PSA testing and prostate cancer mortality
A striking decline in prostate cancer mortality in the US compared with the UK from 1994 to 2004 coincided with a much higher uptake of prostate specific antigen (PSA) screening in the US. Researchers in the UK found that mortality rates in both countries peaked in the early 1990s, at almost identical rates. However, after this, the rate of decline in the US was almost four times that in the UK. The mean ratio of US to UK age-adjusted prostate cancer incidence rates in 1975-2003 was 2.5, with a pronounced peak around the time that PSA testing was introduced in the US.
Another study investigating the impact of PSA screening in Austria found the expected number of deaths from prostate cancer more than halved in the Tyrol region by 2005, 17 years after PSA screening was introduced.
Collin SM, Martin RM, Metcalfe C et al. Lancet Oncol 2008; 9: 445-52. Bartsch G, Horninger W, Klocker H et al. BJU Int 2008; 101(7): 809-16
Adjuvant therapy in breast cancer
Weekly paclitaxel adjuvant therapy for breast cancer may result in better overall survival than other regimens, the results of a US study suggest. A total of 4,950 women with axillary lymph node positive or high-risk lymph node negative breast cancer initially received four cycles of chemotherapy (doxorubicin and cyclophosphamide). They then received one of four adjuvant regimens: IV paclitaxel or docetaxel at three-week intervals for four cycles or at one-week intervals for 12 cycles. Estimated disease-free survival was 81.5 per cent for weekly paclitaxel, 81.2 per cent for three-weekly docetaxel, 77.6 per cent for weekly docetaxel and 76.9 per cent for three-weekly paclitaxel. However, weekly paclitaxel was associated with greater toxicity than the standard three-weekly paclitaxel regimen.
Sparano JA, Wang M, Martino S et al. N Engl J Med 2008; 358: 1663-71
Better care for end-stage dementia
End of life care for older people in the final stages of dementia needs urgent improvement, the authors of a review have concluded. They analysed 29 studies, mostly from the US and UK, and identified four key themes - difficulties associated with diagnosing the terminal phase of the illness (prognostication), communication issues, medical interventions and the appropriateness of palliative care. The researchers say their review highlights the importance of appropriate palliative care for end-stage dementia, but note that an expansion of care might lead to skills and funding shortages, possibly compromising the ability of existing palliative care teams to care for cancer patients.
Birch D, Draper J. J Clin Nurs 2008; 17(9): 1144-63
Smoking and Hodgkin's lymphoma
Smoking appears to increase the risk of Hodgkin's lymphoma, a prospective study has shown. Information on baseline and lifetime smoking among 478,590 participants in the European Prospective Investigation into Cancer and Nutrition was collected between 1992 and 2000. In all, the researchers noted 1,304 cases of non-Hodgkin's lymphoma and 67 Hodgkin's lymphoma. The relative risk for smokers at baseline was more than doubled for Hodgkin's lymphoma, but was not elevated for non-Hodgkin's lymphoma or individual B-cell non-Hodgkin's lymphoma subtypes.
Nieters A, Rohrmann S, Becker N et al. Am J Epidemiol 2008; 167: 1081-9
Screening uptake among South Asians
South Asians are only half as likely to take up an invitation for bowel cancer screening and 15 per cent less likely to attend breast cancer screening than non-Asians, researchers at the University of Warwick have found. They examined uptake in the NHS breast and bowel screening programmes among more than 400,000 residents in Coventry and Warwickshire. Two out of three non-Asians invited for bowel screening participated, compared with one-third of South Asians overall and only a quarter of Muslims. Similar results were seen for breast cancer screening - three-quarters of non-Asians invited attended for screening, compared with less than two-thirds of South Asians overall and just over half of Muslims. The researchers suggest cultural reasons may be at the heart of the issue.
Szczepura A. www2.warwick.ac.uk/newsandevents/pressreleases/south_asian_population
GP fact file on postmenopausal breast cancer
The GP Fact File on Postmenopausal Breast Cancer provides up-to-date information for GPs on the diagnosis and treatment of postmenopausal breast cancer. The authors are Professor David Dodwell, consultant clinical oncologist, and Dr Lorcan O'Toole, specialist registrar in clinical oncology, at Leeds Teaching Hospitals NHS Trust. The fact file addresses issues such as the importance of early diagnosis, hormone receptor positive breast cancer, the risk of breast cancer recurrence after five years of tamoxifen therapy, and extended adjuvant therapy. In summary, early diagnosis and treatment of postmenopausal breast cancer is essential. The majority of patients will be treated with breast-conserving surgery and radiotherapy, followed by hormonal treatment. The optimal duration of treatment is undefined, but at least five years is recommended, or extended adjuvant treatment beyond five years if tamoxifen alone has been used.
The fact file has been supported by Novartis. To request a copy, please email your name, GMC number and surgery address to firstname.lastname@example.org.
Use of humour in caring for terminally ill patients
Humour is an important element of healthcare, even in terminal illness. Researchers in Canada spent nearly 300 hours observing and interviewing staff, patients and families in an intensive care unit and a palliative care unit. They found that humour played an essential part in promoting team relationships and adding a human dimension to the care and support provided to seriously ill patients and their families. Humour enabled co-operation, relieved tensions, developed emotional flexibility and humanised the care experience for patient and practitioner. The researchers say nurses should not be reluctant to use humour as a part of compassionate and personalised care, even in critical situations.
Dean RA, Major JE. J Clin Nurs 2008; 17(8): 1088-95.