How NHS investment in proton beam therapy is coming to fruition

Limb, M. | 2019| How NHS investment in proton beam therapy is coming to fruition | BMJ|364|l313 | https://doi.org/10.1136/bmj.l313

Winter 2019 will be a landmark for the National Health Service, as it will mark the opening of the NHS’s first high energy proton beam therapy unit, at the Christie NHS Foundation Trust in Manchester. Adrian Crellin, NHS England clinical lead for proton beam therapy says: “It is a confirmation that radiation oncology is absolutely a key part of modern cancer treatment.” 

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The two new £125m (€140m; $160m) centres will each treat up to 750 patients a year. “Many of the patients we’ll be treating will be children, young people, and those with what could loosely be termed as rarer tumours,” says Ed Smith, who heads the Christie unit.

Research has advanced since the NHS announced investment in the two national proton beam centres in 2012. Smith, a consultant clinical oncologist, says protons now have “an increasingly proved role in the indications we will treat” and suggests the evidence is “beginning to firm up” for the reduction of long term toxicities.

Conventional radiotherapy uses x rays from multiple directions; a modern variant is high precision, intensity modulated radiotherapy (IMRT), which aims to maximise the dose to the tumour while minimising the dose to the surrounding tissue (Source: The BMJ).

Read the full story at the BMJ 

The full article is available to staff via NHS Athens, alternatively contact the Library for a copy

Understanding patient needs in switching from biologic to biosimilar medicines

The Patients Association | December 2018 | Understanding patient needs in switching from biologic to biosimilar medicines: Final report of survey and focus group findings

Understanding patient needs in switching from biologic to biosimilar medicines: Final report of survey and focus group findings, is a report from The Patients Association which finds that patients with conditions such as rheumatoid arthritis and ulcerative colitis are being switched to new medicines without being informed. 

Biologic drugs are administered by injection or infusion because they are proteins that
are quickly digested and inactivated if given by mouth. Therefore, biologic drugs are
supplied as powders for infusion or solutions for injection.

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The Patients Association reports that in their sample survey of patients (n=262)  and a focus group (n=7) who use biologic medicine- a  sub-set of these 69 had been switched to biosimilars, and more than one in three of these patients reported that they had not been consulted by their doctor prior to the change (Source : The Patients Association)

Read the report from The Patients Association

“Patients are being let down when they need to be supported” [press release]

No “magic bullets” for treating colds, finds BMJ review

BMJ | October 2018 | What treatments are effective for common cold in adults and children?

The BMJ has reviewed over the counter (OTC) treatments for adults’ and children’s colds, with findings indicating there is little evidence of their efficacy.  The review finds that treatments claiming to relieve nasal symptoms of the common cold such as congestion, runny nose and sneezing have little evidence, and where evidence is present it is limited and low quality (Source: BMJ). 

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From the review the BMJ suggests treatments for adults with a small or possible beneficial effect include:

  • decongestants
  • NSAIDs
  • sedating antihistamines
  • antihistamine and decongestant

Treatments for adults with no evidence of effect are:

  • chinese medicinal herbs
  • echinacea
  • garlic
  • vitamin c
  • zinc

Treatments for children with a small or beneficial effect:

  • saline or nasal irrigation

Treatments for children with no evidence of effect are:

  • decongestants
  • NSAIDs
  • chinese medicinal herbs
  • echinacea
  • garlic
  • vitamin c
  • zinc

To view the table which shows the different treatments and  the full article  see BMJ

In the media:

BBC News What works for treating children’s colds?

Future Alzheimer’s treatment

Report suggests joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients | RAND Corporation

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  • The burden of Alzheimer’s disease in high-income countries is expected to approximately double between 2015 and 2050. Recent clinical trial results give hope that a disease-modifying therapy might become available in the near future. The therapy is expected to treat early-stage patients to prevent or delay the progression to dementia.
  • This preventive treatment paradigm implies the need to screen, diagnose, and treat a large population of patients with mild cognitive impairment. There would be many undiagnosed prevalent cases that would need to be addressed initially, and then the longer-term capacity to address incident cases would not need to be as high.
  • Researchers used a simulation model to assess the preparedness of the health care system infrastructure in six European countries — France, Germany, Italy, Spain, Sweden, and the United Kingdom — to evaluate, diagnose, and treat the expected number of patients.
  • Projected peak wait times range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany and 2033 in France, and 2042 in the United Kingdom and 2044 in Spain. Specialist capacity is the rate-limiting factor in France, the United Kingdom, and Spain, and treatment delivery capacity is an issue in most of the countries.
  • If a disease-modifying therapy becomes available in 2020, we estimate the projected capacity constraints could result in over 1 million patients with mild cognitive impairment progressing to Alzheimer’s dementia while on wait lists between 2020 and 2050 in these six countries.

Recommendations

  • In addition to increasing specialist and infusion capacity in each individual country, joint actions and planning in Europe can help provide better coordinated and more timely care for Alzheimer’s patients.
  • A combination of reimbursement, regulatory, and workforce planning policies, as well as innovation in diagnosis and treatment delivery, is needed to expand capacity and to ensure that available capacity is leveraged optimally to treat patients with early-stage Alzheimer’s disease.

Full report: Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer’s Treatment | RAND Corporation

Combination of new drug and chemotherapy used to treat patients with advanced ovarian and lung cancer

ICR | August 2018 | Drug combination gives ‘exciting’ results in ovarian and lung cancer in early trial

The results of an early clinical trial suggest that a combination of chemotherapy and a new drug could be used to provide treatment for patients with advanced ovarian and lung cancer, where other treatments had failed. 

Scientists from The Institute of Cancer Research (ICR), London, and The Royal Marsden NHS Foundation Trust, decided to test vistusertib, which inhibits the activation of a specific molecule in ovarian cancer cells, to determine if the drug combination was safe for patients, the dosage and its efficacy.  The combination of targeted drug vistusertib along with paclitaxel chemotherapy caused tumours of over 50 per cent of patients with ovarian cancer and over 33 % with lung cancer to shrink, and stopped patients’ cancers from growing for almost six months.

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This far exceeds what is expected with standard treatments in patients with advanced disease who have already had, and have now become resistant to, standard treatment (Source: ICR).

Read the full news release from The Institute for Cancer Research Drug combination gives ‘exciting’ results in ovarian and lung cancer in early trial

In the news:

BBC News Drug cocktail can ‘shrink cancer tumours’

The Times Cancer drug Vistusertib gives hope for terminal patients

Adding emollients to the bath unlikely to help children with eczema

NIHR Signal| August 2018 | Adding emollients to the bath unlikely to help children with eczema|10.3310/signal-000629

A year-long trial that studied 482 children with mild eczema, the trial included few cases of severe eczema,  has found that adding emollients to bathwater has little impact on the quality of life. The randomized controlled trial compared the impact of  adding bath emollients in addition to usual care with usual care alone. They found little change in skin-related outcomes or quality of life between those that did or did not have emollients poured into their bath (Source: NIHR).

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Objectives
To determine the clinical effectiveness and cost effectiveness of including emollient bath additives in the management of eczema in children.
Design Pragmatic randomised open label superiority trial with two parallel groups. Setting 96 general practices in Wales and western and southern England. Participants 483 children aged 1 to 11 years, fulfilling UK diagnostic criteria for atopic dermatitis. Children with very mild eczema and children who bathed less than once weekly were excluded.
Interventions Participants in the intervention group were prescribed emollient bath additives by their usual clinical team to be used regularly for 12 months. The control group were asked to use no bath additives for 12 months. Both groups continued with standard eczema management, including leave-on emollients, and caregivers were given standardised advice on how to wash participants.
Main outcome measures The primary outcome was eczema control measured by the patient oriented eczema measure (POEM, scores 0-7 mild, 8-16 moderate, 17-28 severe) weekly for 16 weeks. Secondary outcomes were eczema severity over one year (monthly POEM score from baseline to 52 weeks), number of eczema exacerbations resulting in primary healthcare consultation, disease specific quality of life (dermatitis family impact), generic quality of life (child health utility-9D), utilisation of resources, and type and quantity of topical corticosteroid or topical calcineurin inhibitors prescribed.
Results 483 children were randomised and one child was withdrawn, leaving 482 children in the trial: 51% were girls, 84% were of white ethnicity, and the mean age was 5 years. 96%  of participants completed at least one post-baseline POEM, so were included in the analysis, and 77% completed questionnaires for more than 80% of the time points for the primary outcome. The mean baseline POEM score was 9.5  in the bath additives group and 10.1  in the no bath additives group. The mean POEM score over the 16 week period was 7.5  in the bath additives group and 8.4 in the no bath additives group. No statistically significant difference was found in weekly POEM scores between groups over 16 weeks. After controlling for baseline severity and confounders (ethnicity, topical corticosteroid use, soap substitute use) and allowing for clustering of participants within centres and responses within participants over time, POEM scores in the no bath additives group were 0.41 points higher than in the bath additives group, below the published minimal clinically important difference for POEM of 3 points. The groups did not differ in secondary outcomes, economic outcomes, or adverse effects.
Conclusions This trial found no evidence of clinical benefit from including emollient bath additives in the standard management of eczema in children. Further research is needed into optimal regimens for leave-on emollient and soap substitutes.

 

Full reference: Santer M, Ridd MJ, Francis NA, et al. | 2018|  Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness |BMJ|361:k1332

The study is published in the BMJ, it can be accessed via Athens

20 % of people who experience no improvement on antidepressants after a month need more time to respond

NIHR Signal | August 2018 | A fifth of people, who have no improvement on antidepressants at four weeks, respond if given more time

A new systematic review and meta-analysis is the first to ca that studied calculate the proportions of people with a delayed but positive response at different time points. Adult patients  with acute depression not yet responding to an antidepressant drug has a 1 in 5 chance of substantial symptom reduction between 5 and 8 weeks if they continue taking it. In those unresponsive after eight weeks, 1 in 10 will respond between 9 and 12 weeks. For the researchers, this has implications, for instance altering treatment plans too early can mean needlessly discarding first choice anti-depressants. These findings broadly support clinical guidance to wait for 3 to 8 weeks for antidepressants to work. This includes increasing support in the interim rather than switching to a less preferred antidepressant (NIHR).

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Full details are from NIHR Signal