More cancer specialists to be employed by the NHS

New specialists will speed up cancer diagnoses and improve access to treatment

The UK is facing increased demand for cancer treatments based on the growing number of cases of cancer diagnosed each year and the fact that people are living for longer with cancer. Around 357,000 people in the UK were diagnosed with cancer in 2014. In the year 2022, it has been projected that there will be around 422,000 new cases.

The NHS is to employ more cancer specialists, to speed up cancer diagnoses and get more people into treatment more quickly. The specialists will be trained in areas where there are shortages. It is part of Health Education England’s new Cancer Workforce Plan.

Announcements of extra provision include:

  • 200 clinical endoscopists – to investigate suspected cancers internally
  • 300 reporting radiographers – to identify cancers using x-rays and ultrasound
  • support for clinical nurse specialists – to lead services and provide quality care

The plan is part of a campaign to make sure patients are diagnosed quickly and get better access to innovative treatments that can improve survival rates.

Further detail at HEE: Health Education England unveils plan to transform the future NHS cancer workforce

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Radiation risk with digital mammography in breast screening

This review estimates the risks and benefits of breast screening in terms of deaths due to radiation-induced cancers and lives saved by digital mammography in the NHS Breast Screening Programme in England.

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A radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation induced breast cancers in the NHSBSP in England. The breast cancer mortality reduction in the invited population due to screening, and the percentage of women diagnosed with symptomatic breast cancer who die from that cancer, were collated from the literature. The number of lives saved due to screening was calculated.

The main findings are that:

  • the risk of a radiation-induced cancer for a woman attending full field digital mammographic screening (2 views) by the NHSBSP is between 1 in 49,000 to 1 in 98,000 per visit
  • if a woman attends all 7 screening examinations between the ages of 50 to 70, the risk of a radiation-induced cancer is between 1 in 7,000 to 1 in 14,000
  • it is estimated that about 400 to 800 cancers are detected by the NHSBSP for every cancer induced
  • the mortality benefit of screening exceeds the radiation-induced detriment by about 150:1 to 300:1
  • for the small proportion of women with breasts thicker than 90mm who receive higher radiation doses, the benefit will exceed the risk by about 100:1 to 200:1

Full report at Public Health England

New two-year progress report on delivering the cancer strategy 2015-2020

NHS England’s National Cancer Programme Progress Report (2016-17) shows that the NHS is on track to transform cancer services by 2020/21 | NHS England

NHS England’s two-year progress report shows significant progress has been made towards delivering world-class cancer services in England. Improvements include a £130m investment (over 2016/18) in new and upgraded radiotherapy equipment and £200m over two years to accelerate rapid diagnosis and enhance patients’ quality of life.

The report describes progress across the field including:

  • Modernisation of radiotherapy equipment throughout the country.
  • New models of care introduced to ensure cancer is diagnosed earlier and improve survival.
  • Establishment of Cancer Alliances across the country to bring together clinical leaders, healthcare workers, patients and charities for better coordination of care.

Full document: Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020

Improving the Diagnosis of Prostate Cancer

Improving the Diagnosis of Prostate Cancer | The University of York Centre for Health Economics

In diagnosing prostate cancer, the objective is to find the men with clinically significant prostate cancer, who are at high risk of metastases and who benefit the most from immediate treatment.

This economic evaluation examines a model which simulates the long-term costs and health consequences of immediate diagnosis and treatment compared with monitoring. By linking the diagnosis outcomes with the long-term costs and consequences, the model evaluates the costs and health consequences of the different diagnosis strategies over the patients’ expected lifetime.

Full document: Improving the diagnosis of prostate cancer

Cancer in the West Midlands

This report provides an overview of the burden of cancer and the extent of the identified risk factors, across the West Midlands. | Public Health England

The aim of this report is to equip care providers and policy makers with an insight into the burden of cancer, as well as providing an overview of the extent of the identified risk factors, across the West Midlands population.

It is intended to be used by commissioners of health services to enable more timely diagnosis and improve treatment pathways, and also by local authority commissioners in terms of the wider prevention agenda.

Full document:  Cancer in the West Midlands.

 

The prevalence of comorbid cancer and dementia

Findings suggest that dementia is associated with poorer cancer outcomes

Objectives: A comorbid diagnosis of cancer and dementia (cancer–dementia) may have unique implications for patient cancer-related experience. The objectives were to estimate prevalence of cancer–dementia and related experiences of people with dementia, their carers and cancer clinicians including cancer screening, diagnosis, treatment and palliative care.

Method: Databases were searched  using key terms such as dementia, cancer and experience. Inclusion criteria were as follows: (a) English language, (b) published any time until early 2016, (c) diagnosis of cancer–dementia and (d) original articles that assessed prevalence and/or cancer-related experiences including screening, cancer treatment and survival. Due to variations in study design and outcomes, study data were synthesised narratively.

Results: Forty-seven studies were included in the review with a mix of quantitative (n = 44) and qualitative (n = 3) methodologies. Thirty-four studies reported varied cancer–dementia prevalence rates (range 0.2%–45.6%); the others reported reduced likelihood of receiving: cancer screening, cancer staging information, cancer treatment with curative intent and pain management, compared to those with cancer only. The findings indicate poorer cancer-related clinical outcomes including late diagnosis and higher mortality rates in those with cancer–dementia despite greater health service use.

Conclusions: There is a dearth of good-quality evidence investigating the cancer–dementia prevalence and its implications for successful cancer treatment. Findings suggest that dementia is associated with poorer cancer outcomes although the reasons for this are not yet clear. Further research is needed to better understand the impact of cancer–dementia and enable patients, carers and clinicians to make informed cancer-related decisions.

Full reference: L. McWilliams, C et al. | A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care | Aging & Mental Health |  Published online: 18 Jul 2017

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