Cancer treatment delays during the pandemic

The Staff at National Health Service in UK are doing an admirable job during the pandemic. In the particular, the frontline staff (“patient-facing”) are showing great courage in face of great difficulties and are primarily driven by altruism.

But the pressures of pandemic means many routine scans and hospital clinic appointments have been cancelled particularly during the first wave. There is a great worry about delayed diagnosis of cancer and delayed treatment of cancer.

A paper in BMJ reports that cancer patients survival can be significantly compromised.

But, as with everything else in life, things are not always what they look like at first impression. Even things that are logical and common sense at first glance do not turn out to be simple and clear.

Firstly, delays and cancellations of scans paradoxically could have psychologically benefited some cancer patients . This might seem counterintuitive or even an outrageous statement.

But there are some cancers which are being over diagnosed. A Cancer diagnosis does not always mean a death sentence. Some cancers do not cause problems for a long time or never in the life time of a person. These cancers do not need to be diagnosed promptly. Not being diagnosed with these cancers prevents the psychological burden of a cancer diagnosis. This “over diagnosis” would be expectedly less during pandemic.

Secondly, treatment delays could be caused by a cancer that is advanced and the need for time consuming additional investigations and procedures. Sometimes delays are caused by patients needing to see many medical specialists for the treatment. So it’s the aggressive cancer and the complex patient care that would cause the delay and is responsible for poor outcome rather than the delay by itself.

Read the BMJ article and make your views known.

Mortality due to cancer treatment delay: systematic review and meta-analysis
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4087 (Published 04 November 2020)
Cite this as: BMJ 2020;371:m4087

Overdiagnosis in Cancer
H. Gilbert Welch, William C. Black
JNCI: Journal of the National Cancer Institute, Volume 102, Issue 9, 5 May 2010, Pages 605–613, https://doi.org/10.1093/jnci/djq099

Disparities in head and neck cancer: assessing delay in treatment initiation
Urjeet A Patel et al. Laryngoscope. 2012 Aug.

Khorana AA, Tullio K, Elson P, Pennell NA, Grobmyer SR, Kalady MF, et al. (2019) . Time to initial cancer treatment in the United States and association with survival over time: An observational study. PLoS ONE 14(4): e0215108. doi:10.1371/journal.pone.0215108

Scientific evidence for a healthy diet and prevention of diabetes

Simple things in life can be the most difficult; For instance, Regular Exercise and a balanced Diet for a healthy life.

What constitutes a healthy diet is common knowledge. For example eating Whole grains, Fresh Fruit and Vegetables )

But what is accepted as common knowledge is not always backed up by robust scientific evidence .

So it is good to see two scientific papers in a recent issue of British Medical Journal with one paper exploring the role of fruit and vegetable consumption on type 2 diabetes and another paper exploring the role of whole grain foods on risk of type 2 diabetes.

1. One study found that Vitamin C and carotenoids have a protective effect against diabetes ( eg diet rich in citrus fruits, tomatoes , root vegetables such as carrots )

A word of caution to those rushing to buy vitamin supplements from the authors : “fruit and vegetable intake, rather than vitamin supplements, is potentially beneficial for the prevention of type 2 diabetes”.

2. Another study found that “whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, significantly reduced the risk of developing diabetes.

References

1. Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries.

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2194 (Published 08 July 2020)

2. Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies .

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2206 (Published 08 July 2020)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Health effects of vitamin and mineral supplements

In Western countries, upto two thirds of people take vitamin and mineral supplements regularly.

Many people think it’s common sense to take supplements. Many people don’t realise mega doses of vitamins can cause harm. Paradoxically the people who don’t have a healthy diet are less likely to supplements than those who have a well balanced diet.

A recent article in BMJ reviews the evidence regarding “Health effects of vitamin and mineral supplements” and concludes that “Randomised trial evidence does not support use of vitamin, mineral, and fish oil supplements to reduce the risk of non-communicable diseases”.

This article is certainly a “food for thought”

Reference

Food for Thought 2020. Health effects of vitamin and mineral supplements. BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2511 (Published 29 June 2020). Cite this as: BMJ 2020;369:m2511

Skeie G, Braaten T, Hjartåker A, et al. Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr2009;63(Suppl 4):S226-38. doi:10.1038/ejcn.2009.83 pmid:19888276

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Crowdfunding expensive stem cell therapies

Crowd fund metaphor

If you have come across a desperate request to crowdfund an expensive stem cell therapy, read this well researched BBC article before you contribute.

Hope is a powerful driver particularly when someone is facing immense difficulties in life. Human beings have a natural inclination to fight against all odds and it seems to be inbuilt in our DNA and psyche.

But not all promising treatments do help desperate people searching for a cure.

Reference.

BBC news. The unwarranted hype of stem cell therapies. By Jules Montague. 21 August 2019

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Is processed red meat bad for health?

Yes, red meat especially processed red is bad for health.

In a study published in BMJ, red meat was implicated in causing more deaths.

The authors from Harvard, advocate replacing red meat with equivalent amounts of other protein sources, such as nuts, poultry, fish, dairy, eggs, and legumes, and whole grains and vegetables.

Reference

Association of changes in red meat consumption with total and cause specific mortality among US women and men: two prospective cohort studies. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2110 (Published 12 June 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Low Carb Diet

High carbohydrate diet can make a person put on weight.

The extra weight can put a strain on the knees and logic dictates that over time this can cause knee problems due to excessive “wear and tear”.

So would a Low-Carbohydrate and Low-Fat Diet help to relieve Pain in Individuals with Knee Osteoarthritis.

Yes, low carb diet can indeed have positive effect on Knee pain.

A study testing the efficacy of two dietary interventions found that low carb diet can reduce pain intensity .

Reference

Pain Med. 2019 Mar 13. pii: pnz022. doi: 10.1093/pm/pnz022.

The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis.

Strath LJ1, Jones CD1, Philip George A1, Lukens SL1, Morrison SA2, Soleymani T3, Locher JL4, Gower BA5, Sorge RE1.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Too much of a good thing

Sometimes it is better to leave things alone if they are working well.

Trying to refine things does not always make it lot better.

A case in point is the Troponin blood test used for diagnosis of heart attacks.

The conventional troponin blood test used to work reasonably well. I suppose it is human nature to try and make existing things better.

The high sensitivity troponin tests were developed to diagnose more heart attacks.

Yes, it is a good thing to diagnose more heart attacks quicker.

But the problem is these new blood tests can also generate false positives. It’s like a super sensitive fire alarm which is triggered by impurities rather than by fire. It’s not only annoying, but affects people’s response to alarms.

The high sensitivity troponin test can sound the false alarm for heart attack in lot of hospital patients admitted for something else.

Just because a test is highly sensitive doesn’t make it super useful!

But it looks like the genie is out of the bottle and the high sensitivity troponin tests are here to stay ….

Share your thoughts at the BMJ website through the rapid response option.

References

1. High sensitivity troponin assays: too much of a good thing.

Toll-free link: http://bmj.com/cgi/content/full/bmj.l1640?ijkey=63W6oWyB18vrXHn&keytype=ref

2. True 99th centile of high sensitivity cardiac troponin for hospital patients: prospective, observational cohort study.

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l729 (Published 13 March 2019)

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.

But

(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project