Posts Tagged ‘Cancer’

Tackling late presentation in bowel cancer

By Paul Finan, Professor of Colorectal Surgery, consultant general and colorectal surgeon and Clinical Lead for the National Bowel Cancer Audit 2011 - 30th November 2011 11:15 am

It’s not the easiest of subjects, but we need to talk about the early detection of bowel cancer.

The annual report from the National Bowel Cancer Audit, published today, shows a continuing high mortality rate of 6 and 11.2% for urgent and emergency surgery for bowel cancer.

Today’s report is based on, for the first time, submissions from 100% of trusts, and reports on the management of over 28,000 cases of bowel cancer during the 12 month period ending July 2010.

While the overall picture of care for bowel cancer patients in England and Wales continues to improve, patients who undergo urgent and emergency surgery are still at a much greater risk of death compared to those who have elective and scheduled procedures.

The real problem is late presentation, which is why the Department of Health’s Bowel Awareness Campaign, starting in January 2012, needs the support of every colorectal surgeon in the country to ensure it has the maximum impact locally.

But it is also about how we manage our cases and the need for:

· prompt and senior involvement with acute cases of bowel cancer; and

· implementation of modern management protocols for those patients presenting acutely.

Many more bowel cancer patient lives could be saved if the NHS made more consultant time available for emergencies and new techniques were more widely used.

An innovation that could help improve care is colonic stenting. This technique enables a bowel blocked by a tumour to be opened by inserting a device. This temporary measure buys vital time for the patient to be stabilised, prepared for surgery and for the expert team to be assembled.

A trial is currently underway to prove the safety and value of this approach - the Royal College of Surgeons (RCS) and Association of Coloproctology of Great Britain and Ireland are encouraging as many hospitals as possible to sign up as participation gives surgeons the back up of training and a support network so the technique can be introduced safely for patients.

The NHS could also be doing a lot more to organise how these very sick patients get the care of a consultant surgeon, consultant anaesthetist and the wider team, and access to high dependency and other facilities, from the moment they arrive at hospital and at any time of the day or night, including weekends. The RCS is encouraging commissioners to ensure their local hospital is following the RCS standards for emergency care.

Read more on the National Bowel Cancer Audit 2011.

Read more on the CREST colonic stenting trial, being run from the University of Birmingham.

Read more on the RCS emergency surgery standards.

See the Department of Health’s campaign on Bowel cancer awareness.

The National Bowel Cancer Audit Project is a collaborative, national clinical audit for bowel cancer run jointly by The NHS Information Centre and the Association of Coloproctology of Great Britain and Ireland.

Cancer audit says make time for emergencies

By Mike Broad - 10:55 am

Many more bowel cancer patient lives could be saved if the NHS made more consultant time available for emergencies, say the presidents of the Royal College of Surgeons and Association of Coloproctology of Great Britain and Ireland.

Bowel cancer is frequently only detected at a late stage and a significant number of patients don’t realise they have it until the tumour causes a life-threatening emergency bleed or blockage. These patients are typically in imminent danger and need a quick operation.

The National Bowel Cancer Audit 2011, published today by the NHS Information Centre, shows that while results for planned operations were improving, mortality for emergency patients remained high.

An innovation that could help improve care is colonic stenting. This technique enables a bowel blocked by tumour to be opened by inserting a device. This temporary measure buys vital time for the patient to be stabilised, prepared for surgery and for the expert team to be assembled. A trial is currently underway to prove the safety and value of this approach - and the RCS and ACPGBI encourage as many hospitals as possible to sign up as participation gives surgeons the back up of training and a support network so the technique can be introduced safely for patients.

Professor Norman Williams, president of the Royal College of Surgeons, said: “Last month the RCS produced a report on the failings of the NHS in effectively treating emergency patients and bowel cancer emergencies are a regular situation hospitals face.

“The NHS could be doing a lot more to organise in a way that gets these very sick patients in the care of a consultant surgeon earlier on their arrival at hospital and we would encourage commissioners to find out if their local hospital is following Royal college of Surgeons standards for emergency care.”

Nigel Scott, president of the Association of Coloproctology of Great Britain & Ireland, said: “We fully supports the Department of Health Bowel Awareness Campaign to be launched in January 2012 - in the hope that earlier presentation by patients and more bowel telescopes to find bowel cancer, will boost the success of colorectal cancer treatment further still.”

Read a blog on the issue.

Read more on the National Bowel Cancer Audit.

Money woes hit cancer patients, says charity

BBC Health - 24th October 2011 10:37 am

Financial problems affect more than two-thirds of cancer patients, with some going without food because money is so tight, a charity has claimed.

A YouGov survey of 1,500 patients for Macmillan Cancer comes as the charity challenges the Welfare Reform Bill, being debated in the Lords this week. Macmillan claims thousands could lose out because of proposed changes to the Employment and Support Allowance.

But the government said those who needed the benefit would still get it. Employment and Support Allowance (ESA) claimants are divided into two categories - those undergoing treatment are in the “support group” and there is no time limit.

But those who are deemed able to perform “work-related activities” which might help them eventually return to work face means-testing after 12 months. Anyone with savings over £16,000, or whose partner either works more than 24 hours or earns more than £149 a week, would lose all their ESA.

Read more at BBC Health.

Andrew Lansley makes U-turn on cancer networks

The Guardian - 20th May 2011 9:17 am

Andrew Lansley has been forced to ditch a controversial plan that would have put the NHS at risk of losing the services of teams of cancer experts who help patients, GPs and hospitals.

The health secretary has decided to reprieve England’s 28 NHS cancer networks after MPs of all parties, as well as leading charities and the government’s own cancer tsar, warned that letting them disappear would damage both patient care and the drive to cut the number of cancer-related deaths.

Lansley changed tack after rejecting for many months concerns about his refusal to guarantee the future of the networks once his NHS reforms began in 2012, a stance that Macmillan Cancer Support described as “absolute madness” that could result in some patients dying earlier.

Until now, Lansley has insisted his plans to reorganise the health service in England meant the proposed new NHS commissioning board, not he, could decide whether the networks should continue or not once GP consortia took over the role of commissioning care in 2013. The health secretary’s diminished role in the new era meant he could not tie the board’s hands, said Lansley.

But critics accused him of placing an “ideological” devotion to his NHS blueprint above the need to ensure that health professionals would still be able to call on expert guidance on cancer.

Read more in The Guardian.

Time to get radiotherapy into the thick of it

By Sarah Burnett-Moore - 28th January 2011 11:25 am

On Tuesday I went to a briefing by Cancer Research UK, in the House of Commons, about radiotherapy services, and I was struck by three things.

Firstly: MPs are spectacularly fond of having their photograph taken. They were queuing up to take turns posing with a megaphone. This is therefore the end of my lingering desire to stand for Parliament, I hate having my picture taken. Did I think some of them were there just for the photo op? Well, you might think that, but I couldn’t possibly comment.

Secondly: how realistic The Thick Of It is. I urge those of you who haven’t seen this biting satire to seek it out on DVD or the iPlayer, it’s like Yes Minister, but infinitely more sweary.

Thirdly, and most importantly, I realised how little I knew about radiotherapy. My mother had some 26 years ago, and I share a Royal College with radiotherapists, but that’s about it. So I wasn’t surprised that public awareness of the benefits of radiotherapy is so low. If you are similarly ignorant about radiotherapy, here’s a few stats, if you’re in the know, stick your fingers in your ears and go la-la-la until the numbers stop.

Around 120,000 cancer patients benefit from radiotherapy each year, and 40% of those cured will have had it. More patients are cured by radiotherapy than by chemo. 50% of patients with cancer could be helped by it, but shortages in equipment and staff mean that the uptake is much lower.

Unsurprisingly, the best availability is in Scotland, at 43%, but in Northern Ireland it is a woeful 32%. A third of patients could benefit from Intensity Modulated Radiotherapy, yet less than a tenth get it. Patients needing Proton Therapy have to go abroad to get it.

Radiotherapy services seem to have lost out to the more ‘dramatic’ chemotherapy. Patients having chemo are often very obviously undergoing intense treatment, but patients having radiotherapy can feel just as awful. Travelling to appropriate units can be as gruelling as any dose of FEC. It’s all very well to give chemo at your local branch of Boots, but I don’t see the ASDAs of this world lining up to get a linear accelerator installed, unless they thought it was a way to get people through the checkouts faster.

Only 14% of the public know about the potential benefits of radiotherapy, so the aim of the briefing was to ask MPs to lend their voice to the campaign.

Around 30 MPs found time to attend, which wasn’t a bad turn out considering that the questions in the House were on health. Many stayed for the entire event, and some even asked quite informed and intelligent questions of the panel. So if your MP isn’t asking direct questions about how good your local radiotherapy service is, give him (or her, I’m not going Andy Gray on you) a nudge.

And for those of you who have been reading about the packed cellars at the Palace of Westminster, I didn’t get offered any Pétrus.

One year on we’re fundraising for cancer research

By Sarah Burnett-Moore - 18th January 2011 11:45 am

My father died a year ago today of bowel cancer. Watching him deteriorate was a pretty awful experience.

Although he was over eighty, prior to the diagnosis, he would happily get up at four o’clock in the morning to be first on set at Shepperton, and would drink almost anyone under the table. He had developed a bit of a movie niche as a Dickie Attenborough look-a-like. When he was told that he had cancer it was like the stuffing had been knocked out of him, despite the fact that he had seen both his wife and daughter go through it.

When I saw his first CT scan I knew his prognosis was grave. He tolerated the chemo very badly, and after six months decided to stop it. Unfortunately, his previously static disease began to progress rapidly and he continued to suffer from loss of appetite and peripheral neuropathy.

The last couple of months were pretty harrowing - he was in and out of the local DGH having malignant ascites repeatedly drained. He went to the hospice, but hated it. At the end he was obstructed, and the DGH was attempting to control his pain with Oromorph, which was just coming straight back up the NG tube. When I asked the SHO to change him to sub-cut morphine I received this snotty response: “You do understand the implications of that?” Yes I did, but I couldn’t bear to see him both in pain and terrified.

By the morning he was dead. He had waited for my mother to pop home for a shower and a sandwich, and slipped away when she wasn’t there to see him go.

I haven’t really written about it before because it was all so horrible, but the year marker seemed an appropriate time. However, I have found something positive to do. In June, Troy and I are going to Namibia, we are going to renovate a school, and build the local community a football pitch. What on earth has this got to do with bowel cancer? Well, the project is being organised by The Bobby Moore Fund, which is the bowel cancer branch of Cancer Research UK. Sir Bobby Moore died of bowel cancer at the age of 53, and his wife Stephanie set up the fund to promote awareness and fund research.

Each year the BMF arranges an ambitious overseas project, and I’ve managed to convince the husband, who won’t even go to Glastonbury, to spend ten nights in a tent in the Namibian desert. In order to go, we have to raise a minimum of £8,000 for the Bobby Moore Fund, on top of our £700 registration fees. So far we’ve raised 72% with events ranging from a 5-a-side football tournament, Hallowe’en Bingo, and a Sing-A-Long-A-Santa night.

If you would like to read more about Project Namibia, or if you would like to make a donation, please click here.

It’s going to be hard work, but great fun, and I’ll let you all know how we get on.

Early testing placed at heart of new cancer drive

BBC Health - 12th January 2011 10:26 am

Ministers in England are setting out their plans to improve cancer care in a bid to bring survival rates up to European averages.

The Cancer Strategy focuses on early diagnosis, saying this is the key to saving an extra 5,000 lives a year. Extra money is being promised to give GPs better access to tests, such as brain scans.

At the moment, patients are guaranteed to see a cancer specialist within two weeks if they get an urgent referral from their GP.

The coalition government has promised to keep this target, which was set by Labour, as they say it is clinically justifiable.

However, they believe GPs should have better direct access to testing themselves for those patients who are not classed as urgent but could benefit from further investigation.

To achieve this they are freeing up money to improve access to chest x-rays, ultrasounds and MRI brain scans.

Read more at BBC Health.

Government announces £600m cancer drug fund

BBC Health - 27th October 2010 11:27 am

Patients in England will benefit from a £600m fund to improve access to cancer drugs over the next three years, the government has confirmed.

The move is to address the UK’s poor record of cancer treatment provision compared with the rest of Europe.

Health Secretary Andrew Lansley said cancer patients were already getting extra treatments thanks to an interim fund of £50m which began in October.

From next April, the first of three annual £200m sums will be available.

Mr Lansley said this would enable NHS doctors to buy drugs for their patients that can extend life or improve its quality.

“This £200m a year funding over three years for cancer drugs is a crucial step forward in addressing the disparity in patients’ access to cancer drugs in England compared to other countries.

“My aim is to truly empower patients.”

Read more at BBC Health.

UK cancer fund not a victory for patients

The Lancet - 6th August 2010 11:33 am

The lead editorial in this week’s Lancet criticises the government’s announcement of an emergency cancer fund, saying that is not the victory for patient groups that some believe.

The new £50m fund will be available for six months from October, until the previously announced £200m cancer drugs fund comes into effect from April next year. The fund will enable a doctor whose patient has had funding for a drug declined because it is not approved by the NICE to appeal to their regional SHA panel. These panels will have the power to overrule NICE, and draw on their share of the £50 million to fund the patient’s drugs.

The editorial says: “This raises the spectre of appeals being granted or declined not on the basis of patients’ conditions, but because of where they live: either because their SHA has exhausted its share of the fund, or because their SHA is using stricter funding criteria. Scratch the surface, and it quickly becomes clear that what this fund represents is not the victory for patient groups that some believe. Rather, it is the product of political opportunism and intellectual incoherence.”

A report by national cancer director Prof Mike Richards provided a timely opportunity for the health secretary to announce this policy. The report compared treatment for various diseases in 14 developed countries. The UK ranked highly for providing drugs to fight heart disease and stroke, but was 11th for the provision of drugs for dementia, 13th for drugs for multiple sclerosis, and 12th for cancer drugs that had been on the market for less than five years.

Lansley appeared uninterested in the potential causes of the variations in drug use, and diverted £50m of Department of Health funds earmarked for the Personal Care at Home Bill to the emergency cancer drugs fund. The editorial says: “Presumably emergency funds for dementia and multiple sclerosis drugs will be announced in due course - anything else would be intellectually indefensible.”

The editorial condemns the policy for not only undermining NICE, but also it undermining the entire concept of a rational and evidence-based approach to the allocation of finite health-care resources. It concludes: “New cancer treatments clearly challenge the cost thresholds set by NICE, but innovative schemes have been developed to reduce the cost of drugs - notably bortezomib for multiple myeloma - by rebating costs in patients who do not respond to the drug in question. Lansley’s £50 million slush fund could reduce the incentive for drug manufacturers to engage in mutually beneficial schemes of this type. With ministers claiming that the coalition government is ‘more radical than Thatcher’, there is an increasing sense that a desire to force the pace of change is starting to cloud judgement.”

Read the full editorial.

Emergency fund to fast-track cancer drugs

BBC Health - 28th July 2010 3:00 pm

The government has announced a £50m fund which should give very sick cancer patients access to drugs sooner.

It will mean that from October, rather than next year, doctors in England can offer drugs which have not been approved by the rationing body NICE.

The announcement was made at the launch of a study showing that the UK lags in providing the newest cancer drugs.

The fund will be financed by ditching the former government’s plan for free personal care for the old.

It means that cancer patients will be able to access new drugs earlier to help extend life by weeks or months or improve quality of life in the final stages of the disease.

The government’s cancer tsar Professor Sir Mike Richards, who led the research into the UK’s ranking on drug provision, stressed however it would not improve overall survival rates.

Read more at BBC Health.