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

What’s in a name?

awareness cancer design pink Photo by Miguel on Pexels.com

The word cancer is a dreaded one. Not without a good reason. Cancer is the number one killer. Even when someone has a good outcome, the cancer journey is torture. Emotional turmoil is immeasurably horrendous.

But many people would be surprised to hear that there exists a category of low risk cancers. “Low-risk Cancers are cancers which usually don’t kill; These Cancers are found either incidentally on scans performed for some other reasons or found as part of routine cancer screening.”

Because they are not deadly, Should the patients diagnosed with low-risk cancers be spared the dreaded label of cancer?

Should low-risk cancers be labelled something else and the word cancer used only for the “serious” high-risk cancers ?

Personally, I do not agree with renaming of the low risk cancers..Others disagree

Joint the debate at the BMJ.

Submit your views through rapid response

Reference: 
Should we rename low risk cancers? BMJ

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New test for Prostate cancer

www.freephotosbank.com.photographers1.med_cg124s008d

Research team from Dundee University are developing  a new scan for diagnosis of prostate cancer.  The technique is non-invasive. This novel scan uses an ultrasound process called shear wave elastography (SWE) to detect prostate tumours.

The team’s leader, Professor Ghulam Nabi claims “Our new method is far more accurate and also allows us to identify the difference between cancerous and benign tissue in the prostate without the need for invasive surgery.”

This exciting project was funded by Prostate Cancer UK with support from the Movember Foundation.

The raw data from the paper abstract does call for caution. The test was done in patients who are already known to have prostate cancer. The test was not use to diagnose the cancer. It was a single centre study which usually calls for caution. How well the scan would perform in ” real world” patients who are yet to be diagnosed with prostate cancer remains to be seen.

Early results from about 200 patients are very promising indeed. The test has enormous potential if it is proven to work in a large scale, multi-centre trial.

Links:

  1. The Guardian: https://www.theguardian.com/society/2018/apr/22/prostate-cancer-ultrasound-diagnosis-test.
  2. Daily Mail: http://www.dailymail.co.uk/health/article-5643999/Dundee-scientists-new-non-invasive-ultrasound-detect-prostate-cancer.html.
  3. BBC: http://www.bbc.co.uk/news/uk-scotland-tayside-central-43864875.
  4. Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/29605444

 

Image credit: Anon