UK cancer survival rates lag behind similar countries

Arnold, M. et al |2019| Progress in cancer control: survival, mortality and incidence in seven high-income countries 1995-2014 (the ICBP SURVMARK-2 project)| The Lancet | Doi:https://doi.org/10.1016/S1470-2045(19)30456-5

The Cancer Survival in High-Income Countries (SURVMARK-2), is a longitudinal, population-based study which aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends.

Image source: scienceblog.cancerresearchuk.org

 

While the study’s evaluation indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. The UK was behind Australia, New Zealand, Noway, Canada, Denmark and Norway. Some of the lowest rates of 1-year survival was observed for stomach, colon, rectal, and lung cancer in the UK (Source: Arnold, et al, 2019).

Summary

Background

Population-based cancer survival estimates provide valuable insights into the effectiveness of cancer services and can reflect the prospects of cure. As part of the second phase of the International Cancer Benchmarking Partnership (ICBP), the Cancer Survival in High-Income Countries (SURVMARK-2) project aims to provide a comprehensive overview of cancer survival across seven high-income countries and a comparative assessment of corresponding incidence and mortality trends.

 

Methods

In this longitudinal, population-based study, we collected patient-level data on 3·9 million patients with cancer from population-based cancer registries in 21 jurisdictions in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the UK) for seven sites of cancer (oesophagus, stomach, colon, rectum, pancreas, lung, and ovary) diagnosed between 1995 and 2014, and followed up until Dec 31, 2015. We calculated age-standardised net survival at 1 year and 5 years after diagnosis by site, age group, and period of diagnosis. We mapped changes in incidence and mortality to changes in survival to assess progress in cancer control.

 

Findings

In 19 eligible jurisdictions, 3 764 543 cases of cancer were eligible for inclusion in the study. In the 19 included jurisdictions, over 1995–2014, 1-year and 5-year net survival increased in each country across almost all cancer types, with, for example, 5-year rectal cancer survival increasing more than 13 percentage points in Denmark, Ireland, and the UK. For 2010–14, survival was generally higher in Australia, Canada, and Norway than in New Zealand, Denmark, Ireland, and the UK. Over the study period, larger survival improvements were observed for patients younger than 75 years at diagnosis than those aged 75 years and older, and notably for cancers with a poor prognosis (ie, oesophagus, stomach, pancreas, and lung). Progress in cancer control (ie, increased survival, decreased mortality and incidence) over the study period was evident for stomach, colon, lung (in males), and ovarian cancer.

 

Interpretation

The joint evaluation of trends in incidence, mortality, and survival indicated progress in four of the seven studied cancers. Cancer survival continues to increase across high-income countries; however, international disparities persist. While truly valid comparisons require differences in registration practice, classification, and coding to be minimal, stage of disease at diagnosis, timely access to effective treatment, and the extent of comorbidity are likely the main determinants of patient outcomes. Future studies are needed to assess the impact of these factors to further our understanding of international disparities in cancer survival.

The full article is available from The Lancet 

See also:

Cancer Research Measuring up: how does the UK compare internationally on cancer survival?

BBC News Cancer survival in the UK improving, but lagging behind – study

Signs of a slowdown in new type 2 diabetes cases

Magliano, D., et al | 2019| Trends in incidence of total or type 2 diabetes: systematic review| BMJ| 366| l5003| doi: https://doi.org/10.1136/bmj.l5003

Researchers employed a systematic approach to review trends in the incidence of diabetes, using a systematic review (SR) of literature using studies from the middle of the 1960s to 2014. The SR of 47 studies indicates that the incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. The study’s authors attribut this to preventive strategies and public health education and awareness campaigns could have contributed to the fall in diabetes incidence in recent years.

The findings have now been published in the BMJ . 

BMJ Trends in incidence of total or type 2 diabetes: systematic review

In the news:

BBC News  Signs of a slowdown in new type 2 diabetes cases

Abstract

Objective To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes.

Design Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines.

Data sources Medline, Embase, CINAHL, and reference lists of relevant publications.

Eligibility criteria Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year.

Results Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively.

Conclusions The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different.

Systematic review registration Prospero CRD42018092287.

Daytime napping may lower cardiovascular events

Häusler N, et al. | 2019| Association of napping with incident cardiovascular events in a prospective cohort study |Heart |Published Online First|  doi: 10.1136/heartjnl-2019-314999

Swiss researchers report that people in studies who had a  nap once or twice a week have a lower incidence of cardiovascular incidents than those who did not nap.  Nap frequency may help explain the discrepant findings regarding the association between napping and CVD events.

Abstract

Objective There is controversy regarding the effect of napping on cardiovascular disease (CVD), with most studies failing to consider napping frequency. We aimed to assess the relationship of napping frequency and average nap duration with fatal and non-fatal CVD events.

Methods 3462 subjects of a Swiss population based cohort with no previous history of CVD reported their nap frequency and daily nap duration over a week, and were followed over 5.3 years. Fatal and non-fatal CVD events were adjudicated. Cox regressions were performed to obtain HRs adjusted for major cardiovascular risk factors and excessive daytime sleepiness or obstructive sleep apnoea.

Results 155 fatal and non-fatal events occurred. We observed a significantly lower risk for subjects napping 1–2 times weekly for developing a CVD event compared with non-napping subjects, in unadjusted as well as adjusted models. The increased HR  for subjects napping 6–7 times weekly disappeared in adjusted models. Neither obstructive sleep apnoea nor excessive daytime sleepiness modified this lower risk. No association was found between nap duration and CVD events.

Conclusion Subjects who nap once or twice per week have a lower risk of incident CVD events, while no association was found for more frequent napping or napping duration. Nap frequency may help explain the discrepant findings regarding the association between napping and CVD events.

The study is available in full from the BMJ

In the news:

OnMedica Daytime napping may lower cardiovascular events

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

Full reference: Panagioti, M. et al. | 2019| Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis| BMJ | 366 | l4185| doi: https://doi.org/10.1136/bmj.l4185 

The BMJ has published  a systematic review and meta-analysis of  preventable patient harm across a range of settings, the review is available to read in full from the BMJ

Abstract

Objective To systematically quantify the prevalence, severity, and nature of preventable patient harm across a range of medical settings globally.

 

Design Systematic review and meta-analysis.

 

Data sources Medline, PubMed, PsycINFO, Cinahl and Embase, WHOLIS, Google Scholar, and SIGLE from January 2000 to January 2019. The reference lists of eligible studies and other relevant systematic reviews were also searched.

 

Review methods Observational studies reporting preventable patient harm in medical care. The core outcomes were the prevalence, severity, and types of preventable patient harm reported as percentages and their 95% confidence intervals. Data extraction and critical appraisal were undertaken by two reviewers working independently. Random effects meta-analysis was employed followed by univariable and multivariable meta regression. Heterogeneity was quantified by using the I² statistic, and publication bias was evaluated.

 

Results Of the 7313 records identified, 70 studies involving 337 025 patients were included in the meta-analysis. The pooled prevalence for preventable patient harm was 6%. A pooled proportion of 12%  of preventable patient harm was severe or led to death. Incidents related to drugs and other treatments  accounted for the largest proportion of preventable patient harm. Compared with general hospitals (where most evidence originated), preventable patient harm was more prevalent in advanced specialties.

 

Conclusions Around one in 20 patients are exposed to preventable harm in medical care. Although a focus on preventable patient harm has been encouraged by the international patient safety policy agenda, there are limited quality improvement practices specifically targeting incidents of preventable patient harm rather than overall patient harm (preventable and non-preventable). Developing and implementing evidence-based mitigation strategies specifically targeting preventable patient harm could lead to major service quality improvements in medical care which could also be more cost effective.

 

A life of low cholesterol and BP slashes heart and circulatory disease risk

British Heart Foundation | September 2019 | A life of low cholesterol and BP slashes heart and circulatory disease risk

Research funded in part by the British Heart Foundation (BHF) finds that modest and sustained decreases in blood pressure and cholesterol levels reduces the lifetime risk of developing fatal heart and circulatory diseases, such as heart attack and stroke (Source BHF).

 

The research has now been published in JAMA

 

 

 Ference, B. A., et al | 2019|Association of Genetic Variants Related to Combined Exposure to Lower Low-Density Lipoproteins and Lower Systolic Blood Pressure With Lifetime Risk of Cardiovascular Disease | JAMA | doi:10.1001/jama.2019.14120

Abstract

Importance  The relationship between exposure to lower low-density lipoprotein cholesterol (LDL-C) and lower systolic blood pressure (SBP) with the risk of cardiovascular disease has not been reliably quantified.

Objective  To assess the association of lifetime exposure to the combination of both lower LDL-C and lower SBP with the lifetime risk of cardiovascular disease.

Design, Setting, and Participants  Among 438 952 participants enrolled in the UK Biobank between 2006 and 2010 and followed up through 2018, genetic LDL-C and SBP scores were used as instruments to divide participants into groups with lifetime exposure to lower LDL-C, lower SBP, or both. Differences in plasma LDL-C, SBP, and cardiovascular event rates between the groups were compared to estimate associations with lifetime risk of cardiovascular disease.

Exposures  Differences in plasma LDL-C and SBP compared with participants with both genetic scores below the median. Genetic risk scores higher than the median were associated with lower LDL-C and lower SBP.

Main Outcomes and Measures  Odds ratio (OR) for major coronary events, defined as coronary death, nonfatal myocardial infarction, or coronary revascularization.

Results  The mean age of the 438 952 participants was 65.2 years (range, 40.4-80.0 years), 54.1% were women, and 24 980 experienced a first major coronary event. Compared with the reference group, participants with LDL-C genetic scores higher than the median had 14.7-mg/dL lower LDL-C levels and an OR of 0.73 for major coronary events. Participants with SBP genetic scores higher than the median had 2.9-mm Hg lower SBP and an OR of 0.82 for major coronary events. Participants in the group with both genetic scores higher than the median had 13.9-mg/dL lower LDL-C, 3.1-mm Hg lower SBP, and an OR of 0.61 for major coronary events. In a 4 × 4 factorial analysis, exposure to increasing genetic risk scores and lower LDL-C levels and SBP was associated with dose-dependent lower risks of major coronary events. In a meta-regression analysis, combined exposure to 38.67-mg/dL lower LDL-C and 10-mm Hg lower SBP was associated with an OR of 0.22 for major coronary events, and 0.32 for cardiovascular death.

Conclusions and Relevance  Lifelong genetic exposure to lower levels of low-density lipoprotein cholesterol and lower systolic blood pressure was associated with lower cardiovascular risk. However, these findings cannot be assumed to represent the magnitude of benefit achievable from treatment of these risk factors.

Full article available from JAMA

Manchester study: Smartphones could transform patient care

University of Manchester | August 2019 |Smartphones could transform patient care, finds study 

A smartphone app used remotely to provide information on parents with arthritis could have the potential to transform the care of patients with long-term conditions reports a study now published in the journal Rheumatology.

Remote Monitoring of Rheumatoid Arthritis (REMORA) study designed and tested a system to support clinical care and research, enabling people living with RA to report daily symptoms using a smartphone app with data integrated into the electronic health record (EHR). The study  evaluated the system’s acceptability and feasibility including exploration of participants’ views and experiences of remote monitoring, with specific focus on how integration of smartphone data into the EHR in graphical format influenced consultation

A sample of 20 patients’ data from the app was uniquely integrated into their EHR at their hospital, with the data summarised as a graph visible at their outpatient visit.

The app, jointly designed by patients, clinicians and researchers, allowed patients to input what symptoms they were experiencing each day and the impact it had on their lives.

Their doctors used the data generated by the app when carrying out face to face consultations.

The system provided a “bigger picture” than doctors would otherwise get, capturing “symptoms that would otherwise have been missed”.

And the graphs generated by the app made it easier for patients to participate in consultations and treatment, enabling a shared discussion between the patient and their doctor (Source: University of Manchester).

The authors’ report that:

• Daily remote monitoring using a smartphone app was viewed positively by patients and completed regularly.
• Graphs of patients’ daily data identified changes in disease that would otherwise have been missed.
• Patients valued consultations being focused around their own data, supporting person-centred care.

Read the full news story from University of Manchester

Abstract

Objectives

To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA.

Methods

The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically.

Results

Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients’ RA more visible by providing the ‘bigger picture’, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans.

Conclusion

Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

The full article can be read at Rheumatology

Alternatively, download a copy here 

 

Fish oil pills ‘no benefit’ for type 2 diabetes

Brown, T., Brainard, J., Song, F., Wang, X., Abdelhamid, A. & Hooper, L. | 2019| Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials | BMJ|  366 | l4697|  doi: https://doi.org/10.1136/bmj.l4697 :

Research that investigated whether omega-3 and other fatty acids were beneficial to people with type 2 diabetes has found that increasing long chain omega-3 intake had little or no effect on diagnosis or glucose metabolism; the study’s authors also report that there may be  negative outcomes at high dose. 

Abstract

Objective To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.

Design Systematic review and meta-analyses.

Data sources Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and trials in relevant systematic reviews.

Eligibility criteria Randomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA_1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).

Data synthesis Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.

Results 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes or measures of glucose metabolism. A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.

Conclusions This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.

Systematic review registration PROSPERO CRD42017064110.

 

The full article is available from the  BMJ

In the news:

BBC News Fish oil pills ‘no benefit’ for type 2 diabetes