cancer is suspected, tissue biopsy remains the standard of care for diagnosis. However, the identification and characterization of the disease have become increasingly precise through improved risk stratification and advances in magnetic resonance and functional imaging, as well as from the emergence of biomarkers. Multiple management options now exist for men diagnosed with prostate cancer. Active surveillance (the serial monitoring for disease progression with the intent to cure) appears to be safe and has become the preferred approach for men with less-aggressive prostate cancer, particularly those with a prostate-specific antigen level of less than 10 ng/mL and Gleason score 3 + 3 tumors. Surgery and radiation continue to be curative treatments for localized disease but have adverse effects such as urinary symptoms and sexual dysfunction that can negatively affect quality of life. For metastatic disease, chemotherapy as initial treatment now appears to extend survival compared with androgen deprivation therapy alone. New vaccines, hormonal therapeutics, and bone-targeting agents have demonstrated efficacy in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Advances in the diagnosis and treatment of prostate cancer have improved the ability to stratify patients by risk and allowed clinicians to recommend therapy based on cancer prognosis and patient preference. Initial treatment with chemotherapy can improve survival compared with androgen deprivation therapy. Abiraterone, enzalutamide, and other agents can improve outcomes in men with metastatic prostate cancer resistant to traditional hormonal therapy.

Full reference: The Diagnosis and Treatment of Prostate Cancer  | Mark S. Litwin, & Hung-Jui Tan | JAMA. 2017;317(24):2532-2542

Computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems | BMC Cancer


Background: Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands

Discussion: Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored.

Full reference: Golsteijn, R.H.J. et al. (2017) Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer. 17:446

Effect of ultrasonography surveillance in patients with liver cancer

Liver cancer is a growing global public health problem. Ultrasonography is an imaging tool widely used for the early diagnosis of liver cancer | BMJ Open

Image source: Nephron – Wikimedia // CC SA 3.0

Image shows low magnification micrograph of hepatocellular carcinoma the most common form of primary liver cancer.

Objective: The effect of ultrasonography surveillance (US) on the survival of patients with liver cancer is unknown. Therefore, this study examined the association between survival and US frequency during the 2 years preceding patients’ liver cancer diagnosis.

Methods: This population-based longitudinal study was conducted in Taiwan, a region with high liver cancer incidence, by using the National Health Insurance Research Database. We compared survival between patients who received US three times or more (≥3 group) and less than three times (<3 group) during the 2 years preceding their liver cancer diagnosis, and identified the predictors for the ≥3 group.

Results: This study enrolled 4621 patients with liver cancer who had died between 1997 and 2010. The median survival rate was higher in the ≥3 group (1.42 years) than in the <3 group (0.51 years). Five-year survival probability was also significantly higher in the ≥3 group (14.4%) than in the <3 group (7.7%). The multivariate logistic regression results showed that the three most common positive predictors for receiving three or more US sessions were indications of viral hepatitis, gallbladder diseases and kidney–urinary–bladder diseases; the most common negative predictors for receiving three or more US sessions were male sex and indications of abdominal pain.

Conclusion: Patients with liver cancer who received US three times or more during the 2 years preceding their liver cancer diagnosis exhibited a higher 5-year survival probability.

Full reference: Chiang, J. et al. (2017) Effect of ultrasonography surveillance in patients with liver cancer: a population-based longitudinal study. BMJ Open. 7:e015936

Return to work of cancer patients

To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy | BMJ Open


Objectives: The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes.

Conclusions: RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life.

Full reference: Leensen, M.C.J. et al. (2017) Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands. BMJ Open 7:e014746.

Comments from the first National Cancer Patient Experience Survey in Scotland

Analysis free-text responses from the first Scottish Cancer Patient Experience Survey (SCPES) to understand patients’ experiences of care, identify valued aspects and areas for improvement | BMJ Open

Design: Inductive thematic analysis of seven free-text comment boxes covering all stages of the cancer experience, from a national cohort survey.


Results: Participants made more positive than negative comments (1:0.78). Analysis highlighted the importance to patients of Feeling that Individual Needs Are Met and Feeling Confident Within the System. Comments also provided insight into how Processes and Structures within the system of care can negatively impact on patients’ experience. Particular issues were identified with care experiences in the lead-up to diagnosis.

Conclusions: This analysis provides a detailed understanding of patients’ cancer care experiences, therefore indicating what aspects matter in those experiences. Although the majority of comments were positive, there were a significant number of negative comments, especially about the lead-up to diagnosis. Comments suggest patients would value greater integration of care from services involved in their treatment for cancer.

Full reference: Cunningham, M. & Wells, M. (2017) Qualitative analysis of 6961 free-text comments from the first National Cancer Patient Experience Survey in Scotland. BMJ Open. 7:e015726. 

NICE set to approve trastuzumab emtansine for breast cancer

The NHS in England will soon be able to routinely fund the use of trastuzumab emtansine for people with certain categories of breast cancer, the National Institute for Health and Care Excellence (NICE) has announced in new draft guidance | OnMedica

NICE’s decision means that, by late summer, more than a thousand women and men could benefit from the drug.

HER2-positive breast cancer accounts for about a fifth of the roughly 41,500 women and 300 men who are diagnosed with breast cancer each year in England, but HER2-positive tumours are typically more aggressive than other types of breast cancer. The targeted treatment trastuzumab (Herceptin) is only effective for this type of breast cancer. Trastuzumab emtansine (Kadcyla) is licensed for the treatment of locally advanced or metastatic HER2-positive breast cancer, after trastuzumab and a taxane, taken either in combination or separately.

Currently, trastuzumab emtansine – which at full list price costs about £90,000 per patient – is only available on the NHS through the Cancer Drugs Fund (CDF). But NICE revealed yesterday afternoon that the drug’s manufacturer Roche had agreed a new commercial access arrangement with NHS England. When NICE factored this confidential agreement into a new clinical and cost-effectiveness analysis, also applying end-of-life criteria, it concluded that it can now recommend the drug as cost effective for routine use on the NHS.

Men dangerously unaware of family link to prostate cancer

Two-thirds of men with a family history of prostate cancer are dangerously unaware of their increased risk of the disease and half of all UK men don’t know that a family link makes you two-and-a-half times more likely to get it, according to new research by Prostate Cancer UK.

It’s prompted urgent calls from the charity for men and their families to have a potentially life-saving talk about the disease with their relatives and doctor. Especially since an accompanying study  showed that only 1-in-10 GPs are likely to always ask a man whether any close relatives have had the disease. Although where men did take the lead and initiate a discussion with their doctor, it found their experiences were overwhelmingly positive.