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

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.

Abstract

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

Flexible new method for early cancer diagnosis

Earlier discovery of cancer and greater precision in the treatment process are the objectives of a new method recently developed. | ScienceDaily

Screening of at-risk groups for certain types of cancer, leading to earlier diagnosis, is being described as an area with major potential, both with regard to saving lives and saving money within healthcare. No tissue samples are needed for the method, and the tumor does not even need to be located. Investments are now being made to roll out this innovation across healthcare and broaden the scope of the research in this field.

The technique was created based on the fact that people with cancer also have DNA from tumor cells circulating in the blood, molecules that can be discovered in a regular blood sample long before the tumor is visible via imaging such as tomography, MRI, X-ray and ultrasound.

The researchers have now increased the sensitivity of detecting tumor DNA in blood thousand-fold by eliminating the background noise from the measurements using “DNA barcoding.”

Full story at ScienceDaily

Link to the research: Anders Ståhlberg, et al. Simple multiplexed PCR-based barcoding of DNA for ultrasensitive mutation detection by next-generation sequencing.  Nature Protocols, 2017; 12 (4): 664

Prescription history could help GPs diagnose cancer earlier

“We want to develop a tool that helps GPs diagnose cancer earlier in the hope of saving more lives.”– Dr Jem Rashbass 

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Cancer Research UK-funded scientists are to examine whether identifying patterns in medication given to patients before they develop cancer could improve early diagnosis.

Looking for patterns in prescriptions and other data could help guide GP referrals, especially in patients with non-specific symptoms that don’t obviously indicate cancer.

Only about half of those with the most common cancers have “red-flag” symptoms. And this is even lower in cancers with poor survival rates such as pancreatic, stomach, ovarian and brain cancer.

This research is being led by Health Data Insight which has received funding through Cancer Research UK’s Pioneer Awards scheme. Together with Public Health England and the NHS Business Services Authority they have created an anonymous dataset of nearly all the primary care prescription data – approximately 80 million medications being prescribed each month.

The researchers will then link this information to data in the National Cancer Registration and Analysis Service to look for trends in medications given to patients before they were diagnosed with cancer.

Read more at Cancer Research UK

Organisational characteristics, teamwork & service delivery in lung cancer diagnostic assessment programmes

Honein-AbouHaidar, G.N. et al. (2017) BMJ Open. 7:e013965.

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Objectives: Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs.

Conclusions: This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.

Read the full article here

Significant variation in A&E cancer diagnoses across England

Cancer diagnosis in accident and emergency departments are three times more likely in some parts of England than others | HSJ

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Public Health England data shared with HSJ shows the number of cancer diagnoses in emergency care, often when a patient has attended for another reason, vary from 11 per cent of all cancer diagnoses in one clinical commissioning area to 33 per cent in another.

The figures indicate which areas are better at detecting cancers at an early stage and in primary care services. The percentage of cancer cases diagnosed during an emergency visit to hospital is recognised as a proxy for the effectiveness of primary care.

The national average according to the most recent available data, for quarter three of 2015-16, is 20 per cent of cancer cases being diagnosed in A&E.

In the same period, South Manchester CCG had the highest rate of 33 per cent, compared to 11 per cent for North Somerset CCG, which was the lowest.

Read the full article here