Wednesday 25 April 2012

Are older cancer patients undertreated?

A report by Macmillan Cancer Support has highlighted the problems with cancer investigation diagnosis and treatment in the elderly. The report suggests that decisions regarding cancer investigations and treatment are often based upon age and may fail to take into consideration physical fitness, mental attitudes and social support networks. Some 70 year olds may have a very active lifestyle whereas others can be bed bound.

The report calls for treatment decisions to be made on overall health not just on date of birth.

As a population we are living longer. With the number of people diagnosed with cancer set to double to 4 million over the next 20 years and with half of those cancers being diagnosed in the over 70’s, the investigation and treatment of elderly cancer patients needs to be addressed.

Relative five year cancer survival rates for patients over the age of 75 across the UK currently lag behind those of Europe.

A multidisciplinary approach to diagnosis and treatment is required with input from patients, their families as well as surgeons oncologists and geriatricians.

Minimally invasive diagnostic techniques mean more elderly patients can be diagnosed. Furthermore, the advent of minimally invasive surgical techniques and other novel therapies means that many more treatment options are open to the elderly frailer patient.

Simon Radley April 2012

Tuesday 24 April 2012

Researchers close in on new way to treat aggressive bowel cancers

Targeting a "previously unappreciated" protein could lead to a treatment for aggressive bowel cancers, US researchers have found.
The finding, published in the journal Cell, could apply to up to a quarter of people who develop the disease.
But UK experts warned that, while the research was exciting, drugs targeting TAK1 - previously linked to inflammation - could be some years away.
Two genes - APC and KRAS - drive most bowel cancers. Around eight out of ten bowel cancers carries a faulty APC gene, whereas about half have a faulty KRAS gene.
Cancers in which both of these genes are defective are generally hardest to treat, and new-generation targeted treatments like cetuximab tend not to work in these patients.

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Doctors were certain I was anorexic. In fact, I was one of thousands with Crohn's

Looking back at teenage photos, Fiona Argo can barely recognise herself as the young woman with jutting collarbones and stick-thin legs. But she can see why concerned friends and family thought she was in the grip of an eating disorder.

Between the ages of 16 and 19, Fiona’s weight plummeted from 9½ stone to just 5st, extremely underweight for her 5ft 5in frame. Her periods stopped and her weight was so dangerously low she was told she was at risk of heart failure and even death.

She was diagnosed with anorexia and hospitalised. But while the diagnosis seemed obvious to doctors, friends and family, Fiona remained adamant she was not anorexic.

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Private Healthcare Is Referred to The Competition Commission

Finally the Office of Fair Trading has decided to refer the private healthcare sector to the Competition Commission for further investigation.

There are aspects of the private healthcare market that are badly in need of reform. Transparent fee structures for patients and doctors are required. Theoretically at least NHS patients through their GP’s have the choice of which specialist doctor they can be referred to. This is not necessarily so in the private sector. Insurers are potentially able to influence patient choice by dictating which doctors patients are allowed to see. By not recognising certain doctors, insurance companies influence patient choice in the market.

The chairman of the British Medical Association’s Private Practice Committee, Derek Machin, has welcomed the announcement “the BMA has for many years called for reform of the private healthcare market so that it can deliver a system that is fairer to patients and doctors” he too has called for a probe into what he describes as “the disproportionate power of large commercial insurers over doctors”

As a consultant colorectal surgeon I am currently recognised by all the major insurers. The recent and very public stand off between BUPA and BMI hospitals and recent fee structure changes recently introduced by one major insurer (without any consultation with doctors or their professional speciality bodies) have highlighted to me the need for proper investigation and reform of the private healthcare market.

Simon Radley April 2012

Monday 16 April 2012

Bowel disorder deaths halved in three years by NHS care

Mortality among patients with inflammatory bowel conditions has halved in three years due to improvements in NHS care, according to a UK audit.

The third UK Inflammatory Bowel Disease (IBD) Audit carried out in 2010 uncovered substantial improvements in care for ulcerative colitis and Crohn’s disease since 2006. But it said testing and treatment could still improve.
The report found that deaths among patients with ulcerative colitis fell from 1.7% to 0.8% between 2006 and 2010.
NHS care has also lowered readmission rates for both diseases. The percentage of those seen by a specialist IBD nurse during hospital admission has doubled since the first round of the audit in 2006.
The report said testing for infections such as C. difficile could improve, and all patients should be given heparin where appropriate to prevent blood clots.
It advised that patients should always have a consultation with a specialist nurse if anti-inflammatory treatment is prescribed. All Crohn’s disease patients ought to see a dietician to prevent malnutrition and, if necessary, receive support to stop smoking.

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Link between oral bacteria and bowel cancer?

Bacteria associated with the most common cause of tooth loss in adults could be a pre-curser for the development of bowel cancer, according to a team of scientists.
The link comes as scientists at the Dana-Farber Cancer Institute and the Broad Institure in America found an abnormally large number of Fusobacterium, a bacterium associated with the development of gum diseas, in nine colorectal tumour samples, pointing to the possibility the two could be associated.
Bowel cancer, also known as colon cancer, is one of the top three deadly cancers in the UK. Around 35,000 people get diagnosed with bowel cancer every year and around half of them die.
Although lead author Matthew Meyerson, MD, PhD, co-director of the Center for Cancer Genome Discovery at Dana-Farber and a professor of pathology at Harvard Medical School believes further research is needed to discover the extent of the link, the research suggests the bacterium could be a factor in the development of cancer.
Dr Meyerson stated: “At this point, we don't know what the connection between Fusobacterium and colon cancer might be. It may be that the bacterium is essential for cancer growth, or that cancer simply provides a hospitable environment for the bacterium. Further research is needed to see what the link is.”

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Wednesday 11 April 2012

Colon cancer study backs blood stool screening test

Although colon cancer screening is recommended by many organizations, less clear is which method is best to detect tumors and precancerous lesions.
A new study in the New England Journal of Medicine suggests that a relatively inexpensive and non-invasive test may be just as effective as a colonoscopy.
Meanwhile, a 23-year study, also published in the journal, has confirmed that removing precancerous polyps, known as adenomas, during a colonoscopy can reduce the risk of death from colorectal cancer by half.

In an editorial in the Journal, Dr. Michael Bretthauer of Oslo University Hospital and Dr. Mette Kalager of Telemark Hospital, both in Norway, said that based on the results, "an appealing concept would be to use colonoscopy as a triage screening test, offering it once for everybody at 60 years of age" and using it to classify people into high- and low-risk categories. Low-risk people would not need further screening while those with adenomas would be evaluated regularly.
One in 20 Americans will develop colorectal cancer. About 140,000 cases are diagnosed in the United States each year, resulting in about 49,000 deaths, according to the National Cancer Institute. It is the third most common cancer worldwide.

Article source -

Bowel cancer: Are you aware of the signs?

THE national bowel cancer awareness campaign is now in full swing.
Aiming to raise awareness of the signs and symptoms of bowel cancer, the Be Clear On Cancer campaign, which runs until the end of the month, is encouraging people to visit their doctor straight away if they have any signs or symptoms.
More than 90 per cent of those diagnosed with early stage bowel cancer are successfully treated, so a trip to the doctors could save your life.
Dr John Parker, a GP from the Morrill Street Practice in east Hull, wants people to be aware that for your GP, talking about these problems is an everyday thing – you do not need to be embarrassed.
He said: "Our aim is to detect serious bowel disease, particularly cancer, at an early stage.
"It is important to make your GP your first port of call should you notice a change in your bowels – in particular looseness lasting for more than three weeks or the presence of blood at any time.

Article source -

American Guidelines On Colorectal Cancer Screening

There are already many guidelines and recommendations for colorectal cancer (CRC) screening. In this recent article, published in the Annals of Internal Medicine, a group from the American college of physicians (ACP) have produced a guidance statement on screening.

4 sets of current guidelines were reviewed to produce the statement.

The ACP recommended

1. Clinicians perform individualised assessment of CRC risk in all adults

2. High risk patients are screened from age 40 or 10 years from earliest age of onset of CRC in the family

3. Average risk patients should be screened from age 50 (Afro-Americans should be screened from age 45)

4. Clinicians stop screening at age 75 or in adults with a life expectancy of less than 10 years

5. using a stool-based test, flexible sigmoidoscopy, or colonoscopy as a screening test in average risk patients.

6. colonoscopy as a screening test in high risk patients

7. clinicians should select the test based on the benefits and harms of the screening test, availability of the screening test, and patient preferences.

Whilst screening would appear to be effective for CRC, there is as yet no consensus on the best test or combination of tests. Nor is there consensus on how frequently such tests should be performed.

Whilst the statement includes colonoscopy as a screening test, in fact only faecal occult blood tests and flexible sigmoidoscopy have so far been shown to be effective in large, population based, randomised trials.

The CRC screening process is even not consistent within the UK. Screening in Enlgand is currently based on the faecal occult blood test and carried out between the ages of 60 and 69 whereas faecal occult blood testing is carried out between the ages of 50 and 75 In Scotland.

Ann Intern Med 2012; 156:378-86.

Simon Radley March 2012