Gynaecological cancer – RCR consensus statements

RCR – April 2024

The RCR consensus process was initially developed in 2016 to help reduce variation in UK radiotherapy practice. The gynaecological cancer consensus statements should serve as a practical stimulus for gynaecological cancer teams to review their current radiotherapy service to ensure that they are able to deliver optimal treatment for their patients. They should be adopted in parallel with relevant National Institute for Health and Care Excellence (NICE) guidance.

These areas are covered by the consensus statements: 

1. Image guided and adaptive radiotherapy (IG-ART) for mobile gynaecological targets
2. Brachytherapy
3. Imaging and follow up including late effects
4. Reirradiation of gynaecological cancers
5. Molecular testing and sentinel lymph node assessment in endometrial cancer

Further information – Gynaecological cancer RCR consensus statements

Is cancer diagnosis veering off course?

Nuffield Trust – April 2024

There were nearly 330,000 new cancer diagnoses in England in 2021 – that’s more than 900 people a day finding out that they have a disease which is one of the most common causes of death in England.

Further information – Is cancer diagnosis veering off course?

Gynaecological cancer RCR consensus statements

RCR – Spring 2024

The RCR consensus process was initially developed in 2016 to help reduce variation in UK radiotherapy practice. The gynaecological cancer consensus statements should serve as a practical stimulus for gynaecological cancer teams to review their current radiotherapy service to ensure that they are able to deliver optimal treatment for their patients. They should be adopted in parallel with relevant National Institute for Health and Care Excellence (NICE) guidance.

These areas are covered by the consensus statements: 

1. Image guided and adaptive radiotherapy (IG-ART) for mobile gynaecological targets
2. Brachytherapy
3. Imaging and follow up including late effects
4. Reirradiation of gynaecological cancers
5. Molecular testing and sentinel lymph node assessment in endometrial cancer

Further information – Gynaecological cancer consensus statements

Career and Education Framework for specialist nurses working in the field of long-term follow-up and late effects for children and young people after cancer V2.0

Children’s Cancer and Leukaemia (CCLG) – April 2024

An important resource designed to support nurses who work in the field of long-term follow-up and late effects for children and young people after cancer has been updated and expanded.

Experts from the Children’s Cancer and Leukaemia (CCLG)/Teenagers and Young Adults with Cancer (TYAC) working group, Children’s After Cure Nurses (CANUK), have published the second edition ‘Career and Education Framework for specialist nurses working in the field of long-term follow-up and late effects for children and young people after cancer’.

This work represents a significant review of competencies and career progression for highly specialised nurses working in this field. It builds on original work that was developed by the National Cancer Survivorship Initiative in 2011 and has been brought up to date with current practice in the field of late effects and long-term follow-up (LTFU).

Download the framework – Revised career and education framework launched for long-term follow-up nurses

GIRFT guidance aims to improve diagnosis and treatment times for men with suspected prostate cancer

GIRFT – 10th April 2024

Best practice guidance to help improve the care of patients with suspected prostate cancer is now available to NHS colleagues in a new Getting It Right First Time (GIRFT) resource.

The practical guidance, supported by the British Association of Urological Surgeons (BAUS) and the British Association of Urological Nurses (BAUN), includes a delivery checklist and detailed principles for first-class care across the entire patient pathway – from primary care to secondary care to ongoing monitoring, as well as recommendations for managing biopsies and treatment choices.

Towards Better Diagnosis & Management of Suspected Prostate Cancer has been developed by an expert working group of 20 clinicians to ensure representation across the whole pathway.

Best practice recommended in the guidance aims to speed up the time to diagnosis and treatment, at the same time as reducing unnecessary tests. For example, in primary care the guidance acknowledges that men at higher risk (aged 50 or Black men over 45) can have a prostate-specific antigen (PSA) test after discussion of prostate cancer risk, with no digital rectal examination (DRE) needed if the PSA is raised. In secondary care, it recommends that patients who are fit for radical treatment should go direct to MRI and then have a review with the clinical team with the MRI result, helping to reduce delays to diagnosis and treatment if required.

Read the guidance – Towards Better Diagnosis & Management of Suspected Prostate Cancer

Endocrine health in survivors of adult-onset cancer

The Lancet Diabetes & Endocrinology – 8th April 2024

This review highlights common symptoms and conditions related to endocrine disorders in this cohort, provides a summary of currently available practice guidelines, including medication use, and proposes a practical approach to diagnose affected patients in this group.

Endocrine health in survivors of adult-onset cancer

1,000 voices not 1: a report highlighting differences in cancer care in the UK

Bristol Myers Squibb

To form the foundations of the Cancer Equals campaign (which aims to understand and help address the many factors leading to delays to diagnosis and differences in experiences of cancer across the UK), Bristol Myers Squibb carried out quantitative and qualitative research in partnership with Shine Cancer Support. This research report highlights some of the challenges that people living with cancer are facing and the inequalities that exist in how cancer is experienced across the UK.

Read the report – 1,000 voices not 1: a report highlighting differences in cancer care in the UK

Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication

Journal of health communication, 29(3), 187–199.- 2024

We use language to achieve understanding, and language barriers can have major health consequences for patients with serious illness. While ethnic minorities are more likely to experience social inequalities in health and health care, communicative processes in language-discordant cancer care remain unexplored. This study aimed to investigate communication between patients with cancer and limited Danish proficiency and oncology clinicians, with special emphasis on how linguistic barriers influenced patient involvement and decision-making. 18 participant observations of clinical encounters were conducted. Field notes and transcriptions of audio recordings were analyzed, and three themes were identified: Miscommunication and uncertainty as a basic linguistic condition; Impact of time on patient involvement; Unequally divided roles and (mis)communication responsibilities. The results showed that professional interpreting could not eradicate miscommunication but was crucial for achieving understanding. Organizational factors related to time and professional interpreting limited patient involvement. Without professional interpreting, patients’ relatives were assigned massive communication responsibilities. When no Danish-speaking relatives partook, clinicians’ ethical dilemmas further increased as did patient safety risks. Language barriers have consequences for everyone who engages in health communication, and the generated knowledge about how linguistic inequality manifests itself in clinical practice can be used to reduce social inequalities in health and health care.

Read the article – Communicating without a Shared Language: A Qualitative Study of Language Barriers in Language-Discordant Cancer Communication

The Lancet Commission on prostate cancer: planning for the surge in cases

Key messages

• •We project that the number of new cases of prostate cancer annually will rise from 1·4 million in 2020 to 2·9 million by 2040. Changing age structures and improving life expectancy are predicted to drive big increases in the disease.
• •The projected rise in prostate cancer cases cannot be prevented by lifestyle changes or public health interventions.
• •Late diagnosis of prostate cancer is widespread worldwide but especially in LMICs, where late diagnosis is the norm. The only way to mitigate the harm caused by rising case numbers is to urgently set up systems for earlier diagnosis in LMICs. Trials of screening are urgently needed in LMICs to better inform ways to improve early diagnosis.
• •Early diagnosis systems will need to incorporate novel mixes of personnel and integrate the growing power of artificial intelligence to aid interpretation of scans and biopsy samples.
• •As the rise in prostate cancer is likely to be mirrored by rises in other conditions such as diabetes and heart disease, early diagnosis programmes should focus not just on prostate cancer but on men’s health more broadly.
• •Outreach programmes are needed that harness the broad global availability of smartphones as tools for education about prostate cancer (using both social media and traditional media), as are programmes that assist people with navigation of health-care systems.
• •Most prostate cancer research has disproportionally focused on men of European origin, despite rates of prostate cancer being twice as high in men of African heritage. Better understanding of drivers of ethnic differences in prevalence of the disease is a key research priority.
• •Treatment of advanced prostate cancer remains a problem, and affordable therapies are available but are unevenly distributed. Consistent use of these therapies is a cost-effective way to reduce harm from prostate cancer.
• •There remains a shortage of specialist surgeons and radiotherapy equipment in LMICs, and addressing this shortage is key to improving prostate cancer care globally.

Further information – The Lancet Commission on prostate cancer: planning for the surge in cases