Search the hub

In a new trial, cancer patients across the UK have been using the eRAPID technology system to help them manage their cancer symptoms. The system has been developed by the University of Leeds, and this is the first trial to offer automated advice to early-stage patients whose treatment aims to cure cancer. Hundreds of early-stage colorectal, breast, or gynaecological cancer patients took part in the trial which used computer algorithms to help manage their symptoms and improve their wellbeing. They were able to report online symptoms from home and receive instant advice on whether to self-manage or seek medical attention. Cancer can cause a range of different symptoms for patients living with the disease, as well as from the side effects of treatments such as chemotherapy, which are sometimes life-threatening and all of which lower a patients’ quality of life. Better monitoring and management of these symptoms can help in improving treatment delivery and reducing patients’ physical distress. All patients in the trial received their usual care, with 256 receiving the eRAPID system as additional care. The patients reported better symptom control and physical wellbeing in the early weeks of treatment, with the system preventing symptom deterioration in about 9% of patients after 12 weeks. Dr Kate Absolom, University Academic Fellow in the Leeds Institute of Medical Research at St James’s and the Leeds Institute of Health Sciences at the University of Leeds, said: “The encouraging results from this study will help pave the way for future development and refinement of these interventions in broader cancer settings. The COVID-19 pandemic highlighted the need and speeded a shift towards technology-enabled care, so these study results are very timely.” Programme lead Professor Galina Velikova, at the Leeds Institute of Medical Research at St James’s, University of Leeds, and the Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, said: “Rising numbers of cancer patients are receiving a range of anti-cancer treatments which means patients are living longer and require longer periods of care and monitoring. “Remote online monitoring options have the potential to be a patient-centred, safe, and effective approach to support patients during cancer treatment and manage the growing clinical workload for cancer care.” Read full story Source: Health Europa, 11 January 2021

Smear-test delays during lockdown have prompted calls for home-screening kits. Cervical cancer screening has restarted across the UK - but some women say they will not attend their appointments for fear of catching Covid. Jo's Cervical Cancer Trust is urging "faster action" on home tests for HPV, which causes 99% of cervical cancers. An NHS official said GP practices should continue screening throughout lockdown, and "anyone invited for a cervical smear test should attend". Cancer Research UK said it was not yet known how effective and accurate self-sampling could be in cervical screening. A survey by gynaecological cancer charity the Eve Appeal indicates nearly one in three missed smear tests are the result of people being "put off" by coronavirus. And a Jo's Cervical Cancer Trust survey during the pandemic suggests the same proportion would prefer to take their own human-papillomavirus (HPV) test rather than go to a GP. Acting chief executive Rebecca Shoosmith said coronavirus had added "more barriers" to going for a smear test. "Sadly those who found it difficult before are likely to be no closer to getting tested," she said. "Self-sampling would be a game-changer." Both charities emphasise smear tests are for "women and anyone with a cervix" and transgender and non-binary people may have additional barriers to going. Jo's Cervical Cancer Trust said DIY tests could also help people who had been sexually assaulted and those with disabilities or from backgrounds where smear tests were taboo. Read full story Source: BBC News, 21 January 2021

NHS bosses have instructed hospitals to keep performing urgent cancer surgery despite Covid pressures, after a growing number cancelled procedures because they did not have enough intensive care beds or available staff. They have told England’s regional directors of cancer to ensure treatment of people who need cancer surgery within four weeks gets the same priority as care of patients who have Covid. The move was unveiled in a letter, obtained by HSJ, sent last Friday by Amanda Pritchard, the chief operating officer at NHS England and NHS Improvement. It was also signed by Cally Palmer, the NHS’s national cancer director, and Prof Peter Johnson, a highly respected specialist who is the NHS’s national clinical director for cancer. They have acted after unease among cancer specialists that growing numbers of hospitals, including all those in London, had cancelled urgent operations. Hospitals have felt obliged to do so either because they did not have enough intensive care beds for patients who might need one after their cancer procedure or because surgical staff had been repurposed to help care for Covid patients. Doctors voiced alarm at the scale of recent postponements of what the NHS classes as “priority two” operations. That means they should be done within 28 days to ensure that someone with cancer does not see their disease spread or become inoperable because it was delayed. More than 1,000 cancer patients in London are now waiting to have “priority two” or “P2” urgent surgery, but none have been given a new date for when it will happen, HSJ reported last week. Read full story Source: The Guardian, 18 January 2021

More than 1,000 people needing urgent cancer surgery in London have no date for their treatment, HSJ can reveal. A document leaked to HSJ showed that, at the end of last week, more than 1,000 of London’s cancer surgery patients without an appointment date were defined as P2 (priority two), meaning they needed to be seen within four weeks or risk their condition worsening. The report seen by HSJ also showed more than 300 P2 patients had their surgery postponed in the past week, a statistic NHS England London has so far refused to disclose. Hospitals in the capital are facing their highest-ever COVID-19 occupancy rates, with surgical lists at many trusts being cancelled. Meanwhile, a separate NHSE London document reported in the press this week revealed: “Most NHS Green sites [those cancer surgery sites intended to be covid-free to avoid risk to very frail patients] are now compromised with only a limited number of cases being undertaken in NHS sites this week”. The papers also said the current plans to increase indepedent sector capacity usage were “insufficient to offset the NHS shortfall”, and noted there was a two week lead-in time to move patients into private hospitals “based on clinical rotas, theatre bookings, [and] patient isolation”. Read full story (paywalled) Source: HSJ, 12 January 2021

One quarter of women under 40 have never checked themselves for breast cancer – believing they are too young, or they don’t think it will affect them, or they are just too busy. And half of all women do not regularly check their breasts for signs of cancer. The study of 2,000 women found those aged 18 to 39 are the least likely to look for signs of cancer, with a tenth believing they are not old enough to suffer the illness. But a quarter admit they do not have the confidence to inspect themselves, while 1 in 10 put it off in case they find a lump. It also emerged women from South Asian backgrounds are the least likely to examine themselves compared to other ethnicities, with 40% admitting to never checking at all. This drops to 27% of black women and just 13% cent of those of other ethnicities. Of the South Asian women polled who don’t check themselves for signs of breast cancer, more than a third said they forget or don’t know what they are looking for. While more than 1 in 20 (7%) don’t feel comfortable checking themselves due to cultural reasons. Barriers to going to the doctor when noticing a lump or change in breasts vary – from not wanting to waste their doctor’s time, the fear of not being taken seriously, concerns that a female doctor won’t be available, and not wanting to know what caused the change. Read full story Source: The Independent, 11 October 2021

GPs are failing to urgently refer patients with “red flag” signs of suspected cancer to a specialist, research suggests. Six out of 10 patients in England with key symptoms indicating possible cancer did not receive an urgent referral for specialist assessment within two weeks, as recommended in clinical guidelines, according to a new study. Nearly 4% of these patients were subsequently diagnosed with cancer within the next 12 months. The findings were published in the journal BMJ Quality & Safety. In the study, researchers analysed records from almost 49,000 patients who consulted their GP with one of the warning signs for cancer that should warrant referral under clinical guidelines. Of the 29,045 patients not referred, 1,047 developed cancer within a year (3.6%). Early diagnosis and prompt treatment is crucial to survival chances. Every four-week delay in cancer treatment increases the risk of death by 10%. Read full story Source: The Guardian, 5 October 2021

The number of women in the UK who have not had vital NHS breast screening, which can stop people dying from breast cancer, has risen by an estimated 50% - to nearly 1.5 million women - since services resumed, the leading UK breast cancer charity warns during Breast Cancer Awareness Month. Breast Cancer Now reveals an alarming increase of around half a million women who haven’t been screened since services restarted in summer 2020, estimating that around 1,480,000 fewer women in the UK had breast screening between March 2020 and May 2021, compared to pre-pandemic levels. This comes a year after the charity reported that almost one million women had missed breast screening due to COVID-19 seeing services paused. According to the charity, nearly 12,000 people in the UK could have been living with undiagnosed breast cancer at the end of May 2021, due to the impact of the pandemic on breast screening services and fewer women being referred to specialists with possible symptoms of the disease since March 2020 – a frightening prospect when early detection can stop people dying from the disease. Full article here Source: Breast Cancer Now Also covered in the Independent

It could take more than a decade to clear the cancer-treatment backlog in England, a report suggests. Research by the Institute for Public Policy Research (IPPR) estimated 19,500 people who should have been diagnosed had not been, because of missed referrals. If hospitals could achieve a 5% increase in the number of treatments over pre-pandemic levels, it would take until 2033 to clear the backlog. However, if 15% more could be completed, backlogs could be cleared by next year. Between March 2020 and February 2021, the number of referrals to see a specialist dropped by nearly 370,000 on the year before, a fall of 15%. Behind these figures are thousands of people for whom it will now be too late to cure their cancer, the report, with the CF health consultancy, warns. And it estimates the proportion of cancers diagnosed while they are still highly curable - classed as stage one and two - has fallen from 44% before to pandemic to 41%. IPPR research fellow Dr Parth Patel said: "The pandemic has severely disrupted cancer services in England, undoing years of progress in improving cancer survival rates. "Now, the health service faces an enormous backlog of care, that threatens to disrupt services for well over a decade. We know every delay poses risks to patients' chances of survival." Read full story Source: BBC News, 24 September 2021

A major acute trust in the East Midlands has been forced to restrict how much chemotherapy it is able to offer due to staff shortages. Nottingham University Hospitals Trust confirmed in a statement its chemotherapy service has been affected by long-term staff sickness and staff vacancies. A trust spokeswoman said: “We continue to provide chemotherapy to patients who benefit most from the treatment and the small number of patients affected have been contacted directly by their specialist cancer team and offered support.” She added: “We are recruiting to posts as well as working with neighbouring NHS and private providers to ensure that any delays are minimal.” The trust added all its patient care decisions adhered to national guidance aimed at helping chemotherapy centres categorise and prioritise treatments when these situations arise. The Nottingham Post first reported the difficulties facing the trust, suggesting the restrictions would specifically affect palliative care patients who receive chemotherapy at NUH’s City Hospital site. Read full story (paywalled) Source: HSJ, 23 September 2021

At least three people died and more came to ‘severe harm’ after treatment delays across three specialties at one hospital trust, new reports have revealed. King’s College Hospital Foundation Trust commissioned harm reviews due to problems with a lack of capacity and poor management of waiting lists in endoscopy, dermatology and ophthalmology pre-pandemic. Most of the problems relate to the trust’s southern site, Princess Royal University Hospital, and took place before the current executive team took over. The most recent board papers revealed a review of 614 cases at the PRUH’s endoscopy service found seven cases of “serious harm”. This category includes death and the document revealed three patients had died. The review also “highlighted delays in endoscopy leading to delayed diagnoses of cancer” in 2018-19 and 2019-20. Investigators also found a dermatology patient came to “severe harm” after being lost to follow-up twice by the trust. Read full story (paywalled) Source: HSJ, 17 September 2021

Surgical hubs, new technology and innovative ways of working will help tackle waiting lists and treat around 30% more elective care patients by 2023 to 2024. Backed by a new £36 billion investment in health and social care over the next 3 years, ‘doing things differently’ and embracing innovation will be the driving force to get the NHS back on track. The funding will see the NHS deliver an extra 9 million checks, scans and operations for patients across the country, but it’s not enough to simply plug the elective gaps. The NHS will push forward with faster and more streamlined methods of treatments. Surgical hubs already being piloted in a number of locations, including London, are helping fast-track the number of planned operations, including cataract removal, hysterectomies and hip and knee replacements, and will be expanded across the country. Located on existing hospital sites, surgical hubs bring together the skills and resource under one roof while limiting infection risk and providing a COVID-secure environment, with more planned to open in the coming year. The NHS has been trialling a range of new ways of working in 12 areas, backed by £160 million, to accelerate the recovery of services. This includes setting up pop-up clinics so patients can be treated quickly, in person, and discharged closer to home, as well as virtual wards and home assessments to allow patients to receive medical support from the comfort of their home, freeing up beds in hospitals. GP surgeries are using artificial intelligence to help prioritise patients most in need and identify the right level of care and support needed for patients on waiting lists. The latest cancer tests being deployed across the NHS are also helping speed up diagnosis and spot cancer early on. Thanks to the hard work of staff, a quarter of a million people were checked for cancer in June – the second highest number on record – and more than 27,000 people started treatment for cancer in the same period. Professor Steve Powis, NHS England medical director, said: "Although the pandemic is still with us and we will have to live with the impact of COVID for some time, the NHS has already made effective use of additional resources to recover services. From adopting the latest technologies to more evening and weekend working, NHS staff are going to great lengths to increase the number of operations carried out. The further funding announced this week will support staff to deliver millions more vital checks, tests and operations, so if you have a health concern, please do come forward to receive the care and treatment you may need." Read full story Source: 8 September, Department of Health and Social Care

In recent months, long Covid has received a great deal of media and public attention. Research has found that as many as one in four of those infected with Covid suffer from chronic long-term symptoms, including headaches, dizziness, abdominal pain, heart problems, fatigue, anxiety, depression, cognitive impairment and other conditions. It is a difficult and complex illness, and we must do much more to help those who are struggling with it. At the same time, it is important to realise that rather than being a strange special case, long Covid is probably part of a broader phenomenon that affects many more people. In recent years, doctors and researchers have increasingly realised that many of those who survive an illness of any kind, or who go through serious physical trauma, are at high risk for a range of debilitating and chronic physical, cognitive and mental health symptoms – problems that closely resemble long Covid. As medicine has advanced, clinicians have learned how to save hundreds of thousands of severely ill or injured patients who would have previously died. Although this is a remarkable accomplishment, however, in many cases, survival does not mean complete recovery: some patients find that their bodies, brains and psyches continue to bear the scars of what they have gone through. One non-Covid study found that a year after hospitalisation, a third of patients with severe respiratory failure or shock had significant cognitive impairment. Another found that between a quarter and a third of patients who were treated in the ICU had significant and long-lasting symptoms of anxiety, depression or PTSD. Researchers have found similar results for survivors of other medical conditions, including cancer, multiple sclerosis and ALS. Unfortunately, people with long Covid, as well as other chronic post-illness symptoms, often find that the medical establishment doesn’t understand their experience, and so minimises or questions it. This is not surprising: clinicians tend to pay less attention to how patients with severe illness do once they are out of mortal danger, or once symptoms extend beyond an arbitrary time frame. Read full story Source: The Guardian, 12 September 2021

Cancer operations at one of England’s largest hospital trusts are being delayed as bosses admit patient care on wards is being compromised. Nottingham University Hospitals Trust has been forced to convert one of its few remaining wards for cancer surgery patients into an emergency medical ward to cope with an influx of patients. The Independent understands the trust’s A&E department is regularly overcrowded with 40 or more patients waiting for a bed at the start of most days. In a leaked message to staff sent on Friday and shared with The Independent, bosses at the hospital said the trust was facing an “exceptionally difficult time” which was “probably the most challenging position we have been in since the pandemic began”. It added: “There is no doubt that we are having to compromise the quality of care we are providing to some patients to ensure that we are able to maintain a service for the whole population.” “Our emergency department is over capacity continuously, which means that patients are waiting for extended periods on trolleys with little privacy and dignity because they do not have a bed to go to. We are having to make difficult decisions every day as to whether we can proceed with cancer and urgent operations and we are not able to tell some patients when they will get their operation." Read full story Source: The Independent, 13 September 2021

Screening smokers and ex-smokers could dramatically reduce deaths from lung cancer – Britain’s biggest cancer killer – a major new study has found. Low-dose computerised tomography (CT) scans can detect tumours in people’s lungs early and cut deaths by 16%, according to the UK Lung Cancer Screening Trial (UKLS). The findings have prompted renewed calls from lung cancer experts for the government to bring in routine screening across the UK of all those who are at risk because of their smoking history. They say that early detection means patients can have potentially curative surgery or radiotherapy. “Lung cancer early detection and surgical intervention saves lives,” said Professor John Field of Liverpool University, an author of the trial. Read full story Source: The Guardian, 12 September 2021

Failures by a health board led to eight cancer patients not being appropriately monitored or included in treatment targets after being referred to England, the ombudsman has found. Of the 16 patients on Wale's Betsi Cadwaladr health board's prostatectomy waiting list in August 2019, eight were referred to England for treatment. None of those treated in England met the health board's targets. The health board, which covers north Wales, has apologised to the patients. It said it had accepted the findings of the report and agreed to implement its recommendations. The investigation was launched after a report into the case of a prostate cancer patient raised suspicion there were further incidents. Public Services Ombudsman for Wales Nick Bennett said: "Clearly there's consequences for any type of cancer treatment, where people who are treated in England do not receive the same monitoring, do not receive the same harm reviews... "Going forward, this must never happen again." Read full story Source: BBC News, 9 September 2021

More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses, a new report from Macmillan Cancer Support reveals. One in five of all those living with cancer (21%) are lacking dedicated support. The NHS is suffering from a “shocking” shortfall of 3,000 specialist nurses in England alone, according to the analysis by Macmillan Cancer Support. As a result, cancer patients are struggling with medication, having hospital appointments cancelled because there are not enough staff or experiencing devastating delays to chemotherapy. In some cases, patients are ending up in A&E. Patricia Marquis, England director of the Royal College of Nursing, warned the workforce crisis was having a “devastating impact” on people living with cancer. “Expertise built up over many years is lost very quickly and it is patients who pay the price, as this report shows,” she added. Read full story Source: The Guardian, 8 September 2021

"Bodies would have been piling up" if the Covid vaccine had not been available, the director of intensive care at Belfast City Hospital has said. Dr George Gardiner, a consultant, also said his biggest fear would be having to stop routine cancer surgery. He has called for an end to "tribal politics" in Northern Ireland to allow transformation of the health service, so that cancer and coronavirus can be tackled in tandem. He said the system was currently "one step from chaos" and warned hospitals will not cope with winter if Covid numbers continue to rise. "We need to get everyone who can take a vaccine to take it now before the winter pressures are on us," Dr Gardiner added. "The cancer surgery that we are doing at the minute is life saving. A few more Covid admissions, which could be prevented, will cause us to stop operating because we simply haven't got the capacity to do both." Read full story Source: BBC News, 7 September 2021

According to reports, senior managers at an NHS trust knew up to 30 cancers may have gone undetected two years before an official probe into a backlog of thousands of X-rays. Although the Care Quality Commission (CQC) and Healthwatch made investigations in 2016, neither one were told of potential harm to patients. The backlog was publicly exposed by Ken Hall, who approached the Care Quality Commission in 2016, where it then identified 11,000 X-rays had not been processed, but was subsequently struck off after allegations of fraud. "These go through a rigorous quality assurance process and the Care Quality Commission would not publish any statement in an inspection report that it did not believe to be true." Said the CQC when asked about its findings of no harm after being shown the 2014 trust management committee reports, the CQC also told the BBC it could find no record of inspectors having had sight of them. Read full story. Source: BBC News, 27 August 2021

The new head of NHS England has urged people not to ignore the signs of cancer and encourages people to get checked out if symptoms emerge, such a cough or stomach pain that won't go away. Experts believe certain cancers such as abdominal cancers - throat, stomach, bowel, pancreatic, ovarian - and urological cancers - prostate, kidney and bladder - are the most likely to go unrecognised and suggest anyone with symptoms to tell their GP. "People should not feel like they cannot trouble the NHS, which is open and ready to treat people." NHS England chief executive Amanda Pritchard has said. Read full story. Source: BBC News, 15 August 2021

A report has concluded that significant failings by hospital staff led to the avoidable suffering of Ann Jones, 69, who had bowl cancer, before she died. During their investigation, the Public Services Ombudsman found complications after surgery were not properly identified and weight loss was blamed on psychological factors rather than the pain of a bowel obstruction. Betsi Cadwaladr University Health Board has apologised to Mrs Jones' family. Denbighshire council have also said they were "sincerely sorry" for the distress caused to the family and have issued a written apology to her husband. Read full story. Source: BBC News, 10 August 2021

A new study has revealed poorer communities are facing higher rates of smoking-related cancer than richer areas. Cancer Research UK now want tobacco companies to help fund more stop smoking campaigns to help poorer areas go smoke free. According to new figures from Cancer Research UK, there are nearly twice as many cancers caused by smoking among the poorest people in England compared to the richest. In a new study looking at quantifying the effect of avoidable cancers linked to smoking, researchers have said there were 11, 000 cases of smoking related cancers in groups that had the lowest income, compared to 6,000 in groups with the highest income. “Smoking has accounted for more deaths than Covid-19 in the past year. Public health and prevention services play a vital role in tackling health inequalities as well as improving health and wellbeing across England. This has come into even sharper focus since the pandemic, which has exposed where investment in these services has fallen behind." Says Public health expert, Professor Linda Bauld. Read full story. Source: The Independent, 3 August 2021

Some cancer patients have been left in limbo with their surgeries after the unlocking of the nation on the 19th July. Ms DePastino, who was scheduled to have surgery on Monday to remove cancer from her womb was told it had to be rearranged due to the number of Covid patients being admitted into the Princess Alexandra Hospital in Harlow. So far, Ms DePastino has not been given a new date or allowed to speak to her consultant. “People have got this idea they want to get back to normal but what about people like me whose normal has been ripped away from them? Our only chance at normal is now being delayed or taken away so that people that are completely healthy can go about their business. If we’re going to get back to normal that means people who need care should be able to get care; it can’t be one or the other, that’s not right.” Said Ms DePastino, who also says her pleas to be referred to somewhere else have been ignored. Read full story. Source: The Independent, 1 August 2021

Artificial intelligence (AI) tools and deep learning models are a powerful tool in cancer treatment. They can be used to analyse digital images of tumour biopsy samples, helping doctors quickly classify the type of cancer, predict prognosis and guide a course of treatment for the patient. However, unless these algorithms are properly calibrated, they can sometimes make inaccurate or biased predictions. A new study led by researchers from the University of Chicago shows that deep learning models trained on large sets of cancer genetic and tissue histology data can easily identify the institution that submitted the images. The models, which use machine learning methods to "teach" themselves how to recognise certain cancer signatures, end up using the submitting site as a shortcut to predicting outcomes for the patient, lumping them together with other patients from the same location instead of relying on the biology of individual patients. This in turn may lead to bias and missed opportunities for treatment in patients from racial or ethnic minority groups who may be more likely to be represented in certain medical centres and already struggle with access to care. "We identified a glaring hole in the in the current methodology for deep learning model development which makes certain regions and patient populations more susceptible to be included in inaccurate algorithmic predictions," said Alexander Pearson, one of the authors of the study. Read full story Source: Digital Health News, 22 July 2021

This article by The Telegraph describes how average waiting times for 4.2 million people on the total NHS waiting lists has reached 37 weeks, with analysis showing patients are waiting twice as long as they were before the pandemic. Read full story (paywalled). Source: The Telegraph, 22 July 2021

It has been found there are 10,000 fewer patients starting treatment for breast cancer over the past year in England. Experts are advising patients to go to their GP if they notice anything unusual and not to wait to get screened or checked. Although breast cancer deaths were found to be at an all time low during the pandemic, experts are worried there may be more to the low figures than previously thought. Read full story. Source: Sky News, 15 June 2021