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New cancer strategy could save thousands of lives

About 5,000 lives could be saved each year in England if GPs follow new guidelines on cancer diagnosis.

About 5,000 lives could be saved each year in England if GPs follow new guidelines on cancer diagnosis.The health watchdog NICE say that a new approach is necessary to tackle England’s lagging cancer survival rates.

The guidelines suggest all GPs order certain tests directly, side-stepping referrals to specialists first, to speed up access to treatment.

Charities say they support the changes but warn that more funds are needed.

Doctors have long agreed that the sooner most cancers are diagnosed, the greater the chance of survival.

But according to experts from the National Institute of Health and Care Excellence (NICE), although the situation is improving, thousands of lives are lost each year because tumours are being diagnosed too late.

The new guidelines make wide-ranging changes to previous recommendations, to encourage GPs to think of cancer sooner and lower the threshold at which people are given cancer tests.

For the first time the guidance focuses on key symptoms, rather than encouraging GPs to consider first which cancer a patient may have and then to cross check it with the symptoms.

The recommendations also say all GPs across England should be able to order some cancer tests directly, without waiting for an appointment with a specialist.

For example in certain cases, GPs will now be able to access CT scans and internal examinations such as endoscopies, without a specialist referral.

NICE hopes this will allow patients to get investigations more quickly and take the pressure off specialists’ time.

The committee has produced information to help patients spot the most common signs of cancer so they can seek medical advice quickly.

And the guidance encourages doctors to put “safety nets” in place to ensure difficult cases are not missed.

Patients whose symptoms are worrying but do not currently suggest cancer, for example, should be given follow-up appointments or advice on when to come back.

The Royal College of GPs welcomed the guidance but warned that there might not be enough capacity to do the extra scans and checks, which could cause a backlog and longer wait times for patients.

“It would be regrettable if something that was so well-intentioned resulted in patients being worse off,” said Dr Maureen Baker, chair of the RCGP.

Sara Hiom, from Cancer Research UK, said: “We know the strain the NHS is already under and the number of people diagnosed with cancer is increasing – further investment is essential in order to support this much needed shift in investigative testing. “

She added: “Research would indicate we do fewer diagnostic tests in this country than comparable countries, but there are a lack of workforce, perhaps a lack of kit, to do those tests, so patients may be missing out because there are delays, backlogs or bottlenecks and this really does need to be addressed.”

Health Direct agrees with Cancer Research that not enough diagnostic proceedures are taking place- but we warn that the resources to fund and undertake these extra processes are not in place.

New stroke treatment should be more available

Specialists are urging the NHS to make a new stroke treatment widely available.

New stroke treatment should be more availableStudies suggest the technique for removing blood clots in the brain doubles the chance of recovery for people who have suffered an ischaemic stroke.

The specially designed “Solitaire” stent is highly effective at catching and removing blood clots. However, it is currently only available at 28 specialist hospitals in the UK.

Stroke is one of the leading causes of disability in the UK, and the treatment could benefit a quarter of patients who have a particular type of blood clot in the brain.

Stents are normally used to hold open or strengthen damaged blood vessels, but experts realised this particular device was a very effective way to “catch” and remove blood clots.

The Solitaire stent is made of a nickel-titanium alloy and looks like a net.

The Solitaire stent is used more widely to treat strokes in nearly every other developed nation. In the UK, it is only being used in hospitals that specialise in interventional neuroradiology – and there are only 28 of those.

Anyone who has an ischaemic stroke needs to get to one of these centres within six hours to even have a chance of benefitting from it.

The health regulator for England and Wales, NICE, and Scotland’s regulator, SIGN, have yet to issue guidance.

The treatment has also won the backing of Chest Heart and Stroke Scotland, a group offering free advice and support to stroke survivors and their families.

Chief executive Mark O’Donnell said the Solitaire stent method was “far more effective than any other treatment available”.

He said: “This benefit is over and above that from clot busting alone and can sometimes be used even when patients cannot safely be given clot busting drugs.

“It is likely that 300 to 500 patients could potentially benefit from clot retrieval in Scotland each year. “If this could be delivered, then over 100 people would avoid serious disability and many others would achieve improved outcomes from their stroke.”

Elderly being trapped in hospital warns Age UK

Elderly people are being “trapped” in English hospitals in ever greater numbers as there is nowhere else for them to go.

Elderly people are being Age UK said it was bad for patients’ health, a waste of NHS resources and a huge cost to taxpayers. Its analysis shows patients spent a total of nearly 2.5 million days stuck in a hospital over the past five years.

Age UK says there is a crisis in social care ranging from a shortage of care home places to a lack of district nurses to help people in their own home.

It says the situation has got worse and the number of people being kept in hospital in 2014-15 increased by 19% on the previous year.

The charity’s analysis of NHS England data for the last financial year showed the days spent stuck in hospital included:

  • 174,000 waiting for a residential home place
  • 216,000 waiting for a nursing home place
  • 206,000 waiting for help from social care workers or district nurses to get people back into their own home
  • 41,400 waiting for ramps or stairlifts to be installed into patients’ homes.

Caroline Abrahams, from Age UK, said: “These figures show that year on year, older people are being trapped in hospital in ever greater numbers because of a delayed assessment, care home place, home care package or home adaptation.

“Without decent social care when discharged, whether to their own home or to a care home, hospital stays are often much longer than they need to be and older people are more likely to be readmitted because their recovery stalls.”

She said this was a waste of NHS resources because it cost nearly £2,000 per week for an NHS bed in comparison to around £560 per week in residential care.

“Everyone agrees the way to go is to integrate social care and health much more effectively, but unfortunately our report shows we’ve got a long way to go before really the reality lives up to the rhetoric,” she said .

“And if we can’t get it right for such an important group of people, older people stuck in hospital waiting to get out, really we have to redouble our efforts and do much better.”

NHS failing to direct patients to dentists

NHS patients are still facing problems finding an NHS dentist in England, research suggests.

NHS patients are still facing problems finding an NHS dentist in EnglandA survey found some patients were confused by charges for dental treatment as access to dentistry within the NHS has been a long running problem.

To help patients navigate their way round the system, NHS Choices now provides details of which dentists accept new NHS patients.

But researchers from consumer group Which? found three in 10 advertising availability could not actually take on new patients.

There are 7,500 dental practices that provide NHS services, but only 4,500 of them were advertising as being able to see NHS patients.

Undercover Which? researchers contacted 500 of those, choosing them randomly across the country.

As well as some not having availability, 29% of those that could take on new NHS patients had waits of at least two weeks for an appointment – with one saying it would be eight to nine months before the patient could be seen.

Some practices also made people “jump through unnecessary hoops” such as visiting the surgery to fill out forms or asking patients to pay deposits.

The Which? report said the problems needed to be investigated.

Which? executive director Richard Lloyd said: “We found it frustratingly difficult to get an appointment with a dentist, as information about availability doesn’t reflect reality.

“This is a kick in the teeth for patients and yet more evidence of poor communication from the dental sector.

“We want the Competition and Markets Authority to step in and ensure that dentists put the existing rules into practice so that people can easily find out where they can get NHS dentistry.”

The research comes after an investigation by Which?, published in January, indicated half of patients who had visited a dentist in the past six months had not seen a price list and a fifth had been unsure about the costs ahead of treatment.

Cosmetic surgery cooling off period suggested

Doctors who carry out cosmetic procedures should give patients time to think before agreeing to go ahead.

Cosmetic surgery cooling off period suggestedThe General Medical Council (GMC) has produced the guidance to make surgical and non-surgical procedures, such as facelifts, breast implants, dermal fillers and Botox, safer.

It will now consult doctors and the public about the guidance, however plastic surgeons said they were already using a two week cooling off period.

In 2013, a report by NHS England’s medical director highlighted the risks associated with the cosmetic sector.

This followed safety concerns after nearly 50,000 women in the UK had PIP breast implants fitted.

The French implants were made from an unauthorised silicone filler and were found to have double the rupture rate of other implants.

In January, the Royal College of Surgeons published a consultation on proposals to improve standards in cosmetic surgery.

The GMC sets the standards that are expected of all UK doctors who carry out cosmetic procedures. It also tries to help patients understand what to expect from their doctor.

Some of the main points in the new guidance say that doctors should:

  • Be open and honest with patients and not trivialise the risks involved
  • Give patients enough time and information before they decide whether to have a cosmetic procedure, allowing them time to “cool off”
  • Ask patients to tell them how they have been affected by a cosmetic procedure, both physically and psychologically
  • Not target people under 18 through their marketing and seek additional advice from professionals who treat young people
  • Seek their patient’s consent themselves rather than delegate it
  • Not make unjustifiable claims about the results they can achieve and not give away procedures as prizes

Prof Terence Stephenson, the chairman of the General Medical Council, said some patients in this area were vulnerable and needed protecting.

“We are clear that doctors must not pressure patients to make rushed decisions they may end up regretting and they must give them enough information so they can make an informed choice.”

Rajiv Grover, consultant plastic surgeon and former President of the British Association of Aesthetic Plastic Surgeons (Baaps), welcomed the GMC’s guidance because he said some patients were psychologically unsuitable for cosmetic surgery.

“Cosmetic surgery has for too long been seen as a commodity but unfortunately once an operation is done – it can’t be taken back to the shop.”

He said Baaps had insisted on a two week cooling off period for many years and also encouraged a second consultation with a surgeon before a decision was made.

The association is looking into developing a screening tool to help identify patients who should not have surgery.

The final GMC guidance is expected to be published in early 2016.

Health Direct thinks the GMC initiative is a common sense approach to a growing issue as more people opt for cosmetic surgery.

NHS hits AnE waiting times target

The NHS in England has met its four hour Accident and Emergency (AnE) waiting time target.

The NHS in England has met its four hour Accident and Emergency (AnE) waiting time targetThe 95% target had not been hit for 33 consecutive weeks, since late last September.

Figures for the week ending 24 May show that 95.1% of A&E patients spent four hours or less from arrival to admission, transfer or discharge.

NHS England praised its front line staff for dealing with high workload demands during a tough winter.

A spokesman said: “These latest figures are testament to the excellent services our front-line staff continue to deliver while coming under sustained pressure.”

The improvement comes as the NHS enters the summer period when these pressures tend to ease.

Dr Clifford Mann, president of the Royal College of Emergency Medicine, said there was no room for complacency.

“There is still pressure on the system, which in our view is operating at full capacity.”

He said some A&E units were still not meeting the four-hour target and were stymied by a shortage of hospital beds.

“This exit block must be addressed otherwise the winter of 2015-16 will be hugely challenging,” he warned.

Latest figures show targets for waits in A&E are being missed in other parts of the UK.

In Wales, 83% of patients are being seen within four hours. In Scotland, the figure is 92% and in Northern Ireland it is just under 74%.

Smoking ban cut child hospital admissions

Thousands of children have been spared serious illness and hospital treatment since the smoking ban was introduced in England in 2007.

Thousands of children have been spared serious illness and hospital treatment since the smoking ban was introduced in England in 2007The study, in the European Respiratory Journal, looked at 1.6 million hospital admissions of under 14s from 2001-12.

The law against smoking in indoor public places saw 11,000 fewer children being admitted to hospital with lung infections every year, it found.

Researchers said it showed anti-smoking legislation was improving child health.

The University of Edinburgh study compared the figures for hospital admissions after the ban with mathematical predictions of the number of admissions that would have occurred without the smoking ban.

It estimated that hospital admissions for children with respiratory infections fell by 3.5% immediately after the ban was introduced.

While the biggest effect was seen in the number of children suffering chest infections – which dropped by almost 14% – the number of admissions attributable to nose, throat and sinus infections also went down. But these effects were more gradual, the study said.

There is a well established link between second hand smoke exposure and bronchitis, bronchiolitis, middle ear infections and respiratory tract infections.

Dr Jasper Been, of the University of Edinburgh and Maastricht University, said: “This study is further demonstration of the considerable potential of anti-smoking laws to improve child health.”

“Although our results cannot definitively establish a cause and effect, the rigorous analysis clearly shows that the introduction of smoke-free legislation was associated with significant reductions in hospital admissions among children.”

Data suggested the ban on smoking in public places had also led to a rise in the number of smoke free homes, reducing second hand smoke exposure among children, the study said.

The ban is estimated to have reduced adults smoking in the home from 65% to 55%.

Health Direct estimates that without the ban on smoking the NHS would be treating more sick children at a significant cost which may approximate to £25 million a year- highlighting the savings from preventative changes.

UK drinks more alcohol than estimated

The amount of alcohol people in England drink has been underestimated according to new research.

amount of alcohol people in England drink has been underestimated according to new research

In England surveys measuring typical drinking habits account for only around 60% of alcohol sold, the medical journal BMC Medicine report said.

Report author Dr Mark Bellis said this was because many studies do not include drinking on special occasions.

More than 6,000 people in England were interviewed for the study.

Accounting for special occasion drinking added more than 120 million UK units of alcohol – equivalent to about 12 million bottles of wine – to the population’s alcohol consumption in England every week, it found.

The results could have important implications for public health, researchers said.

“Nationally, we underestimate how much we drink – and as individuals we can turn a blind eye to our heavier drinking periods when we calculate personal consumption,” said lead scientist Dr Bellis, from Liverpool John Moores University.

“For many people, though, these sessions add substantial amounts of alcohol to their annual consumption and inevitably increase their risks of developing alcohol-related ill health.”

The equivalent of more than three quarters of a bottle of wine- or about three pints of beer per drinker every week goes unaccounted for, he said.

The survey measured a medium glass of 12.5% ABV wine as 2.2 UK units, and a 440ml can of 4.5% ABV beer as 2 UK units, but the amount of alcohol units in drinks varies depending on their size and strength.

Researchers conducted telephone interviews with 6,085 randomly-selected members of the public aged 16 and over in England.

Participants were asked about normal drinking patterns and those outside their usual circumstances, such as summer holidays, bank holidays, and weddings.

Most categories of drinkers, based on age groups and levels of typical consumption, reported increased consumption during holidays or special occasions.

People aged 24-35 drank 18 extra units a week on special occasions, the research suggested. The biggest increase was seen in 25 to 35-year-olds, who had the highest level of typical consumption.

People in this drinking category drank an extra 18 units (144g) of alcohol per week on special occasions, the research suggested.

Last year, the Organisation for Economic Co-operation and Development found that people over the age of 15 in the UK drank an average of 10.6 litres of pure alcohol a year – equal to 115 bottles of wine.

According to the Institute of Alcohol Studies, in 2012, men consumed an average of 17 units in the week before they were interviewed, compared with 10.2 units for women.

Prostate cancer gene targeted by drugs

Scientists have published a comprehensive genetic map of advanced prostate cancer.

Scientists have published a comprehensive genetic map of advanced prostate cancer- which suggests nearly nine in 10 patients with advanced prostate cancer could benefit from targeted treatments
The study, published in the journal Cell, shows that nearly nine in 10 men had gene mutations that could be targeted with drugs.

The study was led in the UK by scientists at the Institute of Cancer Research (ICR) London in collaboration with several teams in the United States.

Researchers analysed the genetic codes of tumours from 150 patients with metastatic – or advanced – prostate cancer, whose disease had spread to other parts of the body.

They found that 89% had genetic aberrations for which there were existing drugs or treatments undergoing clinical trials.

Prof Johann de Bono, of the ICR and Royal Marsden NHS Foundation Trust “This is truly a gamechanger. We are calling this prostate cancer’s Rosetta Stone, because we can now decode the disease for the first time.”

“In the past, we used to treat lethal prostate cancer as a single illness but this shows that it is a group of diseases, each driven by their own set of mutations.”

Prof de Bono said it meant that, using genetic testing, it would be possible to individualise patient care, heralding the arrival of personalised treatment for advanced prostate cancer.

More than 40,000 men are diagnosed with prostate cancer and nearly 11,000 die in the UK each year.

Nearly all men with advanced disease develop resistance to hormone therapy, which is used to prevent prostate cancer cells from growing.

In the study, nearly two thirds of the patients had mutations in a molecule that interacts with the male hormone androgen, which is targeted in current treatments.

Scientists at the ICR believe this could open up new avenues for hormone therapy.

Mutations in BRCA1 and BRCA2 genes were found in nearly one in five patients.

Trials at the Royal Marsden/ICR have already shown prostate cancer patients with BRCA mutations can benefit from drugs called Parp inhibitors which disrupt cancer cells’ DNA repair mechanism.

One of these drugs, called olaparib, is now licensed by the EU to treat women with ovarian cancer, who carry BRCA mutations.

The research is part of a move towards treating cancer – not just by its site of origin – such as breast, lung or prostate – but with medicines which target the individual genetic mutations driving the disease which can be common across several cancers.

Prof Paul Workman, ICR chief executive said: “This major new study opens up the black box of metastatic cancer, and has found inside a wealth of genetic information that I believe will change the way we think about and treat advanced disease.”

End Of Life care letting people down

Thousands of dying patients are being let down by poor End Of Life care provision according to the Parliamentary Health Service Ombudsman (PHSO)

End Of Life care letting people downThe health ombudsman’s report detailed “tragic” cases where people’s suffering could have been avoided or lessened.

The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.

One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.

In another case, a 67-year-old man’s family learned of his terminal cancer diagnosis through a hospital note – before he knew himself. This “failed every principle of established good practice in breaking bad news”, the report said.

“There was an avoidable delay in making a diagnosis,” it added. “An earlier diagnosis would have meant opportunities for better palliative care.”

Ombudsman Julie Mellor said that the report made “very harrowing reading”.

She also urged the NHS to learn lessons from the report, adding: “Our casework shows that too many people are dying without dignity.

“Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones.”

Macmillan Cancer Support chief executive Lynda Thomas said: “The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.

“If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care.”

The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.

He said the CQC would continue to highlight those services that were failing.

Health Direct laments “These are appalling cases – everyone deserves good quality care at every stage of ones life- but at the very end of the life dignity should be paramount.”

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