Is England closing the international gap in cancer survival?

open access
  
Background:

We provide an up-to-date international comparison of cancer survival, assessing whether England is ‘closing the gap’ compared with other high-income countries.

Methods:

  Net survival was estimated using national, population-based, cancer registrations for 1.9 million patients diagnosed with a cancer of the stomach, colon, rectum, lung, breast (women) or ovary in England during 1995–2012. Trends during 1995–2009 were compared with estimates for Australia, Canada, Denmark, Norway and Sweden. Clinicians were interviewed to help interpret trends.

Results:

Survival from all cancers remained lower in England than in Australia, Canada, Norway and Sweden by 2005–2009. For some cancers, survival improved more in England than in other countries between 1995–1999 and 2005–2009; for example, 1-year survival from stomach, rectal, lung, breast and ovarian cancers improved more than in Australia and Canada. There has been acceleration in lung cancer survival improvement in England recently, with average annual improvement in 1-year survival rising to 2% during 2010–2012. Survival improved more in Denmark than in England for rectal and lung cancers between 1995–1999 and 2005–2009.

Conclusions:

 Survival has increased in England since the mid-1990s in the context of strategic reform in cancer control, however, survival remains lower than in comparable developed countries and continued investment is needed to close the international survival gap.

The gap in cancer survival between England and comparable countries has galvanised policymakers and clinicians since EUROCARE first launched its European survival comparisons (Berrino et al, 1995). Evidence that survival is generally lower in England has led to target setting and increased investment, aiming to raise survival in England to the standards achieved elsewhere.

Since the Calman–Hine Report recommended strategic improvements to cancer services in England, there has been a series of policy initiatives to improve survival (Expert Advisory Group on Cancer, 1995). The NHS Cancer Plan for England (Department of Health, 2000) was the second national cancer plan in the world (following Norway's). It emphasised centralisation, specialisation and use of multi-disciplinary teams (MDTs). A further suite of measures to improve prevention, earlier diagnosis and patient management was launched through the Cancer Reform Strategy (Department of Health, 2007) to address continuing concerns about the survival deficit in comparison to other high-income countries.

In 2009, the Department of Health in England formed the International Cancer Benchmarking Partnership (ICBP), a consortium of epidemiologists, clinicians and policymakers tasked with understanding survival differences between the United Kingdom and five other high-income countries with universal healthcare system coverage: Australia, Canada, Denmark, Norway and Sweden.....

Trends in 1- and 5-year net survival in Australia (A), Canada (C), Denmark (D), England (E), Norway (N) and Sweden (S) by period of diagnosis. Estimates of net survival are presented for the calendar periods of diagnosis 1995–1999, 2000–2004 and 2005–2009. Simple linear regression lines are presented for each combination of country and cancer using data from these three periods, to indicate the average change in survival. An estimate of net survival for England only is also presented for the calendar period of diagnosis 2010–2012.

.... For example, during 2000–2009, the percentage of women with ovarian cancer receiving surgery who were treated in a specialist trust rose from 43 to 76%, and the number treated by a specialist surgeon (caseload of >18 patients per year) rose from 20 to 55% (Butler et al, 2015).....

.....Despite steady improvement in survival from stomach, colon, rectal, lung, breast and ovarian cancers in England over the past two decades, survival remained lower than in Australia, Canada, Norway and Sweden for patients diagnosed in 2005–2009, and typically also for patients diagnosed in 2010–2012 in England compared with those diagnosed in 2005–2009 elsewhere. The improvement in survival between 1995–1999 and 2005–2009 was sometimes larger than in the leading countries, particularly in comparison with Australia, Canada and Sweden, leading to some narrowing of the international cancer survival gap......

..... Evidence that survival in England improved faster than in other countries during 1995–2009 was strongest in relation to Australia, Canada and Sweden. This could be explained by a partial ‘ceiling effect’ in those countries, given that they generally had the highest survival at the beginning of the study period. Alternatively, more regionalised health systems in those three countries might have limited the efficacy of national cancer control strategy and the power of national guidelines......

Anti–PD-1–Related Pneumonitis during Cancer Immunotherapy — NEJM

Correspondence

 The clinical oncology community has rapidly expanding access to a variety of immunotherapeutic agents for the treatment of several types of cancers. Thus, knowledge of the spectrum of manifestations of autoimmune pneumonitis may assist other clinicians in managing this rare but potentially serious toxic effect.

2015 John Maddox Prize call for nominations · Sense about Science

2015 

 The prize is open to nominations for any kind of public activity, including all forms of writing, speaking and public engagement, in any of the following areas:

    Addressing misleading information about scientific or medical issues.
    Bringing sound evidence to bear in a public or policy debate.
    Helping people to make sense of a complex scientific issue.

The prize is open to nominations for any kind of public activity, including all forms of writing, speaking and public engagement, in any of the following areas:

• Addressing misleading information about scientific or medical issues.
• Bringing sound evidence to bear in a public or policy debate.
• Helping people to make sense of a complex scientific issue.

- See more at: http://www.senseaboutscience.org/pages/maddox-prize-2015.html#sthash.vSq8H191.dpuf

The prize is open to nominations for any kind of public activity, including all forms of writing, speaking and public engagement, in any of the following areas:

• Addressing misleading information about scientific or medical issues.
• Bringing sound evidence to bear in a public or policy debate.
• Helping people to make sense of a complex scientific issue.

- See more at: http://www.senseaboutscience.org/pages/maddox-prize-2015.html#sthash.vSq8H191.dpuf

Candidates for the John Maddox Prize must be nominated. The nominator should normally be an individual who is familiar with the work of the candidate but self-nomination will be considered in exceptional circumstances. This is a global prize: people from and in any country can be nominated.

the Oncologist - Giving Bad News (Editorial) - SPIKES

open access

refers to:
Editor's Note: See the related article, “Confronting Therapeutic Failure: A Conversation Guide,” on page 946 of this issue.

Combo Rx May Boost Ovarian Cancer Outcomes, But Too Few Get It

media

 MONDAY Aug. 3, 2015, 2015 -- Chemotherapy delivered directly into the abdomen significantly improves survival among women with advanced ovarian cancer, a new study finds.
However, fewer than half of U.S. patients who could benefit from this treatment -- called intraperitoneal chemotherapy -- are receiving it, according to Dana-Farber/Brigham and Women's Cancer Center researchers.
The investigators studied whether a combination of intraperitoneal (IP) and intravenous (IV) chemotherapy was as effective in clinical practice as in a clinical trial involving women who'd had surgery for stage III ovarian cancer......

JCO (open access)  Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer

 INTRODUCTION

Several randomized clinical trials have demonstrated that intraperitoneal and intravenous (IP/IV) chemotherapy improves survival in women with optimally resected, stage III ovarian cancer, compared with IV chemotherapy alone.^1–3 In 2006, the National Cancer Institute (NCI) issued a rare Clinical Announcement encouraging IP/IV chemotherapy use after the Gynecologic Oncology Group (GOG) conducted a randomized trial, GOG-172, that demonstrated a 16-month improvement in median overall survival.

To date, however, few studies have examined the impact of this announcement on the use of IP/IV chemotherapy in clinical practice or investigated whether the survival benefit in GOG-172 is representative of outcomes outside of clinical trials.

Specialty Society Clinical Practice Guidelines: Time for Evolution or Revolution?

JAMA Network

..... Therefore, to create CPGs that the public trusts, that clinicians and patients can readily implement, and for which compliance can be easily measured, the CPG development process should continue to be led by specialty societies but with a new model that integrates other stakeholders, including patients. Specialty societies will need to use a consortium process in which authors are not just from the specialty society ranks and the focus is on concise, rigorously evidence-based, highly practical, implementation- and measurement-focused CPGs with COI transparency. This approach could be disseminated broadly and adopted so that specialty society CPGs can be effectively used in critical efforts to improve the quality and safety of care and reduce cost.

Psychosocial Factors Associated With Withdrawal From the United Kingdom Collaborative Trial of Ovarian Cancer Screening After 1 Episode of Repeat Screening

open access (pdf)

 Abstract: Objective: The United Kingdom Collaborative Trial of Ovarian Cancer Screening
(UKCTOCS) aims to establish the efficacy of 2 different ovarian cancer screening schedules. The psychosocial substudy examines the psychological factors associated with the screening program.

Methods: Women aged 50 to 75 years from 16 UK gynecologic centers randomized to annual multimodal screening or ultrasound screening (US) groups were followed up for 7 years. Psychosocial data from women who withdrew from the study after a repeat screen were examined.

Results: Sixteen percent (3499/21,733) of women requiring a repeat screening test in addition to annual screen withdrew from the study: 12.9% (1560/12,073) from the multimodal group and 20.1% (1939/9660) from the US group. An estimated relative risk of withdrawal is 1.46 (95% confidence interval, 1.36Y1.56; P e 0.001) for the US arm. High anxiety trait and increased psychological morbidity significantly influenced withdrawal, even when age, screening center, and group were taken into account (P G 0.001). The risk of withdrawal decreased significantly the longer a woman stayed in UKCTOCS, irrespective of the number of screens and intensity in the preceding year.

Conclusions: Withdrawal rate was greater in women undergoing US screening and in those who had repeats earlier inUKCTOCS. Having a high predisposition to anxiety, high current state anxiety, and above threshold general psychological morbidity all increased the withdrawal rate.

 Interpretation
There are no other OCS studies of comparable design
and size with which to compare these UKCTOCS withdrawal
results. What we have shown is that women with a high
predisposition toward anxiety are more likely to drop out of
screening, as do those who experience high anxiety after their
most recent scan. Furthermore, the more invasive the initial
screening procedure is, that is TVS, rather than a multimodal
approach, the more likely withdrawal will be after a repeat
scan or false-positive result.

CONCLUSIONS
The United Kingdom Collaborative Trial of Ovarian
Cancer Screening included a comprehensive psychosocial
arm that has permitted an in-depth appraisal of not only the
psychosocial harms and benefits of OCS but also some of the
factors that might enhance or inhibit attendance and re attendance.
Next year, the National Screening Committee is
scheduled to review its policy on OCS in women after the
UKCTOCS study against criteria that include psychosocial
factors. These results should assist policy makers when
considering the optimal screening methods and any accompanying
educational resources, especially aimed at ameliorating
anxiety.

An apoptosis-enhancing drug overcomes platinum resistance in a tumour-initiating subpopulation of ovarian (HGSC) cancer (CA125; carboplatin...)

open access - Nature Communications  (technical)

• Abstract•
• Introduction•
• Results•
• Discussion•
• Methods•
• Additional information•
• Accession codes•
• References•
• Acknowledgements•
• Author information•
• Supplementary information

Abstract: High-grade serous ovarian cancers (HGSCs) are deadly malignancies that relapse despite carboplatin chemotherapy. Here we show that 16 independent primary HGSC samples contain a CA125-negative population enriched for carboplatin-resistant cancer initiating cells.....
Discussion .... This study provides evidence that CA125-negative HGSC cells have stem properties and are inherently platinum resistant. The de novo platinum resistance of this tumour subpopulation can explain why these cancers consistently reappear after first-line platinum-based chemotherapy. On the basis of the promising preclinical results here, improving outcomes for this deadly malignancy could be achieved simply by supplementing existing therapies that work well against the majority of tumour cells with agents that sensitize the CA125-negative cells to carboplatin.

 How to cite this article: Janzen, D. M. et al. An apoptosis-enhancing drug overcomes platinum resistance in a tumour-initiating subpopulation of ovarian cancer. Nat. Commun. 6:7956 doi: 10.1038/ncomms8956 (2015).


media (easier to comprehend)

A common type of ovarian cancer, high-grade serous ovarian cancer, often responds well to the chemotherapy drug carboplatin; however, it frequently recurs following the treatment. Now, UCLA researchers has discovered that malignant cells that do not produce the protein CA125, which is a biomarker used to test for ovarian cancer, have an increased ability to repair their DNA and resist cell death from the chemotherapy. This allows the cells to elude the drug and live long enough to regrow the original tumor. The results of the five-year study were published on August 3 in the peer-reviewed journal Nature Communications.......

Urinary melatonin and risk of ovarian cancer (eg. night shift work)

abstract

PURPOSE: 

Melatonin has anti-carcinogenic properties, including modulation of estradiol production, cell cycle regulation, and promotion of apoptosis. Urinary melatonin has been inversely associated with breast cancer in some studies, but the association with ovarian cancer has not been investigated.

CONCLUSIONS:

These results are consistent with our previous study in which we reported no association between night shift work and ovarian cancer; however, given the small sample size in our study, additional evaluation in larger studies is warranted.