Breast cancer mortality down 66% in 20 years

Cancer Research UK – July 2023

Today, more than 90% of women diagnosed with early-stage breast cancer will survive the disease for 5 years or more.

That’s thanks to research. And to the people who take part.

Between 1993 and 2015, more than half a million women in England were diagnosed with early-stage breast cancer. Not only did they face something life-changing, they also helped change things for the better.

Here’s how. Patients can choose to share their NHS health data, which researchers can apply to use to track trends over time. 512,447 women contributed their information to a groundbreaking study we funded into how breast cancer mortality in England has changed since the early 1990s.

This is what they showed us: women in England diagnosed with early breast cancer today are 66% less likely to die from the disease within the first 5 years than they were 20 years ago.

“The prognosis for patients with breast cancer has improved,” says oncologist and senior author Dr David Dodwell, from the University of Oxford’s Department of Population Health. “And that improvement is dramatic.”

Let’s put it another way. In the late 1990s, the average 5-year risk of dying from breast cancer after being diagnosed with the disease in its early stages was 1 in 7. Now it’s 1 in 20.

“Our general feeling that things are getting better has been confirmed,” continues Dodwell. “And not only that: we can probably be more optimistic than we had dared to hope.”

We can use that optimism now as much as ever. There’s still much more to do.

The NHS in England at 75: priorities for the future

NHS England – June 2023

Ahead of the NHS’s 75th birthday, the NHS Assembly has developed an independent report: The NHS in England at 75: priorities for the future. This will help the NHS, nationally and locally, respond to long term opportunities and challenges. 

The Assembly found a growing consensus that the NHS should now focus on three key areas for long term development: better preventing ill health, personalising care and delivering more co-ordinated care closer to home.

The report draws on the feedback of thousands of people who contributed to a rapid process of engagement (NHS@75 engagement), and the Assembly’s huge breadth of experience. 

The Assembly will continue to draw on the insights gained from the NHS@75 engagement to explore the key developments outlined in more detail. The findings will help inform the work of NHS England to develop strategies for the years ahead in partnership with Integrated Care Systems. 

Read the Report – The NHS in England at 75: priorities for the future

Young people who have a long wait for a cancer diagnosis have reduced quality of life

NIHR – 21st June 2023

A study of more than 800 young people with cancer found that those whose diagnosis took longer were at increased risk of anxiety, depression and reduced quality of life.

Thinking you have cancer symptoms, or being told by a GP that you may have cancer (before a confirmed diagnosis), can be frightening. In adults, a long wait before receiving a cancer diagnosis is thought to harm mental health. There is little research in teenagers and young adults on the impact of the time it takes to get a cancer diagnosis.  

The BRIGHTLIGHT study included 830 young people aged 12 – 24 years, and was carried out in England between 2012 and 2014. Researchers found that a wait of 2 months or more to see a specialist (from first noticing  symptoms) was linked to reduced quality of life and depression. Having 3 or more GP appointments before being referred to a specialist was linked to reduced quality of life and anxiety. Delays in seeking help (the period between the first symptoms and seeing a GP for the first time) was linked with depression.  

Speeding up the diagnostic process for teenagers and young people with cancer could reduce the impact on their mental health, the researchers say. However, this could be difficult to achieve in practice. Providing emotional support to this group while they wait, or shortly after diagnosis, may help.  

The data from this study are almost 10 years old, so the speed of diagnosis and the experiences of young people may have changed since.

Further information – Young people who have a long wait for a cancer diagnosis have reduced quality of life

This Alert is based on: Forster A, and others. Associations between diagnostic time intervals and health-related quality of life, clinical anxiety and depression in adolescents and young adults with cancer: cross-sectional analysis of the BRIGHTLIGHT cohort. British Journal of Cancer 2022; 126: 1725–1734.

Times to cancer diagnosis in young people: Herbert A, and others. Diagnostic timeliness in adolescents and young adults with cancer: a cross-sectional analysis of the BRIGHTLIGHT cohortLancet Child and Adolescent Health 2018; 2: 180–190.

Presenting symptoms in young people with cancer: Koo MM and others. Association of Self-reported Presenting Symptoms With Timeliness of Help-Seeking Among Adolescents and Young Adults With Cancer in the BRIGHTLIGHT StudyJournal of the American Medical Association Network Open 2020; 1; 1–11.

A study examining cancer diagnosis in young people: Dommett RM, and others. Achieving a timely diagnosis for teenagers and young adults with cancer: the ACE “too young to get cancer?” study. BMC Cancer 2019; 19: 616. 

Continuation of funding for systemic anti-cancer therapy following a break in treatment

NHS England – 16th June 2023

The various different types of cancer medicines and treatments are collectively termed systemic anti-cancer therapies (SACT).

The policy information here outlines how funding for SACT can continue following a patient’s break in treatment. Such a break may be to allow for recovery from drug-related side effects, interruptions to treatment due to surgery and/or radiotherapy, treatment for a new illness, medical emergencies unrelated to the cancer, etc.

Reducing radiotherapy for some breast cancer patients is likely to have released thousands of appointments for the NHS without compromising safety, NICE finds.

NICE – June 2023

The updated guideline on the diagnosis and management of early and locally advanced breast cancer published today by NICE (14 June 2023) recognises the positive impact that shorter intensity and duration of radiotherapy for some people with invasive breast cancer after they’ve had surgery has had on services and patients.

Until recently it was standard practice for people with invasive breast cancer having surgery to have 15 radiotherapy treatments (or ‘fractions’) giving a total of 40 units of radiation (measured in Gray, (Gy)) over 3 weeks.

During the COVID-19 pandemic NICE said the NHS should consider alternative radiotherapy schedules to reduce the risk to vulnerable cancer patients of catching COVID and to reduce pressure on hospitals.    

For its updated guideline NICE looked at new clinical trial evidence that did not show any difference in terms of breast cancer-related mortality or disease recurrence between a higher dose and longer intensity of radiotherapy treatment and a lower dose shorter intensity of radiotherapy treatment, and the committee agreed that the shorter intensity regimen was safe.

The updated guideline now recommends that people should be offered 26 Gy in 5 fractions over 1 week as part of routine practice.

Long COVID can impact fatigue and quality of life worse than some cancers

NIHR – 12th June 2023

A new study funded by NIHR has found that fatigue is the symptom long COVID patients are most affected by. Long COVID can also have a worse effect on quality of life than some types of cancer.

Researchers at UCL and the University of Exeter examined the impact of long COVID on more than 3,750 patients. All patients had been referred to an NHS long COVID clinic and used a digital app as part of their treatment plan.

In order to be referred to a long COVID clinic, a patient must have had symptoms for at least 12 weeks after an acute infection.

Patients were asked to complete questionnaires regarding how long COVID was affecting them. Questions included the impact of long COVID on daily life, levels of fatigue, depression, anxiety, breathlessness, brain fog and their quality of life.

Results showed that many long COVID patients reported being seriously unwell. Fatigue scores were worse or similar to those with cancer-related anaemia or severe kidney disease. Long COVID patients’ health-related quality of life scores were also lower than those with advanced cancers. In addition, the impact of long COVID on the daily activities of patients was worse than that of stroke patients and comparable to those with Parkinson’s disease.

Further information – Long COVID can impact fatigue and quality of life worse than some cancers

Background study – Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study

Cannabis‐based medicines and medical cannabis for adults with cancer pain

Cochrane Database of Systematic Reviews – June 2023

There is moderate‐certainty evidence that oromucosal nabiximols and THC are ineffective in relieving moderate‐to‐severe opioid‐refractory cancer pain. There is low‐certainty evidence that nabilone is ineffective in reducing pain associated with (radio‐) chemotherapy in people with head and neck cancer and non‐small cell lung cancer. There is low‐certainty evidence that a single dose of synthetic THC analogues is not superior to a single low‐dose morphine equivalent in reducing moderate‐to‐severe cancer pain. There is low‐certainty evidence that CBD does not add value to specialist palliative care alone in the reduction of pain in people with advanced cancer.

Further information – Cannabis‐based medicines and medical cannabis for adults with cancer pain