Prehabilitation for people with cancer

Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer | The Royal College of Anaesthetists, Macmillan Cancer Support, and the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration

This document calls for changes to the delivery of cancer care across the UK, with a greater focus on prehabilitation including nutrition, physical activity and psychological support.

What is prehabilitation?

Prehabilitation supports people living with cancer to prepare for treatment. It promotes healthy behaviours and prescribes exercise, nutrition and psychological interventions based on a person’s needs, to help them find their best way through.

When should it be implemented?

Prehabilitation should be implemented in the early stages of the patient pathway, ideally soon after diagnosis and well in advance of treatment for maximum benefit. It should be seen as part of the rehabilitation pathway, as a way to optimise a person’s health and wellbeing, maximising their resilience to treatment throughout the cancer journey.

What are the benefits?

Prehabilitation offers patients and care givers three main benefits:

  • Personal empowerment: A sense of control and purpose, which prepares people for treatment and improves their quality of life
  • Physical and psychological resilience: An opportunity to improve physiological function and psychological wellbeing, which offers resilience to the effects of cancer treatment, enhances the quality of recovery and helps people to live life as fully as they can
  • Long-term health: An opportunity to reflect on the role of healthy lifestyle practices after a cancer diagnosis, to promote positive health behaviour change.

Further detail at Macmillan Cancer Support

Full document: Prehabilitation for people with cancer: principles and guidance for prehabilitation within the management and support of people with cancer

Excess weight and cancer risk

New figures from Cancer Research UK show that people who are obese now outnumber people who smoke two to one in the UK, and excess weight causes more cases of certain cancers than smoking.

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Almost a third of UK adults are obese and, while smoking is still the nation’s biggest preventable cause of cancer and carries a much higher risk of the disease than obesity, Cancer Research UK’s analysis revealed that being overweight or obese trumps smoking as the leading cause of four different types of cancer.

Excess weight causes around 1,900 more cases of bowel cancer than smoking in the UK each year. The same worrying pattern is true of cancer in the kidneys (1,400 more cases caused by excess weight than by smoking each year in the UK), ovaries (460) and liver (180).

The charity wants the Government to act on its ambition to halve childhood obesity rates by 2030 and introduce a 9pm watershed for junk food adverts on TV and online, alongside other measures such as restricting promotional offers on unhealthy food and drinks.

Full story: Obese people outnumber smokers two to one| Cancer Research UK

See also: Obesity ’causes more cases of some cancers than smoking’ | BBC News

A miniature robot that could check colons for early signs of disease

University of Leeds | July 2019| A miniature robot that could check colons for early signs of disease

An  academic at the University of Leeds is a senior author of a piece of research that demonstrates it is technically possible to guide a tiny robotic capsule inside the colon to take micro-ultrasound images. The capsule, known as Sonopill, has taken an international consortium of scientists and engineers a decade to develop. 

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It is hoped that the technology will one day mean patients will not need to undergo an endoscopic examination- as the Sonopill is capable of intelligent magnetic manipulation. Based on the principle that magnets can attract and repel one another, a series of magnets on a robotic arm that passes over the patient interacts with a magnet inside the capsule, gently manoeuvring it through the colon (Source: University of Leeds).

The full news story is available from the University of Leeds

Full reference:

Norton, J.C. et al. | 2019| Intelligent magnetic manipulation for gastrointestinal ultrasound | Science Robotics | Vol. 4|31| eaav7725
DOI: 10.1126/scirobotics.aav7725

Abstract

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Diagnostic endoscopy in the gastrointestinal tract has remained largely unchanged for decades and is limited to the visualization of the tissue surface, the collection of biopsy samples for diagnoses, and minor interventions such as clipping or tissue removal. In this work, we present the autonomous servoing of a magnetic capsule robot for in situ, subsurface diagnostics of microanatomy. We investigated and showed the feasibility of closed-loop magnetic control using digitized microultrasound (μUS) feedback; this is crucial for obtaining robust imaging in an unknown and unconstrained environment. We demonstrated the functionality of an autonomous servoing algorithm that uses μUS feedback, both on benchtop trials and in vivo in a porcine model. We have validated this magnetic μUS servoing in instances of autonomous linear probe motion and were able to locate markers in an agar phantom with 1.0 ± 0.9 mm position accuracy using a fusion of robot localization and μUS image information. This work demonstrates the feasibility of closed-loop robotic μUS imaging in the bowel without the need for either a rigid physical link between the transducer and extracorporeal tools or complex manual manipulation.

Rotherham NHS staff can request a copy of this article here 

 

 

BMJ Open study: Alcohol consumption as a modifiable risk factor for breast cancer

Sinclair JMcCann MSheldon E, et al | 2019| The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics| 

New research now published in the BMJ Open, recruited women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in these settings, the study used a mixed-methods approach- interviews and surveys- to ask women about their knowledge and attitudes towards alcohol as a risk factor for breast cancer.
The findings highlight that only 20 per cent of women in the sample recognised alcohol as a breast cancer risk factor, almost half of NHS staff identified it as a risk factor. 
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Objectives Potentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.

Design A mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.

Setting Women attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.

Participants 205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.

Results Alcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.

Conclusions Levels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.

Read the article in full from the BMJ Open

In the news:

BBC News Women not aware enough of breast cancer link to alcohol

Waiting times for elective and cancer treatment

Only 38% of NHS trusts meeting 62-day waiting times standard for referral to treatment for cancer patients. Waiting list for elective care has increased by 1.5 million since March 2013.

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The Public Accounts Committee has published NHS waiting times for elective and cancer treatment. The report finds the percentage of patients treated within waiting times standards continues to get worse for both elective (non-urgent care) and cancer treatment.

It also finds NHS organisations are not being sufficiently held to account for ensuring patients’ rights to treatment within maximum waiting times for elective care and that national organisations lack curiosity regarding the impact of longer waits on patient outcomes and patient harm.

Further detail: NHS failure to meet waiting times targets risks patients’ lives

 

A data-driven approach to cancer care

This publication brings together healthcare experts to discuss the potential of a data-driven approach to cancer care. 

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The following articles show how data are currently shaping the delivery of cancer care, how to gain the most from data that are currently available and how to maximise the potential of this data in the future:

  • Health inequalities data tell an unjust tale of two cities
  • Simple changes could improve cancer care now
  • The right data?
  • The evolution of cancer data to improve patient care
  • Accelerating research and improving patient care
  • Building a picture of patient benefit
  • How NICE can keep pace with science

Full report: A data-driven approach to cancer care | Reform | AbbVie UK

Female patients more likely to survive but experience worse side effects from cancer treatment

OnMedica  | May 2019 |Female patients more likely to survive but experience worse side effects from cancer treatment

Oncologists from The Royal Marsden NHS Foundation Trust have led analysis into patient data for more than 3000 people with cancer of the oesophagus and stomach; their findings indicate that female patients being treated with chemotherapy prior to having surgery were significantly more likely to experience side effects such as nausea (10% compared to 5%), vomiting (10% versus 4%) and diarrhoea (9% versus 4%), than male patients. 

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The analysis of four large randomised controlled trials, in collaboration with the UK Medical Research Council Clinical Trials Unit at University College London, will be presented in a poster session at this weekend’s American Society of Clinical Oncology Annual Meeting in Chicago, could potentially help to tailor the management of patients and also highlight those more at risk from specific side effects (Source: OnMedica).

Full story from OnMedica