Factors in men’s choice of active surveillance for low-risk prostate cancer
Many personal, organisational and national factors can help or hinder men from choosing active surveillance over radical treatment when they have low-risk prostate cancer. Men are more likely to adhere to this plan of regular monitoring if they and their families are fully informed and understand that it includes the option of further treatment if necessary.
The recent ProtecT trial demonstrated that there was no difference in 10-year survival rates between men with low risk localised prostate ...
Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated.
This high-quality implementati...
Single routine offer of a blood test for prostate cancer did not save lives
Offering all men aged 50 to 69 a single, screening prostate-specific antigen (PSA) blood test did not prevent deaths from prostate cancer.
This large trial included 573 UK general practices and over 400,000 men. It found that men who were invited to have a PSA test were 19% more likely to be diagnosed with prostate cancer, but no less likely to die from the condition, over an average 10 years of follow up. Forty per cent of men took up the offer.
Controversy over PSA testing has persisted for ...
Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery
A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment.
This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatmen...
Common osteoporosis drugs may prevent breast cancer spreading to bone
Drugs commonly prescribed to prevent bone thinning probably help prevent the spread of early breast cancer to the bones in a few women, when taken in addition to standard cancer therapies. However, the overall benefits may be small, for example preventing spread to bone or death in about one extra woman in every 100 treated for about five years. This is a complex area because many of the treatments for breast cancer are known to worsen bone thinning, but there are other bone strengthening benefi...
Being overweight or having diabetes are both linked to cancer
For western high-income countries such as the UK, an estimated 15% to 16% of cancers could be avoided by preventing diabetes, obesity or excess weight (defined as a Body Mass Index [BMI] greater than 25). A high BMI was responsible for almost twice as many cancers as diabetes.
Around 5.6% of cancers globally in 2012 were attributable to diabetes or high BMI. Because obesity is increasing globally, this number may rise by 25% by 2035.
Although the links between high BMI, diabetes and cancer hav...
Men feel physically and psychologically ill-prepared for prostate cancer surgery
Following prostate cancer surgery men often experience physical changes, such as urinary incontinence and erectile dysfunction, causing negative emotions and distress. This review found that men felt poorly prepared – psychologically and physically – for the changes they might experience after surgery. Surgery was often described as "life-changing", and men described worrying about their future.
NICE recommend that men and their partners/carers are fully informed about pro...
Pilocarpine improves dry mouth caused by radiotherapy
Out of several treatments tested, the drug pilocarpine gave the most significant improvement in dry mouth following radiotherapy for head and neck cancer. Less dry mouth and increased salivary flow were twice as likely after taking pilocarpine than after a dummy pill.
Dry mouth from radiotherapy impairs quality of life. Although people can try simple measures at home, such as sucking ice cubes, they may wish to discuss pilocarpine treatment with their GP. Side effects from this medication are u...
Second-hand smoke levels in Scottish prisons equivalent to living with a smoker
Staff in Scottish prisons inhale roughly the same amount of second-hand smoke at work as they would in the average smoking household (32μg of fine particulate matter per m3). Some activities, like inspecting a smoky prison cell, exposed staff to far higher levels (up to 753.6μg per m3).
Despite smoking bans in public spaces across the UK, around three-quarters of prisoners smoke. This poses health threats from second-hand smoke to staff and prisoners alike.
This NIHR study detailed the s...
New evidence confirms three-yearly surveillance interval for people at intermediate risk of bowel cancer
People with benign growths (adenomas), who are at intermediate risk of bowel cancer, benefit from follow-up colonoscopy. However, some of the patientsat the lower end of risk in this intermediate category may not benefit from more than one follow-up.
This NIHR-funded cohort study reviewed data for 11,944 intermediate-risk patients from UK hospitals. Within this group, particular features were identified which placed them at higher risk, such as the presence of larger or highly abnormal adenomas...