Cancer survival rates continue to improve
The number of cancer survivors in the UK is increasing by about 3 per cent per year, according to an analysis of cancer registry data. Using data from cancer registries in England, Northern Ireland, Scotland and Wales, the researchers estimated that there were two million cancer survivors in the UK at the end of 2008. This equates to approximately 3 per cent of the population overall and one in eight people aged 65 or over. Prostate and female breast cancers were the most prevalent. The researchers say that their estimates will prove useful to those involved in planning and providing treatment.
Maddams J, Brewster D, Gavin A et al. Br J Cancer 2009; 101: 541-7
HPV and penile cancer
HPV types 16 and 18 are associated with about half of penile cancers, researchers in Spain have found. Their systematic review of 31 studies evaluated the prevalence of different HPV types in a total of 1,466 penile cancers. Overall, HPV prevalence in these cases was 46.9 per cent, with just over 60 per cent being associated with HPV 16 and about 13 per cent with HPV 18. Basaloid and warty squamous cell carcinomas were the most frequent HPV-related histological types. The authors estimate that some 7,000 cases of penile cancer could be prevented every year by eradicating HPV 16 and 18.
Miralles-Guri C, Bruni L, Cubilla AL et al. J Clin Pathol 2009; 62(10): 870-8
Combination therapy in multiple myeloma
Combining lenalidomide with low-dose rather than high-dose dexamethasone for the treatment of multiple myeloma improves survival and lowers toxicity, according to the results of a controlled trial. A total of 445 patients with multiple myeloma were randomised to lenalidomide plus dexamethasone at either high dose (maximum 480mg) or low dose (maximum 160mg). At one year, overall survival was 96 per cent in the low-dose group, compared with 87 per cent in the high-dose group (p = 0.0002). Just over half of those on the high-dose regimen had grade three or worse toxic effects in the first four months, compared with 35 per cent of patients on the low-dose regimen (p = 0.0001).
Rajkumar SV, Jacobus S, Callander NS et al. Lancet Oncol 2009; doi: 10.1016/S1470-2045(09)70284-0
Minimally invasive radical prostatectomy
The popularity of minimally invasive radical prostatectomy (MIRP) has risen despite lack of data on outcomes and higher costs compared with open retropubic radical prostatectomy (RRP), say US researchers. This population-based observational study compared outcomes among men with prostate cancer who underwent MIRP (n = 1,938) with those who had RRP (n = 6,899). Men who underwent MIRP had shorter hospital stays (median two versus three days for RRP), fewer respiratory and miscellaneous surgical complications and strictures, and a similar postoperative use of additional cancer therapies. However, they experienced more genitourinary complications (4.7 per cent versus 2.1 per cent for RRP), incontinence (15.9 versus 12.2 per 100 person-years) and erectile dysfunction (26.8 versus 19.2 per 100 person-years) than men who had RRP.
Hu JC, Gu X, Lipsitz SR et al. JAMA 2009; 302(14): 1557-64
Breast cancer detection
Clinical breast examination in addition to mammography improves breast cancer detection and sensitivity, but also increases false positives. Researchers in Canada compared results for 232,515 women screened at centres offering mammography and clinical breast examination with those for 57,715 women screened at centres offering mammography alone. Sensitivity was about 95 per cent for the initial screen, for women attending centres offering breast examination and mammography, compared with about 89 per cent at centres offering mammography alone. However, the false-positive rate for women without cancer screened with both techniques was about 12 per cent for the initial screen, compared with 7 per cent for those screened using mammography alone.
Chiarelli AM, Majpruz V, Brown P et al. J Natl Cancer Inst 2009; 101(18): 1236-43
Acupuncture in treating xerostomia
Acupuncture has been shown to be effective for radiation-induced xerostomia in a small pilot study. It involved 19 patients who received acupuncture twice a week for four weeks and were assessed using xerostomia inventory and patient benefit questionnaire scores. The results showed that treatment improved the salivary flow and general well-being of patients compared with baseline. Both scores were significantly better after acupuncture on weeks four and eight compared with baseline, and there was a significant difference in physical well-being at week eight.
Garcia MK, Chiang JS, Cohen L et al. Head Neck 2009; 31(10): 1360-8
GPs' role in end of life care
The RCGP has launched a new strategy for end of life care, giving GPs a central role in the radical upgrading of patient services. Recommendations include greater integration with the quality and outcomes framework, more GP involvement in care homes and improved out-of-hours palliative care.
Author of the report Professor Keri Thomas said end of life care was part of the core business of general practice but new challenges meant a more consistent, systematic approach was required across primary care.
The RCGP has established an End of Life Care Working Group to develop and implement policies across the UK. Professor Thomas, the RCGP clinical champion in end of life care, said the strategy would aim to build on the current Gold Standard Framework, refine educational resources, support research concerning best practice and strengthen teamworking with nurses. 'Care of the dying is a litmus test for the health service and challenges general practice to respond with the best that the profession has to offer - clinical expertise, considered professionalism, personalised care and human compassion.
'The importance of the holistic role of the GP is poised to come into its own in a way never previously encountered,' said Professor Thomas.
Housework can help cut cancer risk
A daily dose of housework could help to cut the risk of breast cancer, say US researchers. Women who stay fit and active by doing moderate-to-vigorous activities were 17 per cent less likely to develop the disease.
Peters TM, Moore SC, Gierach GL et al. BMC Cancer 2009; 9: 349 doi:10.1186/1471-2407-9-349